Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)
Bowel preparation and clear liquid diet
- Drink one bottle of magnesium citrate, which you can purchase at your local pharmacy, the evening before your surgery. Do not eat or drink anything after midnight.
- Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.
Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through. Please follow the diet below.
- Clear broths (no cream soups, meat, noodles, etc.)
- Chicken broth
- Beef broth
- Juices (no orange juice or tomato juice)
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Tea (you may add sweetener, but no cream or milk)
- Coffee (you may add sweetener, but no cream or milk)
- Clear Jell-O (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (not marshmallow)
What to Expect during Your Preoperative Consultation
During your initial consultation with your surgeon, he or she will review your medical history as well as any outside reports, records and X-ray films (e.g., CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for surgery, you will then meet with a patient service surgery coordinator to arrange for the date of your operation.
Note: It is very important that you bring ALL of your X-ray films and reports to the initial consultation with your surgeon.
What to Expect prior to the Surgery
Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.
These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was sent.
Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:
- Physical exam
- Electrocardiogram (EKG)
- Complete blood count (CBC)
- Blood coagulation profile (PT/PTT)
- Comprehensive metabolic panel (blood chemistry profile)
During Your Hospitalization
Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.
- Postoperative pain: Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (one to two days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery.
- Drain: You can expect to have a small drain coming out of an incision in your back over the kidney area for approximately one to two days. The fluid from the drain will often appear blood-tinged. If persistent drainage occurs, you may have to go home with the drain and have it removed in your doctor's office.
- Stent: You may have a plastic internal ureteral stent in place located between the kidney and the bladder to promote drainage from the kidney.
- Nausea: You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea.
- Urinary catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while you are asleep) for approximately one to two days after the surgery. It is not uncommon to have blood-tinged urine for a few days after your surgery.
- Diet: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated; it also provides a way to receive medication.) Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day. Once on a regular diet, pain medication will be taken by mouth instead of by IV or shot.
- Fatigue: Fatigue is common and should start to subside in a few weeks following surgery.
- Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you by the nursing staff during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help prevent pneumonia and other pulmonary complications.
- Ambulation: On the day of surgery, it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can also expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to prevent blood clots from forming in your legs.
- Hospital stay: The length of hospital stay for most patients is approximately two days.
- Constipation/gas cramps: You may experience sluggish bowels for several days or several weeks. Suppositories and stool softeners are usually given to help with this problem. Taking mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation, and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.
What to Expect after Discharge from the Hospital
- Pain control: You can expect to have some incisional discomfort that may require pain medication for a few days after discharge. Tylenol should be sufficient to control your pain.
- Showering: You may shower at home. Your incision sites can get wet but must be padded dry after showering. Tub baths can soak your incisions and therefore are not recommended in the first two weeks after surgery. You will have adhesive strips across your incisions. They will either fall off on their own or can be removed in approximately five to seven days. Sutures underneath the skin will dissolve in four to six weeks.
- Physical activity: Taking daily walks is strongly advised following surgery. Prolonged sitting or lying in bed should be avoided and can increase your risk for forming blood clots in the legs as well as developing pneumonia. Climbing stairs is possible but should be limited. Driving should be avoided for at least two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity an average of three weeks after surgery.
- Sexual activity: If a vaginal incision is required during surgery, the patient may feel pain during intercourse. Therefore, the patient should abstain from sexual activity for four to six weeks after surgery.
- Diet: No restrictions. Drink plenty of fluids.
- Medications: You can resume your usual medications after surgery with the exception of aspirin or other blood thinners, which can increase the risk of bleeding.
- Follow-up appointment: You will need to call soon after your discharge to schedule a follow-up visit with your doctor for two weeks after your surgery.
Professor of Oncology
Executive Vice Chairman, Department of Urology
Director of Adult Urology
Director, Minimally Invasive and Robotic Surgery
To make an appointment for consultation, please call 410-955-6100.
In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 for The Johns Hopkins Hospital or 410-550-0100 for Johns Hopkins Bayview Medical Center and ask to speak to the urologist on call.