Discharge usually occurs the day following surgery. Case managers are available to assist you as you prepare to go home. Your case manager may be able to help with questions or concerns about financial matters and financial counselors are available as well. You should start talking with a case manager after surgery if you have special needs. Home health care is not usually necessary but can be arranged for patients after discharge. Nurses can also come to your home and assist with management of the catheter, if necessary.
On the day of discharge, you will receive detailed instructions from your doctor and your nurse. The following precautions should be taken after surgery:
- You may shower the day after surgery but do not scrub your incisions
- No heavy lifting more than 10 pounds for 4 weeks following surgery
- Continue walking after discharge and try to walk more each day
- Begin exercise and normal activity gradually, 4 weeks after surgery
- You may resume driving when the catheter is removed and you are off narcotic pain medications
- Expect it to take two weeks before your normal stamina returns
- It is usually advisable to take 2 to 3 weeks off from work after surgery. At that point, patients who do office work can usually start working half time. Patients who do heavy work should plan to be off for 4 to 6 weeks. Disability forms can be filled out through your doctor’s office.
Managing Your Catheter
You will be sent home with a catheter to drain your bladder and 2 urinary drainage bags; one that can be worn under your pants (leg bag) and a bigger bedside bag to be used at night. The nurses will teach you how to change from one bag to the other. The urinary drainage bags should be emptied frequently, and the bag should always be positioned lower than your bladder to facilitate drainage. The catheter will remain in place for 7 days after surgery. After discharge, you should call your doctor’s office to arrange for an appointment to have the catheter removed.
If you experience external irritation from the catheter, try applying lubricant to the penis where the catheter exits the urethra. Internally, irritation from the catheter may cause“ bladder spasms,” which can be uncomfortable and make you feel like you need to urinate. These spasms are usually mild and can be controlled with medication, if necessary. Bladder spasms may occur at the time of a bowel movement and can result in leakage of some urine or blood around the catheter. Some blood in the urine after surgery is normal, especially with activity. If large amounts of blood or large blood clots are seen in the urine, you should notify your doctor. A small amount of leakage around the catheter is normal and can be managed by wearing incontinence pads. You can buy these pads (Poise pads, Depends Male Guards) at your local pharmacy. If drainage of urine through the catheter stops or if large amounts of urine drain around the catheter, call your doctor. This usually means that the catheter is blocked, which can be correctly easily.
Medication and Pain Relief
You will be sent home with a narcotic pain medication, stool softener and a 3-day course of antibiotics. The antibiotics should be started the day before the catheter is to be removed. Your nurse can call these prescriptions to your pharmacy so a family member can pick them up before you get home. Most patients are off narcotic pain medications after 3-5 days, and are usually pain free within 1-2 weeks
Pain should continue to diminish but you should stay on top of it to prevent severe pain episodes. Patients often notice it is difficult to get out of bed due to incisional pain. The best method is to roll onto your side first before sitting up. Similarly, to get into bed, you should lay onto your side first and then roll slowly onto your back. Try to take pain medications before planned activities. Alert your doctor if severe pain continues. If pain is not severe enough to require the narcotic pills that are prescribed, substitute extra strength Tylenol or anti-inflammatories such as ibuprofen or Aleve. Bloating can sometimes continue at home and is best relieved by ambulation. Because the narcotic pain medications can cause constipation, it is important to drink plenty of fluids, eat sufficient fiber in your diet, and take the stool softener daily. Stop taking the stool softener if you experience loose stools or diarrhea.
It is normal to have some swelling and/or bruising in the penis and scrotum following radical prostatectomy. This can be minimized by elevating the legs while sitting and placing a towel under the scrotum for elevation. Some patients may notice mild swelling of the legs after surgery. If this swelling gets severe in one leg compared with the other, or if it is associated with pain or redness, you should notify your doctor immediately.
Most patients can shower when they return home. Wash your incisions daily with soap and water. Don’t scrub, and gently dry the area. The site where the JP drain was removed may leak for a few days but will spontaneously seal up on its own. You can continue to change the dressings to keep the site clean. Do not submerge yourself in water for 2 weeks after surgery. When you shower, keep a family member close by in case you get dizzy or need to sit down. While you have a catheter in place, you can either hang the collection bag over the edge of the shower or disconnect the catheter from the collection bag and let the urine flow into the shower drain.