Prostate clinic > Some practical advice
Emergency - when to call your doctor
- If you find that you suddenly cannot pass urine yet your bladder is full.
- If you have had a biopsy or operation, and develop symptoms of
infection:
- high temperature
- pain on urination
- cloudy, smelly urine
- swollen or painful testicles - If you have a catheter in place and notice that urine does not drain into the collecting bag for several hours.
- If you suddenly start to pass blood in your urine. Drink extra fluids and call your doctor. If clots start to form, there is a risk that you will be unable to pass urine, in which case you will need to go to hospital urgently to have a catheter inserted via the penis to drain urine from your bladder.
Having an operation
Consent By signing a consent form, you are formally agreeing to undergo the treatment specified on the form. So do not sign it lightly.
- Be sure that you know what the operation involves, what the side effects and risks are, and what effect the operation will have on the course of your illness.
- Be aware that you may need to undergo an investigation of your prostate and bladder carried out under general anaesthetic.
- Ask who will be performing the surgery and who will be around afterwards.
If you are not completely satisfied, do not sign the form
Talking to the anaesthetist Before your operation, you will meet your anaesthetist. He is a fully trained doctor who has specialized in the administration of anaesthetics. You might be asked some of the following questions about your medical history.
- Have you had surgery before? If so, were there any problems or complications?
- Has any member of your family had a problem following an operation?
- Are you taking any medicines that have been prescribed to you or that you bought from a chemist, such as aspirin or Plavix (clopidogrel) or warfarin?
- Do you or any member of your family have any allergies (for example, to plasters or antibiotics)?
- Do you have any back, chest or heart problems?
- Do you smoke?
The anaesthetist will also ask about your teeth. This may seem a strange line of questioning, but he needs to know whether there is anything in your mouth, such as a cap or a crown, that might come loose during the operation.
Do not be afraid to ask him about any questions or concerns that you may have.
Physical appearance
Some men feel that their penis appears shorter in length after radical prostatectomy, though not in circumference. However, it is somewhat relative. If there is a noticeable difference, it is very slight. It happens because the newly sutured urethra has been necessarily shortened and therefore had the effect of ‘pulling back’ the penis into the body just a little.
After a few months, the urethra will stretch to accommodate most of the change. On erection, the difference is usually of little or no consequence.
Eating and drinking
If you have had an operation, whether open, transurethral or laparoscopic, you will probably feel tired and sore. It is a good idea to eat foods that will help you to avoid constipation, so that you do not have to strain to empty your bowels. Eat sensibly, including plenty of fresh and dried fruit (for example, prunes), fresh vegetables, wholemeal bread and high-fibre breakfast cereals, such as All-Bran, in your diet. Laxatives such as Milpar may also be helpful.
Also keep your fluid intake up - try to drink 2 litres (more than 3 pints) a day if possible. This may take a bit of readjustment as you might have reduced the amount you drank before your operation in an effort to keep the number of trips to the toilet down. Water or flavoured squash drinks are fine, but try not to overdo your intake of tea, coffee or cola. It is also worth trying cranberry juice, as this probably reduces the likelihood of urinary tract infections (it is thought to work by making the environment of the bladder and urethra unfavourable to bacteria).
Looking after a catheter
If you have a catheter inserted during surgery (for example following a radical prostatectomy or HIFU) and have to keep it for a few days after you have been sent home, it is important to keep it clean. The hospital staff will probably have shown you how to do this, so this short section should act as a reminder.
The catheter itself: The catheter must be kept clean. If
possible, always wash your hands before touching it or any part of
the system. Twice a day, wash the area of skin where
the catheter enters your body with soap and water, and then dry it
thoroughly. Do not use anything else, such as talc, around
this area.
The catheter is held in place by a Velcro strap, which fits around
the catheter and your leg, and prevents it from being pulled.
The leg bag is securely attached to your leg by a leg-bag support, which is rather like a sock. The leg bag will fill with urine during the day and you will feel it getting heavier as it fills. Do not let it become too full - open the tap over the toilet and drain the urine from the bag at regular intervals. Always wash your hands before and after doing this.
The night bag should be attached to the bottom of the leg bag, and the tap should be opened to allow urine to drain into the night bag, which should be attached to a stand (you will have to be shown how to do this). In the morning, do not forget to close the tap before removing the night bag. After disposing of the urine, rinse the night bag with warm water so that it is ready to be used again the next night.
Changing bags Unless there is a problem, only change your catheter bag once a week. To dispose of a bag, empty it, rinse it out and put it in a sealed plastic bag with your household waste.
Leakage This can occur if the bladder muscle goes into spasm. If you leak a little urine outside of the catheter, check that the connection between the catheter and the leg bag is still good and that urine is still being collected in the leg bag. If it is, then carry on as normal, but let your doctor or nurse know what has happened. If the bladder spasms are very troublesome then removing some of the fluid from the catheter balloon can be very helpful. You will usually need to see your doctor or nurse to sort this out. Alternatively, your doctor may prescribe a drug to reduce bladder contractions, such as Detrusitol XL (tolterodine) or Vesicare (solifenacin).
If urine is not collecting in the bag, check that:
- the bag is below the level of your bladder (if, for example, you are using the night bag on the stand)
- there are no twists or kinks in the catheter
Also ask yourself whether you have been drinking sufficient fluids or whether you are constipated, as this can be a sign that you are dehydrated. If 1-2 hours pass without any urine draining into the bag, contact your doctor or nurse immediately - the catheter may have become blocked, in which case it will have to be flushed or changed.
Blood in the urine. Blood is commonly seen in the urine after radical prostatectomy. As you become more mobile, the catheter can irritate the bladder and lead to blood in the urine. You may also see blood in the urine when you open your bowels. Do not worry about it unless you can see large clots or pieces of tissue passing down the catheter. These can cause a blockage and you should contact your doctor or nurse for advice.
Infections. You should contact your doctor if you have any of the following symptoms, as they may be due to infection:
- cloudy urine
- a burning sensation (cystitis)
- strong-smelling urine
- a high temperature
- shaking attacks