56456757The following are pre-operative preparation checklists our patients follow before their surgery. If you have any questions or concerns about any items on our checklists, please contact our office immediately to ensure a smooth operation.

 
 

Post-Operative Instructions for Patients Who Have Undergone Prostatectomy

Post-Operative Instructions for Indiana Pouch Cystectomy Patients

Post-Operative Instructions for Neobladder Cystectomy Patients

Clear Liquid Diet Guidelines

Kegel exercise routine

 
 

Post-Operative Instructions for Patients Who Have Undergone Prostatectomy

1. No sitting on hard benches. Have pillows under you.

2. No straining with bowel movements. Take 300 mg Colace (stool softener) or 30cc milk of magnesia by mouth. Do not use suppositories (nothing per rectum).

3. Walking is fine. Listen to your body; when you feel tired, take a rest.

4. Catheter should never have any tension on it. Always have slack on the catheter.

5. You may shower but do not bathe.

6. Do not take off the Steri-Strips on your wound the first week after surgery. They will fall off in the shower.

7. Keep catheter clean (yellow tube coming out of penis) with soap and water.

8. If you notice blood in your urine, drink more fluids (non-alcoholic beverages).

9. Do not fall asleep with leg bag on as it has a small capacity. Change to the over-night bag if you are going to sleep.

10. Wash the inside of the leg bag and over-night bag with one part white vinegar and three parts water, then rinse well with water.

11. For pain control, you may use Vicodin one or two tabs by mouth at bed time ONLY IF NEEDED. Vicodin is very constipating, therefore use as little as possible. Extra-strength Tylenol may be used during the day.

12. Do not drive for two weeks after your operation.

13. Bring a Depends for men with you when you have your catheter removed.

Printable Instructions for for Patients Who Have Undergone Prostatectomy
 
 

Post-Operative Instructions for Indiana Pouch Cystectomy Patients

If any of the symptoms or problems described below persist, contact Dr. Scherr’s office immediately.

Dr. Scherr has successfully created a new bladder using a piece of your bowel. You have two stents (one pink and one blue), a stoma (a piece of your bowel through your abdomen and skin), a stomach catheter (yellow catheter sutured into the stoma), and a urostomy bag covering your stoma, stomal catheter, and stents.

The stoma will eventually be free of stents and tubes and drain urine on its own. While healing from your robotic cystectomy, these tubes are necessary. The stents allow the ureters to heal to the new bladder and continue to drain urine.

Note: Flushing is not required for an ileal conduit; please do not attempt to flush any of the tubes, stents, or stoma.

Note: You will always have a bag over the conduit.

Urostomy Bag Changing: The Urostomy bag and wafer will need to be changed every 4-5 days and as needed (leaking, damage to bag). If need to order more bags, you can contact our New York City office, or visit Hollister Woundcare’s website.

Supplies needed:

Normal saline solution/sterile water
Paper towels
Urostomy bag and wafer with flexible foley catheter connector
Scissors (dedicated to ostomy care)
Adhesive skin prep
Guaze
Garbage can

Steps for Changing the Urostomy Bag:

  1. Wash hands.
  2. Put on gloves if desired.
  3. Assure that the bag and foley tubing are completely empty prior to making any moves.
  4. Place a few paper towels on lap under the bag.
  5. Loosen the bag and wafer from the skin, gently assuring that the stents are not catching.
  6. Once the bag is removed, gently clean the stoma and skin with a moist gauze pad and pat the skin dry (not the stoma).
  7. Place the stent tips in a gauze pad or paper towel to assure that urine does not get on the skin. Note: It is very important that urine does not get on the skin. If it does, be sure to pat the area dry.
  8. Measure the stoma and cut the wafer slightly larger, to assure that we do not cause breakdown of the stoma.
  9. Prep the skin around the stoma with the skin prep.
  10. Separate the front and back of the urostomy bag so that the stents will fit in the bag.
  11. Attach the wafer to the urostomy bag and quickly place it over the stoma and stents, sealing it to the skin with gentle pressure from the hands.
  12. Reinforce the wafer with ½ paper tape if desired.

If the bag continues to leak, that means that the skin was not dry or prepped properly and the process must be repeated with a new wafer.

Post-Hospital:

The stents are removed in Dr. Scherr’s office in approximately one to two weeks, however this will vary from patient to patient. Alert Dr. Scherr if: your temperature becomes greater than 101 degrees F, if you have chills, if nausea and vomiting are persistent, if little urine flows out of stents, if there is little or no pain control, or skin breakdown. Also, if the surgical site becomes red, swells, or if there is drainage, contact Dr. Scherr immediately.

Printable Post-Operative Instructions for Indiana Pouch Cystectomy Patients
 
 

Post-Operative Instructions for Neobladder Cystectomy Patients:

If any of the symptoms or problems described below persist, contact Dr. Scherr’s office immediately.

Dr. Scherr has created a new bladder using a piece of your bowel.

You currently have: two stents (one pink and one blue), a suprapubic tube (yellow catheter in your abdomen), a foley catheter (tube coming from your urethra), and a urostomy bag covering the suprapubic tube and stents.

