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Perineal Prostatectomy Pre- and Postoperative Instructions

Prior to Surgery

What to Expect prior to 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 primary care physician's office within one month prior to the date of surgery.

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)
  • Urinalysis

These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 410-614-0102 or 410-614-3230 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 received.

Preparation for Surgery

Drink only clear fluids for a 24-hour period prior to the date of your surgery.

Clear liquid diet
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.

  • Water
  • 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 
    • Tang 
    • Hawaiian punch 
    • Lemonade 
    • Kool-Aid 
    • Gatorade 
  • 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 snowballs (not marshmallow)

A bowel preparation called a Fleet Prep Kit #1 must be purchased at your local pharmacy (this is an over-the-counter item). You must start the preparation the day before surgery and follow the instructions included in the kit.

Do not eat or drink anything after midnight the night before the 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.)

If you wish, you may donate blood to minimize the need for a transfusion from another person.


What to Expect after Surgery

What to Expect after Discharge from the Hospital

Immediately after surgery you will be taken to the recovery room, then 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 (IV) catheter or by injection (pain shot) administered by the nursing staff. (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.) 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. Occasionally patients will have incisional pain, which can last for several months.
  • Nausea: You may experience transient nausea during the first 24 hours following surgery, which can be related to the anesthesia. Medication is available to treat persistent nausea.
  • Urinary catheter: You can expect to have a urinary catheter (Foley) draining your bladder (which is placed in the operating room under anesthesia) for approximately one week after surgery. If the urethra is not healed, it may stay in longer.
  • Pelvic drain: The wound drain is placed in the operating room. This drain is usually removed the morning after surgery but may be kept in as long as a week if a leak at the anastomosis occurs.
  • Diet: You can expect to have an IV catheter in overnight. Most patients are able to tolerate ice chips and liquids the day of surgery and clear liquids the first day after surgery. Once on a regular diet, pain medication will be administered by mouth instead of by IV or shot.
  • Fatigue: Fatigue is common and should start to subside in a few weeks.
  • 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 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 after 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 expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to prevent blood clots from forming in your legs while you are lying in bed.
  • Hospital stay: The length of hospital stay for most patients is approximately one day.
  • Constipation: You may experience sluggish bowels for several days to a week after surgery. Suppositories and stool softeners are usually given to help with this problem. Taking one teaspoon of mineral oil and milk of magnesia at home will also help to prevent constipation.
  • Wound care: Some patients develop some drainage from the incision after they go home. This can either be clear fluid (seroma) or a mixture of blood and pus. You should call your doctor and report the color and amount of drainage.

What to Expect after Surgery

  • Pain control: You can expect to have some pain that may require pain medication for a few days and occasionally lasts for a few weeks after discharge. Afterward, Tylenol should be sufficient to control your pain in most cases.
  • Urinary catheter: You may have some bloody discharge around the catheter during a bowel movement. This is not uncommon and will subside. It is also not unusual to feel some increased pressure in your bladder during a bowel movement. If you see blood in your urine (not uncommon) it will help to increase your fluid intake. By increasing your fluid intake, your urine will remain diluted, preventing blood clots from forming and obstructing your catheter. Increasing your fluid intake will also help to stop the bleeding. Bloody urine is usually insignificant and resolves on its own. You may notice some leaking around the catheter when you are walking around. This can be managed through the use of Depend adult diapers or other absorbent materials. If you notice that your catheter stops draining completely, lie flat and drink a lot of water. If your catheter is still not draining after one hour you may have to have your catheter irrigated. You must notify the urology office, call the urology resident on call (see contacts) or visit your local emergency room. Please have the doctor at the emergency room call prior to removing the catheter.
  • Urinary tract infection: You may develop a urinary tract infection related to the urinary catheter (usually due to placement and catheter removal). It is important to check the clarity of your urine before the catheter is removed as well as drainage around the catheter. If you notice any urinary frequency or burning after the catheter is removed you may have an infection. It is important to call your doctor with any of these symptoms. Your doctor may prescribe an antibiotic to prevent such infections.
  • Showering: You may shower at home. Your wound sites can get wet but must be padded dry. Tub baths can soak your incisions and therefore are not recommended in the first two weeks after surgery. Sutures underneath the skin will dissolve in four to six weeks.
  • Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided, as it can increase the risk of pneumonia and forming blood clots in your legs. If you notice any pain or swelling in your leg, chest pain (especially when deep breathing), shortness of breath, sudden onset of weakness or fainting and/or bloody sputum, please notify us immediately or go to your local emergency room. Climbing stairs is possible but should be limited. Driving should be avoided for at least one week after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) until instructed by your doctor. Most patients return to full activity on an average of three weeks after surgery. It is common for patients to feel fatigue or weak for a while. The length of time it takes to recover may vary.
  • Diet: No restrictions. Drink plenty of fluids.
  • Follow-up appointment: You will need to call soon after your discharge (unless arrangements were made before discharge) to schedule a follow-up visit for a cystogram, voiding trial and catheter removal to be done one week after your surgery. The Foley catheter will only be removed if your cystogram is negative. For this appointment, please call the Johns Hopkins Outpatient Center at 410-955-6101.
  • Long-term follow-up: A PSA test is required three months following surgery and at regular intervals thereafter.

Appointments

To make an appointment for consultation, please call 410-550-7008.

Note: Patients must remember to bring all pathology reports, prostate-specific antigen (PSA) values and glass pathology slides to their consultation appointment. The pathology slides will be submitted for review at Johns Hopkins.

Directions to Johns Hopkins Bayview Medical Center

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