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Radical Prostatectomy

Mater Private Hospital Springfield

Mater Health Services has a strong history, providing exceptional care to the Queensland community for more than 100 years. This tradition of care has been continued with the establishment of Mater Private Hospital Springfield.

Mater Private Hospital Springfield is an innovative, unique and contemporary hospital with a total of 80 beds, four digitally integrated operating theatres, a day surgery unit and a state-of-the-art cancer care centre featuring a linear accelerator and 15 medical oncology treatment bays.

Mater Private Hospital Springfield also offers a range of medical and surgical services including: General Medicine; Medical Oncology; Rehabilitation; Respiratory; Ear, Nose and Throat; Gastroenterology; General Surgery; Gynaecology; Ophthalmology; Oral and Maxillofacial; Orthopaedics; Plastics and Urology.

All rooms and facilities are equipped with the latest technology and have been designed with the family in mind, with a fold out bed in each room so family and friends can stay overnight. Integrated room controls allow patients to control temperature, blinds and lighting for optimal comfort.

Mater is committed to caring for the Greater Springfield community and as it continues to grow our services will grow with it.

For more information about Mater Private Hospital Springfield, please call 07 3098 3900.

Visiting hours

Mater Private Hospital Springfield is committed to providing family centred care and has no set visiting hours.

Our Mission

In the spirit of the Sisters of Mercy, Mater Health Services offers compassionate service to the sick and needy, promotes an holistic approach to health care in response to changing community needs and fosters high standards in health-related education and research.

Following the example of Christ the Healer, we commit ourselves to offering these services to all without discrimination.

Our Values

Mercy: the spirit of responding to one another

Dignity: the spirit of humanity, respecting the worth of each person

Care: the spirit of compassion

Commitment: the spirit of integrity

Quality: the spirit of professionalism

At Mater Private Hospital Springfield, we acknowledge that having an operation can be a very stressful experience. In keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients' needs, this booklet aims to alleviate some of your concerns. It explains the general day to day events that may occur during your visit and the things to expect when you are discharged from hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please speak to your doctor or nurse.

Our pastoral care team also offers a caring support network to all patients. The dedicated members of this team are available at your request.

Our expectations

We expect that you will stay in hospital for three to five days or until you have achieved the following:

• you are able to maintain an adequate oral intake
• your pain is controlled with oral analgesia (pain medication)
• you are mobilising to the same level as you were prior to your admission
• your wound is healing well with no signs of infection
• you understand how to manage your wound, catheter (and drain if applicable).

Preadmission service

You should expect to be contacted approximately 48 to 72 hours before your planned admission by one of our hospital administration team who will confirm your personal details and provide you with an estimate of any excess or hospital expenses not covered by your private health insurance.

Additionally one of our preadmission team will contact you to talk about your procedure and complete a nursing assessment and health history interview. This allows you to ask any questions about your upcoming hospital stay and for our staff to ensure we have all relevant details required.

Day of admission/ surgery

Before coming to hospital please ensure that you have:

• had nothing to eat or drink as per the instructions given to you by the preadmission clinic or your doctor
• showered and dressed in clean clothes. No skin products are to be used following your shower. (e.g. deodorant, perfume, body lotion, powder, make up)
• left your valuables at home. You may wear your wedding band only
• brought the following with you:
  • your X-rays
  • your operation consent form
  • any paperwork given to you by your doctor in his rooms
  • your medications in their labelled containers or packets.

On your arrival to the hospital please check in with our friendly front reception staff in the main foyer on level 2 of the hospital. When you check in staff will confirm your details, assist you to complete any required paperwork and direct you to the appropriate patient care area.

Our Nursing staff will:

• apply an identification band
• complete your nursing assessment form
• take your temperature, pulse, blood pressure and weight
• ask you to change into a theatre gown and paper pants
• apply anti-embolic stockings. These assist with blood flow through your legs and decrease the risk of blood clot formation while you have decreased mobility
• take details of any family member who would like to speak to the surgeon after the operation (preferably mobile phone number)
• complete your preoperative checklist.

You will be transferred to the operating theatre on a wheelchair or on your bed if you have received a premedication.

Your luggage will be delivered to the ward where it will be stored in a locked room until after you have returned from theatre.

After your surgery

• Immediately following your surgery you will be transferred to the recovery room where you will be observed closely until you are more awake.
• It is common to need oxygen which will be given via a face mask.
• When you have recovered sufficiently from the anaesthetic you will be returned to your room in the post-operative ward. The nurses will take vital signs—your pulse, respiration rate, temperature, blood pressure and check your wound, drain/s and urinary catheter regularly.
• A urinary catheter will be in place to drain urine from your bladder.
• You will have one or two drains in your abdomen close to your wound site to allow any collecting blood to drain away. The tubes are attached to containers so that the fluid can be measured daily. Take care not to pull on the tubing.
• Your pain will be managed by a patient controlled analgesia (PCA) pump. For further information please refer to the information sheet provided to you prior to your surgery. Your doctor will order additional pain relief and anti-nausea medications for you. Please tell your nurse if you have any pain or nausea, so these symptoms can be managed.
• Following your operation you will be offered ice to suck or water to sip. After a few hours you can begin to drink fluids as you are able. Intravenous fluids (a drip) will be administered until you are able to eat and drink.
• When you are feeling more awake your nurse will assist you to have a wash and change into your own bed clothes (if possible).
• If requested by your doctor, a physiotherapist will visit the day following surgery to explain exercises that will help with your post-op recovery.
• It is important that you begin your breathing and leg exercises. These help prevent complications such as chest infections and blood clots in your legs and should be carried out every hour that you are awake.

