Dr James Thompson is an experienced robotic, laparoscopic, endoscopic and open urological surgeon. He has sub-specialty training in (and passion for) the treatment of prostate, bladder and kidney cancer using the latest robotic surgery techniques and for high-impact cancer research that has the ability to immediately improve quality of life and cancer cure rates for the community.
Recovery guide for Prostate Surgery
DAY OF ADMISSION
The hospital will contact you on the business-day prior to surgery regarding your admission time and fasting time.
You will arrive at the hospital at your designated time, undergo an admission process with admin staff and a nurse then be dressed for surgery.
Your anesthetist will call you for a phone Pre-op assessment, then will assess you in person on the day of the operation, in the pre-op anaesthetic bay.
THE OPERATION
Robotic prostate surgery takes 4 to 5 hours on average, depending whether your lymph nodes need to be removed, etc.
When you return to your room after 2 hours in the recovery room, you will have a urinary catheter, abdominal drain tube and intravenous fluid therapy in your arm.
You will have 6 tiny incisions above and beside the belly button; these will be covered with a waterproof dressing. They can be removed 5 - 7 days after surgery.
Routine blood tests will be performed day 1 (and often day 2) post op in hospital.
LENGTH OF STAY
Usually 2 days.
Once you are eating, passing wind, able to walk comfortably and your pain is well-controlled, then we like to get you home because you are able to sleep better, eat better, walk around more and recuperate more comfortably.
PAIN CONTROL
You will be given a slow release oral pain tablet (eg Palexia), IV Panadol, an anti-inflammatory medication and short acting powerful pain reliever (morphine/ endone), if needed.
Please inform the nurses if your pain is not controlled, it is important to communicate to them your level of pain so we can ensure it is relieved in a timely fashion or if severe that a doctor assesses your promptly.
Pain relief requirements are very individual. Some patients require very little analgesia, others require more; whatever the case you will be sent home with suitable analgesia tailored for your individual needs, to take as required.
PHYSIOTHERAPY
All men should have seen a specialist pelvic floor physiotherapist prior to surgery. We would like you to see the pelvic floor physio again 3-5 weeks after your operation, before your 6 week follow up appointment with your surgeon.
You will have been instructed on how and when to do your pelvic floor exercises. Keep doing your exercises up until the surgery. You are unable to do them while the catheter is in place. Once your catheter has been removed, you can gently restart your exercise program (if you over-do it and have pain, then ease off for a few days), to help with regaining urinary continence as soon as possible.
The day after your operation, you will be seen by the hospital physiotherapist to ensure you are able to deep breathe, cough and get up out of bed and walk.
DIET AND ELIMINATION
You are able to have ice chips and water as soon as you are fully awake. You will then progress to a clear fluid diet that night, but if you have nausea from the anaesthetic and pain drugs (a common side effect), don’t try to drink until the nurses have fixed your nausea (nausea is easily treatable with a number of nausea medicines we keep in the surgical ward).
Once you have passed flatus (wind from the back passage) and if your abdomen is not too distended, you will be able to have a light meal, usually for lunch on the first post-operative day. This is a sign that your intestinal activity is starting to recover. We do not expect your bowels to open for 2-4 days; this is normal.
Many patients worry about the return of normal bowel function. Remember you have been fasting pre operatively, then on clear fluids and pain meds that can be constipating, so it does take a few days for the bowels to start working again.
It is important that you do not become constipated; do not sit on the toilet and strain. A laxative and softener will be given to you in hospital and that medication will be given to you to take home with you.
When you return home have a good fluid intake and eat an iron rich, high fibre diet.
THE CATHETER
The catheter will be in place for 7-14 days, depending on the unique anatomy of your bladder and prostate and thus how long the join between bladder and urethra will take to heal and become water-tight. A cystogram (injection of dye up the catheter to fill the bladder, then X-ray to check for any leaks at the join) is sometimes but not always required, prior to catheter removal. The catheter is held in place by a water filled balloon that is deflated prior to removal.
