Radical Prostatectomy: Frequently Asked Questions

Pre-operative Evaluation

When should I stop aspirin prior to surgery?

7 days.    It is okay to take Tylenol.

When should I stop taking NSAIDS (Ibuprofen, Aleve, Naprosyn, Celebrex) prior to surgery?

7-10 days

Do I need to stop taking any over the counter supplements prior to surgery?

Do not take any vitamins, supplements, or over-the-counter medications 10 days prior to surgery, unless approved by your surgeon's office.

I take coumadin (warfarin, plavix), should I stop taking it prior to surgery?

You must stop coumadin prior to surgery.  The scheduling of holding the coumadin is an individualized decision that your primary care physician will make with you.  Typically, patients are asked to stop taking coumadin 5 days prior to surgery.  Please consult your primary physician to determine the exact timing of holding the coumadin in your circumstance. 

Which of my other medications will I take prior to surgery and when should I stop them?

You will meet with our anesthesia service in the days preceding your surgery.  They will instruct you in the management of your additional medications.

Should I donate my own blood prior to surgery?

At Virginia Mason for prostate surgery, less than 5% of patients require blood transfusions.  The risk of acquiring a transmittable disease after a transfusion is less than 1/ 300,000.  The decision to donate "autologous" blood is an individual one.  Insurance typically will pay for autologous blood only if it is used.

24 hours prior to surgery

What should my diet be prior to surgery?

The day before surgery, you will be asked to stop solid foods after breakfast. 

Is there a bowel preparation I need to take prior to surgery?

Depending on the type of surgery and your previous medical history a bowel preparation will be used.  You will receive either 2 Fleets enemas (to be taken the evening prior to surgery) or 1-2 bottles of Magnesium Citrate (to be taken in the afternoon prior to surgery).  Your surgeon will tell you which of the preparations you will need. 

The morning of surgery, you may only have 16 oz of clear liquids and all consumption must stop 2 hours prior to check-in.

When will I know my surgery time?

You will receive a phone call with your surgery time and check in time between 1-5pm the day prior to surgery.

Day of Surgery

What should I bring with me on the day of surgery?

A list of the medications you take at home, comfortable clothing and toiletries.  Leave all valuables at home including wedding rings and watches.  Bring reading glasses if you wear them.  Do not wear contact lenses.

In the Hospital

How long will I be in the hospital?

The majority of patients are discharged home 24-48 hours after surgery.

After Discharge

The pain medication seems to make me constipated, what should I do?

Constipation is a common side effect of pain medications.  It may be several days after surgery before you have a normal bowel movement.  Keep your fluid intake up.  You may take prunes, mineral oil, warm prune juice or milk of magnesia for relief.   Do not take any rectal suppositories or enemas.

What should I eat once I am at home?

You are free to resume your normal diet.  Until you have a normal bowel movement, however, we recommend that you take primarily liquids.

How do I arrange my follow-up appointment?

You should call you physician's office after arriving home.  Typically, you will be seen in follow-up 6-12 days after surgery.

*Please bring briefs and some type of incontinence pad (e.g.: 'Depends, 'Poise', or store brand name) to your 1st post-op visit.  Incontinence pads are available at local drug and grocery stores.


Catheter

Who teaches me to take care of my catheter?

Prior to discharge, your nurse will show you and family how to take appropriate care of the catheter.

How do I manage my Foley Catheter?

When out in public, remember to use the leg bag and fasten it comfortably under loose fitting pants such as sweat pants or loose running pants.  Prevent rubbing of the catheter against the opening of your penis by securing the leg bag on your lower leg in a way that the tubing doesn't catch or move with each step.  You should remember to drink lots of fluid while your catheter is in place.  Also, it is normal for your catheter to leak when having bowel movements.

What does it mean when I see blood in my urine?

The balloon on the tip of the catheter can irritate the bladder causing some bleeding.  Usually, the bleeding will resolve with hydration and rest.  If the color of the urine looks like tomato juice, you should call our office immediately.

Are any particular fluids better to drink than others?

Any fluid is acceptable to drink.  Water is usually best.

Will I use a leg bag or the larger Foley catheter bag at home?

You will use both.  The nurse will show you how to use a leg bag when you are walking about, and the larger "bedside bag" when you are ready to go to sleep.  Make sure to hook the bedside bag on to something (i.e.: a chair or the drawer of a bedside table) so that it doesn't pull on your catheter.  You will learn how to change from one bag to another.

Exercise

Is exercise important after surgery?

Yes!  No matter how active and fit you were prior to surgery, you will experience reduced strength and be limited in your level of activity following your prostate removal.  To return to normal activity, you will need to follow a sensible exercise program, adapted to your level of health and fitness.  Realistically it will be 6-8 weeks before you are back to your pre-surgical stamina and strength.  However, you will be surprised that by employing a basic exercise program, how good you will feel in just a few weeks. 

When do I start exercising after prostate surgery?

You should begin almost immediately.  By the late afternoon or early evening following surgery, the nursing staff will assist you in getting up at the side of your bed or into a chair.  This is the first form of exercise that you will perform on the road to recovery so your understanding and participation is important.

