Prostatectomy

A prostatectomy (PRAH-stuh-TEK-tuh-mee) is an operation to remove all or part of the prostate---the walnut-sized gland in the groin that produces the fluid in male semen. Because the prostate completely surrounds the urethra---the tube that drains urine from the bladder out through the penis---any enlargement or tumor can restrict the normal flow, causing symptoms such as difficult, painful, or frequent urination. If the condition becomes serious, or a tumor threatens to spread, your doctor may recommend surgery.

There are several types he can perform:
Transurethral (TRANS-yew-REETH-rull) Prostatectomy: In this operation, the doctor advances a cystoscope (a long metal tube with a magnifying glass and a light on the end) up the urethra to the prostate, where he uses tiny surgical tools to snip away the surrounding prostate tissue. This surgery takes about 30 to 60 minutes. Although it's less invasive than other types, you may still need to stay in the hospital for several days after surgery.
Perineal (PAIR-uh-NEE-ull) Prostatectomy: In this operation, the prostate is removed through an incision between the rectum and the scrotum. Potentially cancerous lymph nodes in the area may also require removal. To reach them, the doctor will insert a thin metal tube called a laparoscope (LAP-er-uh-scope) through 3 or 4 small incisions in the lower abdomen. All told, the surgery lasts 2 to 3 hours. You'll remain in the hospital for 4 to 6 days.
Retropubic and Suprapubic Prostatectomy: These operations require a larger incision in the lower abdomen, through which the prostate and nearby lymph nodes can be removed. Like perineal surgery, the operation takes 2 to 3 hours and is followed by a 4 to 6 day stay in the hospital.
Risks
Temporary or even permanent impotence often follows a complete prostatectomy, and up to 15 per cent of those undergoing the operation will have at least temporary difficulty holding urine. (Both problems are less likely following a transurethral operation.) In addition, there are the risks that accompany any type of surgery, such as the danger of heavy bleeding or infection. However, if a cancerous prostate is left in place, the disease can spread to other parts of the body and eventually prove fatal. And even if the problem is only benign enlargement, it usually gets worse.

IF YOU'RE HEADING FOR THE HOSPITAL...
Before You Go

* The Week Before Surgery:
* You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take any over-the-counter medicines.
* Your doctor will tell you whether you need to have blood drawn for tests.
* If you're scheduled for a perineal prostatectomy, the doctor may want you to clean out your bowels prior to surgery in order to prevent infection afterwards. You may be asked to eat high-fiber foods and drink 6 to 8 glasses of water daily for 1 or 2 days before the operation. On the day before surgery, you also may have to drink a cathartic to quickly expel the contents of the bowels, and take an enema to help clean them out. The doctor may also prescribe an antibiotic.
* The Night Before Surgery:
* Your physician may suggest you take a sleeping pill.
* Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.

When You Arrive

* Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
* Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There
You may encounter the following procedures and equipment during your stay:

* Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
* Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
* Chest X-ray: The doctor will check this picture of your lungs and heart to help make sure that you can handle the stress of the operation.
* Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
* IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
* Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
* Anesthesia: This medicine will make you comfortable during surgery. Depending on the type of anesthesia, you may be awake during the operation, or completely asleep. You and your doctor will decide which approach is best for you. There are three possibilities:
* Spinal Anesthesia: In this type of anesthesia, a pain-killing medication is injected into your spine. It will leave you awake during surgery, but numb below the waist. Feeling will return in about 2 hours.
* Epidural Anesthesia: This approach requires insertion of a tiny tube into the spinal area. The tube is left in place so that you can be given additional pain-killing medication, if needed. As with spinal anesthesia, you will be awake during surgery, but numb below the waist.
* General Anesthesia: This type of anesthesia puts you completely to sleep. It is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.

After Surgery

* Drains: These thin rubber tubes are inserted around an incision to drain away fluid. They'll be removed as the draining stops.
* Oxygen: During your recovery, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
* Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
* Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
* Incentive Spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to foll
ow each deep breath with a cough.
* Pressure Stockings: These tight elastic stockings keep blood from pooling in the legs and causing clots. They are often used after more invasive operations such as a retropubic or suprapubic prostatectomy.
* Pneumatic Boots: These plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens different parts of the boot to help push the blood back up to the heart and keep clots from forming.
* Ice: For pain or swelling, you can put ice in a plastic bag, cover it with a towel, and place this over the surgery area for 15 to 20 minutes out of every hour as long as necessary. Do not sleep on the ice pack. Treatment with ice is most effective when started right after surgery and used for 24 to 48 hours.
* Heat: After the first 24 to 48 hours you may use heat for pain or swelling. Use a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the surgery and helps it heal faster.
* Activity: You may need to rest in bed for a while. But even if you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
* Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
* Foley Catheter: This is a type of tube sometimes inserted into the bladder to drain the urine. The catheter may make you feel as though you have to urinate. Relax and the catheter will drain the urine for you.
* Don't pull on the catheter because this could cause injury.
* Don't kink the catheter; this will stop the flow.
* Don't lift the bag of urine above the catheter. If you do, the urine will flow back into your bladder, possibly causing an infection.
* Liquid may be run through the catheter to wash out any blood clots that form after surgery. This can cause painful cramps. If that happens, let the doctor know so that your pain medicine can be increased.
* The catheter will be taken out when you can urinate on your own.
* Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
* Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
* Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
* Medicines:
* Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
* Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
* Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
* Stool Softeners: These medications make bowel movements softer so you won't need to strain.

After You Leave

* Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
* When you are allowed to bathe or shower, carefully wash any stitches or staples with soap and water, then put on a clean, new bandage. Change the bandage any time it gets wet or dirty.
* Make an effort to eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. A healthy diet encourages healing and boosts energy. Also try to drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day.
* Slowly start to do more each day. Rest whenever you need to. Once you feel stronger, start a regular exercise program. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy.
* Don't sit for a long time in a car---or anywhere else. Sitting like this promotes bleeding.
* Do not lift anything heavy until your doctor says it's OK.
* Your doctor will tell you when it's OK to drive and to return to work. You can resume having sex after 6 to 8 weeks. Although you may have an orgasm, there may not be any semen. After a [font=Arial Black]prostatectomy, semen sometimes leaks into the bladder. It is normal for your urine to look a little milky.

Call Your Doctor If...

* Your urine becomes cherry-colored or bright red.
* You are running a high temperature.
* Your skin is itchy or swollen, or you have a rash. You may be allergic to your medicine.

Seek Care Immediately If
*
You have sudden trouble breathing or develop chest pains.
* You have shaking chills

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