It is important that the catheter be protected at all time; it is secured to your leg with a device called a “stat lock” it allows the catheter to move but not pull. DO NOT ALLOW ANY DOCTOR OR NURSE TO REMOVE OR CHANGE THE CATHETER EXCEPT YOUR SURGEON OR THEIR REGISTRAR WITH THEIR DIRECT APPROVAL, because if a well-intentioned but non-expert person tries to pass a catheter through the delicate join, they could cause irreversible damage with lifelong complications.
Always wear your leg bag below the knee-level because it requires gravity to drain;If lying in bed with the legs up, you must attach the extension bag (which goes on the floor) to the leg bag; also keep the leg bag on the inside of your leg, this will avoid twisting.
Urine may leak around the catheter, a little is normal, also a little blood around the catheter is normal.
Occasionally there is an intermittent cramp-like pain in the lower abdomen/ bladder and into the penis together with excessive leakage from around the catheter; this may come and go in waves; this is caused by bladder muscle spasms (like muscle cramps); if this is the case you should take an anti-spasm medicine for the bladder such as Vesicare (5-10mg once daily), or alternatives are Betmiga, Ditropan or Enablex. These medications relax the bladder and reduce the bladder spasms causing the cramping pain and leakage. You will only require this drug if the leakage is excessive, a tiny bit of leakage is normal.
It is important that you do NOT take the Vesicare or other bladder relaxant medication the day before, or day of, your catheter removal as they can weaken the bladder such that you are unable to pass urine.
Shower normally, taking care to clean around the catheter.
You will be given a supply of leg bags and overnight bags to take home with you from hospital; you will also be given a spare stat lock to replace if needed.
The leg bag is able to stay in position for 3-7 days, and should be changed at least once per week; a new overnight bag is to be attached each night then disposed of in the morning.
Do not disconnect the leg bag from the catheter. Attach the overnight bag to the bottom of the leg bag; instructions will be given to you on discharge.
WHAT TO WEAR TO HOSPITAL
Please bring comfortable pyjamas to hospital and a supply of undies. The undies that we recommend are the firm trunks with the legs in them. They come up high on your tummy for comfort they are also firm, giving excellent scrotal support.
It is not uncommon to have some scrotal swelling and loose undies or loose boxer shorts are unsuitable. Bring firm underwear (e.g. tight briefs or tight boxer shorts that lift and gently compress the scrotum) to hospital with you.
You will need Tena for Men (or alternate brands) level 2 pads when the catheter is removed. If they are required in hospital they are provided by the hospital.
TED stockings, which will be given to you on admission; these anti-embolus stockings are worn for 4 weeks after surgery to prevent a DVT (blood clot), especially important if you have lymph node removal.
· if you have extensive lymph node removal, to prevent a blood clot (DVT) you will be discharged with a 4 week supply of once-daily Clexane injections (usually 40mg, but 20-60mg depending on your weight and kidney function). You need to self-inject just under the skin into either the abdomen (in the region above the level of the belly button and below the ribs) or the outside of the upper arms (less preferable as less fat here and difficult to self-inject).
· You should NOT inject into the abdomen below the belly button or the thighs, because fluid from this area does not reliably drain into the blood stream after pelvic lymph node removal, so if injected here it may not be effective in preventing clots.
CYSTOGRAM
If a cystogram is required you will be informed during your Hospital stay, date and time will be provided on discharge.
Before the catheter is removed an x-ray may be performed, for example if you have a thin bladder or large prostate such that more extensive reconstruction with stitches at the join was required; this is called a cystogram. This x-ray is done to determine if the anastomosis (join between the bladder and urethra) has healed. You will be given a time and date for the cystogram before you leave hospital, or our office will contact you with these details.
You will often be given an antibiotic to take for this procedure, for prevention of an infection. It is called norfloxacin and you will be given 6 tablets to take, twice per day, the day before the cystogram, the day of the cystogram and the day after.