You will be asked to stand and walk the morning following surgery.  To stand, you will need someone to support you under your arm.  With a nurse's help, stand and walk to a chair.  When comfortable you may begin to walk in the hallway.  During your hospital stay, you should plan on walking every hour when you are awake.

How will I know if I have pushed myself too far?

Weakness, dizziness, fatigue, nausea and feeling flushed are some feelings associated with doing too much.  You will notice that you will tire sooner with less exercise than before.  You may also feel some discomfort, warmth, or stretch down in the pelvic area.  When you exercise you should try to stop and rest before these symptoms become too severe.  Push yourself but be sensible.  It is better to do several shorter periods of exercise rather than a few longer ones.  You may also see blood in your urine if you overdue it.

What about pain medication and exercise?

Whether it is in the hospital or home, you will need pain medication to allow you to move around easily for the first week or so.  Anticipate when you will be doing something active and pre-medicate yourself.  Oral pain medications take about 20-30 minutes to take effect.   Slowly work yourself off the narcotic pain medication and use Tylenol instead.

What can I do once I get home?

When you get home, continue your program of rehab and recovery by developing a plan of exercising and keep to it.  The foundation for this program should be frequent short periods of walking.  As you feel comfortable or as you need to get out of the house, move your walks outdoors, at first to the back yard.  Then walk the block.  In time you will be walking a block then two then a mile and so forth. 

When can I drive?

You may drive after the catheter has been removed as long as you have stopped taking narcotic pain medications.

When can I return to work?

You may return to work without restrictions 6 weeks after surgery.

May I stretch or perform Yoga?

Stretching can also be started almost immediately, even while in the hospital.   Again it is important to start very gently and sensibly by listening to your body.  If you feel pulling or it hurts, STOP.

What other activities can I do and when?

  • Walking - The day after surgery
  • Treadmill - Level treadmill is OK (walking pace)
  • Walking up stairs - You may walk up stairs in your home to get to your destination, do not do so for exercise for 6 weeks.
  • Golf - Putting only for 6 weeks
  • Bicycle Riding/ Motorcycle riding - 3 months following surgery
  • Lifting more than 10 pounds - 6 weeks


Post Operative General

How can I avoid post-operative constipation?

Minimize the use of narcotic pain medicines (Vicodin, Percocet, Endocet), drink lots of water, and take stool softeners.  If needed, prune juice or a teaspoon of mineral oil can help as well.  Until you have a normal bowel movement, which often does not occur until 4-5 days after surgery, you should plan on eating primarily liquids.

Urine is leaking around my catheter, what should I do?

This is usually related to bladder spasms.  This is an inconvenience, but not a long-term problem.  If the leakage around the catheter becomes bothersome, call the Urology nurse at your doctor's office to consider taking an anti-spasmodic agent (Ditropan or Detrol).  Leaking may also occur when having bowel movements.

How long will I need to wear a pad?

This period of time varies.  Some people never require a pad; others will use pads for 3-4 months.  Your use of pads depends on the volume and duration of leakage.

Sexual Function Recovery

How often should I use Viagra, Levitra or Cialis after surgery?

You should begin using one of the above three agents within the first 10 days after your catheter has been removed.  You do not need to attempt intercourse (masturbation is acceptable).  You should take 50 mg of Viagra or 10 mg Cialis or 10 mg Levitra (if approved by your physician) 3 times weekly.  If you do not see improvement in your erections after 2 weeks of therapy, you should call your physician to receive the next line of treatment.

When can I have intercourse?

You may have intercourse as soon as you are comfortable to do so.  Remember that you may not lift anything heavier than a laptop computer for 6 weeks following surgery.  Intercourse, therefore, should be appropriately tailored.

If I am having erections without Viagra, Levitra or Cialis, do I have to take the medication?

No.

How soon will I recover my erections?

Your post-operative recovery of sexual function has many variables including: your pre-operative level of function, your age, whether you underwent a nerve sparing procedure.  You should ask your physician how soon and to what degree you should expect recovery.

Will my erection be shorter after surgery (what fills the space where the prostate used to be)?

The bladder fills the space where your prostate used to reside.  Your penis may be 1 cm shorter with a full erection following surgery.

Continence Recovery

When will my catheter be removed?

The catheter is removed between 9-14 days after a radical retropubic prostatectomy and 6-14 days after the laparoscopic radical prostatectomy.

Who will remove my catheter?

During your follow-up appointment, your physician or nurse will remove the catheter.  The catheter is not to be removed prior to that appointment.

Can I do exercises to enhance my urinary control?

You will receive instructions on Kegel exercises, designed to strengthen the external continence muscle and control of urinary flow.

How long until my urinary control returns?

Most patients note significant resolution of urinary incontinence by 12 weeks following surgery.  Improvement will continue for a full year after surgery.

What should I wear to clinic when my catheter is removed?

Comfortable clothes with jockey shorts (not boxers).

Will I know when I need to urinate?

Yes, your bladder will begin to feel full and you will have the sensation of needing to urinate.

Exercise Summary
Be gentle with yourself as you rehabilitate from your surgery.  Give yourself time to heal but stay active with time to rest in between.  Walking is the best thing to do so get out and see what is going on in the neighborhood.  Add the other activities as tolerated and recommended by your doctor.   Create your own exercise program from the following table with suggestions from your doctor.  Find activities that are fun and get going back on the road to recovery.