Breathing exercises: Take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.

Circulation exercises: Firmly move your ankles up and down to stretch and contract your calf muscles.

Day of discharge—days one to three

Mobility

The day following your surgery, and if instructed by your doctor, you will be assisted to mobilise four times a day by the nursing staff and/or physiotherapist. By the second day after your surgery you will be encouraged to mobilise independently, however your nurse can assist you if you still need some support or supervision. It is important to move around in order to maintain good circulation and prevent complications. It is advisable to plan quiet afternoons and rest. We suggest you limit your visitors.

Hygiene

The day following your surgery nursing staff will assist you with your hygiene needs. By the second day after your surgery you will be encouraged to become more independent however your nurse can assist you if you still need some assistance or supervision. Hygiene of the catheter is particularly important to remove secretions from the end of the catheter and penis. Your penis and scrotum should be washed each day in the shower with soap and a clean washer. Additionally, at least twice a day or more frequently if required, the catheter should be cleaned using a baby wipe.

Diet

The day following your surgery you should order a very small, light breakfast. If this is tolerated you should be able to progress to a normal diet by the second day as ordered by your doctor.

Treatments

You will need to continue wearing the anti embolic stockings for the duration of your stay in hospital and for at least two weeks after you go home.

Dressings and drains

You will have a dressing over your wound. One or two drains may be present in your abdominal wound. These drains are removed when the amount of drainage reduces to an appropriate level and will be removed when ordered by your surgeon.

Swelling and bruising of the scrotum is common after this surgery. Wearing firm but comfortable cotton underwear from the day following your surgery can prevent this.

Observations

Your vital signs, wound, drain/s and urinary catheter will be monitored regularly.

Tests and procedures

A blood sample will be taken on the day following your surgery. Additional tests of the urine or drain fluid may be ordered by your doctor if required.

Medications

Your IV drip should be removed two or three days following your surgery. It will only remain in place longer if you are not tolerating an adequate oral intake or if medications are required intravenously. The PCA pump will removed on the first or second day following your surgery.

Please tell your nurse if you have any pain or nausea, so these symptoms can be managed.

Elimination

Your urinary catheter will remain in place. On the second day following your surgery a leg bag will be applied during the day. Nursing staff will teach you how to care for your catheter at home. 

To prevent constipation you will be prescribed a laxative medication.

Consults

Your surgeon and urology nurse will visit throughout your stay in hospital.

If requested by your doctor a physiotherapist will visit you during your stay to provide advice and information on exercises required to assist your recovery

Day of discharge—days three to five

• Discharge time is 10 am.
• A discharge summary form will be discussed and provided.
• Your own medications will be returned to you and any new ones supplied.
• Your X-rays will be returned to you. Please remember to ask for them.
• You will be given an appointment to return to the hospital for removal of the catheter.

What to expect after you go home

Pain management

You may require some mild pain relief for wound discomfort as ordered by your surgeon.

Activity

Avoid heavy lifting and any strenuous activity that may cause unnecessary strain on your wound for six to eight weeks after your surgery.

It is important that you maintain mobility at home. Begin with gentle short walks and aim to gradually increase your activity as you feel comfortable.

Refer to the information provided by your physiotherapist for further advice on suitable exercises.

Continue to wear the anti embolic stockings, especially overnight, for at least one to two weeks after your surgery.

Nutrition

You should aim to drink between six to eight glasses of fluid per day—at least half of this should be water. This promotes good bladder and bowel function. Maintaining a healthy and nutritious diet will also aid your recovery.

Wound Management

Usually you will have a waterproof (duoderm) dressing in place which allows you to shower as usual. All the stitches are internal so there are no clips or stitches to be removed. The dressing will be removed when your catheter is removed unless it becomes soiled before then.

Bowel management

It is important to prevent straining from constipation. Maintaining a high fibre diet and drinking plenty of fluid will assist in the prevention of this. Even people who do not normally suffer from constipation may require the addition of Coloxyl, pear juice or Agarol to assist in keeping the bowel motions soft and easy to pass. It is not unusual for a small amount of blood and/or urine to leak out around the catheter, at the tip of the penis, while having a bowel motion. You may also notice blood in your urine at times.

Drain care

It may be necessary to go home with a drain in place. Further information will be provided to you if required.

Catheter care

Some people experience a small amount of blood in their urine after this surgery. If it is a large amount or the blood appears bright red then seek advice from your doctor.