If your catheter is unable to be removed due to any sign of leakage at the join thread requires further time to heal, and the x-ray is to be repeated after 1-2 weeks, then you will be given a prescription for another course of 6 Noroxin tablets.
CYSTOGRAM APPOINTMENT
Most of our cystograms are attended at Dr Carl Bryant’s radiology, located at St George Private Hospital on level 2.
On the day of your cystogram, go directly to Bryant Radiology, at your appointment time; your request form has already been delivered to them.
Once you have had the cystogram, wait for the results and bring them to The Urology Practice rooms at Hurstville Private Hospital.
If there is no leak, your catheter will be removed in our office by the nurse/ surgeon.
If you do NOT need to have a cystogram, you will be given a date and time to attend our office for removal of the catheter.
REMOVAL OF CATHETER
When your catheter is removed, you will experience some urinary incontinence; the Continence pads will be needed.
It is a good idea to bring a spare pair of undies to the appointment for removal of your catheter.
Once the catheter is removed, you will need to have a good fluid intake over the next couple of hours in order to fill your bladder so we ensure you can pass urine. Around 1 out of every 10-20 men have trouble passing urine because the join is tight and the swelling has not yet gone down, thus they need the catheter re-inserted for 3-5 days to give more time for the swelling to settle. Do not worry if this occurs, it is common and often is actually a good sign that you will become fully continent sooner than the average man. It can also be a sign that your bladder muscle is a little weak due to age or chronic blockage by an enlarged prostate.
An ultrasound of your bladder will be performed in our rooms to ensure you are emptying your bladder well. When our nurses are happy with your progress, you may then return home.
A 6 week post-operative appointment with your surgeon will be made for you and you will be given a pathology request form for a PSA test.
This PSA test is to be done a few days before your 6 week follow up appointment.
If you live more than 2 hours away from the hospital, you will need to make arrangements to stay overnight in Sydney.
A very small percentage of patients will have a problem passing urine the first night the catheter is removed; this is uncommon, but can happen. This is why we like you not to be more than one hour away from the hospital where your surgery was performed.
Bezzina House is an accommodation facility attached to St George Public Hospital. It is affordable accommodation for patients who are undergoing treatment for cancer.
Many of our patients have used Bezzina House for the overnight stay when their catheter is removed.
ACTIVITY AFTER SURGERY
As mentioned, you will be assisted by the hospital physiotherapist to get out of bed on your 1st day post-op.
You may shower normally; the wound may be washed with soap and water.
A dissolving suture is used on your incisions.
You may walk, climb stairs, but for the first 4 weeks avoid squatting down or lifting anything heavier than 5- 6 kgs.
Wait for 4 weeks before beginning any heavy exercises such as jogging, strenuous swimming or lifting weights.
You are able to drive after two weeks, as long as you are not on strong analgesics and are relatively pain free, thus able to twist your body in order to check blind spots over your shoulder and able to slam on the brakes without pain (eg if a child or car darted out in front of you).
When discharged, avoid sitting with your feet on the floor for long periods; move around and sit with your feet up on a stool.
Do not plan any long car trips or plane flight for 4- 6 weeks after the operation to avoid prolonged sitting and DVT risk.
PROBLEMS OR CONCERNS AFTER SURGERY
If you have a problem or concern after surgery, you are always able to contact us at our office, between 9 am and 5 p.m. Monday to Friday on 8046 8000 when we have a nurse to take your call, and we can get in contact with your surgeon urgently if needed.
If the nurse is busy with another patient a message will be taken and we will return your call during the day.
If it is urgent please inform the secretary so they can have the nurse call you back immediately.
If you experience a problem after hours, on the weekend or on a public holiday, please call the hospital where you had your surgery and they will inform your surgeon, or the surgeon on call.
If it is of extreme urgency, please call an ambulance and inform the hospital where you are taken to of your recent surgery and ask them to contact your surgeon.