The tube in your urethra communicates with the suprapubic tube meaning both tube ends terminate or end in your newly created bladder (neobladder).

Note: Since bowel tissue has been used to create a new bladder, you will notice the presence of mucous in your urine. This situation requires maintenance flushing of the suprapubic tube and foley catheter to help “thin” out these secretions and avoid blockage of the tube. We will begin having the nurses flush the suprapubic tube and foley on post operative day three (this may vary from case to case). Do not flush without Dr. Scherr’s orders.

We will begin having the nurses flush the suprapubic tube and stomal catheter on post operative day three (this may vary from case to case). Do not flush without Dr. Scherr’s orders.

Change the urostomy bag every 5 days and as needed (i.e. leaking under the wafer). The urostomy bag is temporary while the suprapubic tube and stomal catheter are in.

Steps for Changing the Urostomy Bag:

Supplies needed:

  • One irrigation kit (contains 60 ml/cc irrigation syringe and basin)
  • Normal saline solution/sterile water
  • Paper towels

Steps for Changing the Urostomy Bag:

  • Wash hands.
  • Draw up 60 ml/cc normal saline 0.9% or sterile water into syringe.
  • Place syringe tip in stomal catheter (red rubber tube) and flush gently.
  • After flushing the suprapubic tube, flush the foley with 60cc x 2 (two syringes full) of normal saline/sterile water and pull back – you should get back what you put into the tube.
  • Make sure that the irrigant you instill is subtracted from the total urine output.
  • Do not irrigate the stents.

Note: the irrigant should and usually will flow through the suprapubic tube and out of the foley catheter.

Note: Do not overfill bladder more than 60cc x 2 (two syringes full), three times a day.

Note: You may flush the specified amount into the tubes and notice that you are not able to remove the irrigant or see it expressed from the opposite side. If this happens, just reconnect the catheter to the drainage bag, you should see the irrigation fluid. Never force an irrigation.

Note: If irrigating the suprapubic tube you will need to deliver it outside of the urostomy bag; you may pinch off the foley and gently draw back after inserting irrigant into the suprapubic tube.

Objective of flushing/irrigating is to remove the mucous.

On discharge:

Alert Dr. Scherr if: your temperature becomes greater than 101 degrees F, if you have chills, if nausea and vomiting are persistent, if little urine flows out of stents/tubes, difficulty irrigating stomal catheter or suprapubic tube, if there is little or no pain control, or skin breakdown. Also, if the surgical site becomes red, swells, or if there is drainage, contact Dr. Scherr immediately.

All of your tubes will eventually be removed, this is a step by step process and is individualized on a patient to patient basis.

  • Expect your stents to be removed in the office in about 1 to 2 weeks after the discharge.
  • The foley will be removed in about 2 to 3 weeks after discharge.

The suprapubic tube will be removed in about 3 to 4 weeks after discharge.

Printable Post-Operative Instructions for Neobladder Cystectomy Patients
 
 

Clear Liquid Diet Guidelines

Clear liquids are basically anything you can see through. When having soups, make sure you can see through them and that they have no pieces of vegetables. When having Jell-O or frozen ices, there should be no pieces of fruit.

Soups

You may have as much as you desire of the following:

  • Clear Consomme
  • Broth & Packaged Broth
  • Bouillion

You may not have any other type of soup, not even puree.

Fruit Juice

You may have as much as you desire of the following:

  • Apple Juice
  • White Grape Juice
  • Cranberry Juice

You may not have any other type of juice.

Other Beverages

You may have as much as you desire of the following:

  • Sanka
  • Weak Tea
  • Postum Coffee (black)

You may not have milk, milk products, cream, or any other beverages.

Desserts

You may have as much as you desire of the following:

  • Jell-O
  • Frozen Ices
  • Gelatin

You may not have ice cream or any other types of dessert.

Sweets

You may have as much as you desire of the following:

  • Granulated Sugar
  • Sugar Candy
  • Gum

You may not have any other type of sweets.

Printable Instructions for Clear Liquid Diet
 
 

Here is the Kegel exercise routine as developed at Beth Israel Hospital in Boston:

1. While standing, squeeze the pelvic muscles and hold for up to 10 seconds. This is the squeezing you do to stop urination, a tightening up of the buttocks and anus. Remember to breathe while squeezing. It may help to count out loud.

2. Relax for a count of 10.

3. Repeat as often as you can, up to 15 times, until you are tired or unable to keep squeezing for the full 10 seconds.

4. Relax for a minute or so.

5. Do a short-cycle exercise. Squeeze for one second, then relax for a second. Repeat that 10 times, then rests for a moment.

6. Repeat the short-cycle pattern 10 times.

7. Do the exercises as often as your doctor allows. Exercise only the pelvic muscles. There is no benefit in tensing up other muscles during the routine.

6 cycles per day = totaling 60 mins ( 1 hour)
1 cycle = 10 short repetitions + 10 long repetitions with equivalent relaxation period.
1 cycle should take 10 minutes to complete.

*Taken from the American Cancer Society’s Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery.

Printable Instructions for Kegel Exercises