The catheter usually stays in place for 9 to14 days after the surgery. Initially the urine is drained into a large two litre bag that hangs by the bedside. Once you become more mobile, a smaller 500 ml drainage bag is fitted to your leg. Once applied, this leg-bag remains in place until the catheter is removed. Empty your bag at least four times a day or whenever it is ¾ full or becoming heavy. 

It does not require cleaning (unless it is being worn for more than three weeks).

It is very important to ensure that the leg-bag is positioned so that it does not pull on the catheter. The leg straps need to be comfortably but securely applied so that the leg bag remains high on your thigh with no tension or traction on the catheter. This may mean that you need to adjust the leg-bag straps regularly to ensure that there is a comfortable loop of catheter between you and the bag.

Anytime a person has a catheter inserted into their bladder, there is a risk of an infection occurring. There are four main strategies that you can take that will minimise this risk:

1. Careful hand washing before and after emptying or handling the catheter or bag

Simple steps to emptying a urine drainage bag:

• wash your hands with soap and water
• place the drainage bag over the toilet ensuring that the valve does not touch the toilet
• open the valve and let the urine drain into the toilet. Do not let the valve touch the toilet bowl
• close the valve and wipe with toilet paper or a baby wipe
• wash your hands.

Attaching the two litre night bag onto the leg bag:

• wash your hands with soap and water
• check that the night drainage bag is closed
• wipe the end of the leg bag with an Alcowipe (avoid touching the end once you have wiped it) and wait approximately one minute for it to dry
• connect the night bag to the lower end of the leg bag (test to make sure the connection is secure)
• open the leg bag valve to allow drainage into the night bag
• wash your hands
• once in bed, the lower end of the leg bag and straps can be adjusted to improve the flow of urine (in a downward direction towards the night bag)
• apply the leg strap at the knee to secure the night bag ( to keep the valve straight and secure)
• hang the night bag on a bedside drawer or knob or place in a plastic bucket/bowl at the side of the bed. Ensure that it is below the level of your bladder to promote drainage. It should not touch the floor
• in the morning, empty the night bag and dispose of in a plastic bag in the bin.

2. Increasing your intake of fluids to approximately 1.5 to 2 litres to ensure that the urine is pale in colour and that it is constantly flushing through the catheter. If the urine is dark and appears concentrated then you may not be drinking an adequate amount of fluid.

*Important: If you have a heart or medical condition that restricts the amount you can drink, please check with your specialist before increasing your intake of fluids.

3. Clean around where the catheter enters the body to ensure that any blood or secretions are washed away rather than drying and encrusting on the catheter. This can be done two to three times a day (depending on the amount that is coming out) using a clean washer and a small amount of soap or a baby wipe.

It is not unusual for a small amount of blood and/or urine to leak out around the catheter, at the tip of the penis while having a bowel motion.

4. Taking an antibiotic daily as directed by your doctor. This will continue until the catheter is removed.

Troubleshooting 

Dislodged catheter

To avoid pulling or dislodging the catheter, ensure that the leg straps are securely applied. If the catheter is dislodged, contact your doctor urgently.

Blocked catheter

If you feel a sensation of “fullness”and suspect that your catheter may be blocked:

1. immediately empty the drainage bag
2. use the unblocking technique of placing you finger over the non-return valve and “pumping” at the soft spot near the catheter’s Y-connection (the nurses will demonstrate this technique)
3. change your position (e.g. stand, sit or lie on your side)
4. observe the drainage bag and if urine does not appear to be draining out then it is important to receive assistance with this as soon as possible.

Attend your nearest emergency department or doctor.

Removing the catheter

You will return to the hospital for three to five hours to have your catheter removed. Before arriving you should take two sachets of Ural which were provided to you on your day of discharge.

Some patients require a cystogram before the catheter is removed. If this applies to you, please notify the nurse before they remove the catheter.

It is advisable to wear a pad in your underpants before the catheter is removed so that when you stand up any leakage is contained.

After the catheter has been removed you will be asked to pass urine in a urinal. Each time you pass urine you must notify the staff who will then measure the volume left in your bladder using a portable bladder scanner. This is referred to as a ‘trial of void’.

Following removal of the catheter

• There may be some stinging initially when you pass urine due to irritation of the urethra. This should improve each day.
• Reduce your drinking to approximately 1.5 litres today following your catheter being removed.
• Usually after passing urine several times with <100mls left in your bladder, the trial of void is complete. This process takes approximately three to five hours.
• Your wound dressing will be removed.
• The urology nurse usually sees you prior to going home to discuss continence and what you may expect in the next phase of your recovery.

It is important to notify your surgeon if:

• You notice any unusual discharge from your wound or if it becomes red or inflamed.
• You develop a fever, chills or shivering and/ or a temperature above 38 degrees Celsius.
• You have pain that is not relieved by simple analgesia.
• You have nausea or vomiting which does not settle.
• You are experiencing difficulty or are unable to pass urine.
• Your urine is smelly or cloudy.
• Stinging or burning when passing urine (after your catheter is removed).

Useful phone numbers

Queensland Cancer Fund Helpline (provide written information, prostate cancer support groups and individual counselling) —13 11 20

National Continence Helpline —1800 330 066.

Contact details

Mater Private Hospital Springfield—07 3098 3900