Perineal Prostatectomy Report

[Guest guest]

Well, it's been over two weeks since my perineal prostatectomy. I

thought that with all the support and information provided by this

forum, I owed the group a report.

I can't say enough about Doylestown Hospital, in Doylestown PA.

http://www.dh.org

From the surgeons, to the nursing staff, to the multitude of

volunteers, this hospital is superb. Especially, when compared to the

large center city hospitals in Philadelphia. " Doylestown " is a highly

efficient and caring, first rate facility, large enough to attract a

fine set of doctors and surgeons.

I was released two days after the surgery. Visiting nurses were

arranged by the hospital and provided excellent care at home.

Since the perineal approach is only done in about 5 percent of

patients, I thought that a detailed account would provide valuable

information for those considering this operation.

In this approach, a u-shaped incision is made in the perineum,

between the scrotum and the anus. There is no laparoscope, or robot

involved. The surgeon goes in, has an excellent view of the gland,

removed the prostate, snips and sutures what he has to, and closes.

The operation takes about an hour and a half, from start to finish,

much shorter than a DaVinci procedure. I was under general

anesthesia, rather than a Spinal. I did fine with that, as well as

being in a super lithotomy position ( I was worried about my spine

and arthritis).

Unfortunately the last two weeks at home have been very uncomfortable

and difficult for me. I'm sure this is true for most folks, no matter

what kind of surgery they have considered. No one walks out of the

hospital after major surgery and says, " That was a piece of cake. "

In reality, the incision is much closer to the anus than the

scrotum. As such, dealing with the aftermath is similar to dealing

with rectal surgery. Although I was given stool softeners and

laxatives prior to my release, I found myself totally blocked up and

constipated. It took a " Citrate Bomb " to get me going. The magnesium

citrate did its job, but was an extremely painful experience.

The incision and drain in between my legs feels like I have a whole

new, alien anatomy. I hope the tissue will eventually soften and

recede.

The Catheter

If ever there was an ultimate torture device for a male, it would be

the Foley Catheter. Insert one of these into any terrorist, and by

the end of a week, you could obtain anything you needed to know. I

tried my best not to PANIC!

The catheter came with two collection bags. The " leg bag " is

definitely more convenient and personal, but it is small and must

continually be emptied. The large, " overnight bag " is, as my wife

says, " GROSS! " This is especially true during the first few days

after surgery when the collection is still full of blood and looks

like Hawaiian Punch. My suggestion is to place the bag in a plastic

bucket and carry it around by the handle.

Another problem is to find a suitable lubricatant for the end of the

penis. Although the end of the foley is held in the bladder by a

liquid-filled balloon, the penis must still adjust itself in and out

of the tube. Several lubricants were suggested including antibiotic

gel, Vaseline, Aquaphor, and surgical lubricant. The problem with

all of these was that after a short period of time, they would dry up

and form a sticky gum, which made things even worse.

Finally, after nine long, hard days and nights, it was time to have

the catheter removed. The procedure did NOT hurt. At that point, I

wouldn't have cared if they had to go in and drill the tube out! I

just wanted to be free of that thing!

I hung around the hospital for an hour and a half, drinking and

peeing, to see what kind of control I had. To my surprise, I could

start and stop my urination without dripping. The stream was good.

Was I going to be one of those lucky folks who had instant control?

Well, I thought so, but no such luck. The next day, I started to

dribble. It was " Pad " time.

The Pads

A friend of mine had the misfortune of needing a prostatectomy a few

years ago. He had kept a large plastic tub, full of every type of

pad, from Depends to famine napkins with wings. He gladly gave me

the whole tub. He never wanted to see it again!

Depends adult diapers were certainly " overkill " . Yet the little pads

were really too small and narrow to do the job. I tried

Depend " Guards for Men " , but they were too thick (I was reminder of

seeing my 25 pound grandson waddling out of his wading pool wearing a

22 pound saturated diaper…).

Current Status

At a little over two weeks in, I'm left with a good deal of scrotal

pain and some dribble. I'm still taking Oxycodone for pain Trying to

restrict its use, not so much worried about becoming an addict, but I

don't want the resulting constipation.

The best follow-up care information I've found can be viewed at:

http://www.med.umich.edu/1libr/urology/postcare/rprostatectomy.htm

It mentioned several ideas I had not seen elsewhere, such as the use

of Flomax, and rolling up a washcloth for scrotal support.

Hanging in there,

Ron