Urology: Procedures and What to Expect

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Cystectomy and Ileal Loop Urinary Diversion [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.  They will need to review laboratory blood tests, radiology studies done and your pathology.  It is important to bring in your pathology glass slides from an outside facility for our Ochsner pathologists to review.  Your doctor may order additional radiological imaging.  After review of your history and examination, your doctor will discuss all treatment options (and their risks and benefits).  You will meet with one of the surgery schedulers to set up a surgery date.

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and urine culture

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and Plavix

You will meet with a stomal nurse prior to surgery to mark the ostomy site(urinary drainage site) on the abdomen prior to surgery.

Golytely Bowel Preparation and 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.
You will need to drink 3-4 liters of Golytely until the watery stool is clear and free of solid matter. It is important to drink 8 ounces every 10 minutes, and rapid drinking of each portion is preferred over drinking small amounts continuously. The solution is more palatable if chilled before consumption. Do not eat or drink anything after midnight the night before the surgery.  The bowel prep should be completed by 9pm the night before surgery.

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.

  • 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
    • Gator Aid
  • Tea (you may add sweetener, but no cream or milk)
  • Coffee (you may add sweetener, but no cream or milk)
  • Clear Jello (without fruit)
  • Popsicles (without fruit or cream)

What to expect after Cystectomy and Ileal Loop Urinary Diversion
Activity:

  • You should continue walking when you return home, gradually increasing the distance. The walking will help you build strength.
  • Take planned rest periods during the day. The best gauge is your own body and how you feel.
  • You may walk up and down stairs as soon as you return home, but take them slowly. Plan activities so you need only go up and down several times a day. You will gradually build up to your pre-op routine as you regain your strength.
  • Avoid heavy lifting greater than 15 pounds or strenuous activity for several weeks after you are discharged. Heavy lifting can increase abdominal pressure, which can put a strain on your incision and could create a small hernia. If you need to brace yourself to pick something up, it is too heavy.
  • Avoid bending. This is tiring and also increases abdominal pressure. If you must pick something up, bend at your knees (not at your waist) and stoop to pick up the object.
  • Avoid driving for at least two weeks after surgery. Take car breaks every several hours for extended trips. Get out of the car and walk around a bit.
  • Do not drive any motorized vehicle, or sign any legal documents while taking narcotic pain medications. The narcotic medication may cause alteration in visual perception and impair judgment.

Bathing when you go home:
Gently wash your incision with soap and water. Rinse and pat dry. You may take a shower. Do not take a tub bath until the incision has healed completely.
If you have white strips called "steri-strips" on your incision, they should fall off in about seven days. If they do not fall off, you may remove them.
Once your incision has healed completely, you may take a tub bath with your pouch on or off. Try to choose a time when the stoma is less active if you choose to bathe with the pouch off. Wait a few hours for adhesive to dry after putting on a new pouch before getting into the water.

Diet:
Return to normal eating habits.  Small frequent meals are better tolerated at first.
You may notice that garlic, onions, spices or asparagus may cause an odor of your urine. If you notice and increase in odor, simply limit these foods in your diet if you choose.

Drink fluids on a regular basis to assist in flushing mucous from the urine. The mucous is produced by the piece of bowel that was used to make the ileal loop. Drinking fluids will keep the mucous thin and prevent plugging of the stoma.

Recreation:
Even with a stoma you can ski, ride horseback, bowl, swim, and enjoy yourself in a variety of activities. Your stoma will not keep you from having fun. You should avoid weight lifting and contact sports such as wrestling or football, which could harm your stoma.

Clothing:
You can wear any clothing you want as long as it is loose around the area of the stoma. Tightness around the stoma can cause a rubbing effect and could start to bleed. You can wear belts.

Work:
If you were working before surgery, you should be able to return to work. Just remember to avoid heavy lifting for at least 4 weeks.

Travel:
The Stoma therapist has discussed this with you and has given you a list of resource centers across the country for your supplies.

The following are a few points to remember about what she has discussed with you.

  • Always pack more supplies that you usually need.
  • If you are traveling by airplane, train, or bus, always keep a carry on bag with your ostomy supplies with you. Do not check them with other baggage.
  • If you are in a foreign country or climate. Check with your doctor or local stoma therapist, about foods and water.
  • When you travel by car, fasten the lap-type seat belt below or above your stoma. Over the shoulder seat belts are preferred.
  • Keep your pouches in a cool, dry place.

Sexual Activity:
Because of the importance placed on physical beauty, the idea of ostomy surgery can be threatening. At first it may be difficult to believe that an intimate relationship is still possible. So do not ever assume your partner is "turned off" by your stoma or pouch. Talk together about your feelings and your urostomy. Your partner may be afraid of hurting you and you need to let him or her know that sexual activity will not harm your stoma. Woman of childbearing age need to plan for birth control, at least until your doctor approves of a pregnancy after enough healing has taken place.
The following are a few basic tips to remember about sex:

  • Empty your pouch first.
  • Be sure you have a good seal around your pouch

You may choose to wear a pouch cover. Men may find it helpful to use a cummerbund; women may find it helpful to wear panties with an open crotch.

Please do not hesitate to speak with the enterostomal nurse or the doctor about any sexual concerns you have. They will be most helpful in assisting you through some of these very important issues and questions.

Special Considerations:

  • For a man, if your scrotum is swollen, wear supportive briefs or an athletic support. When resting, elevate your scrotum on a towel.
  • Avoid constipation. If you do become constipated, take an over the counter laxative such as milk of magnesia or miralax. Drinking prune juice or orange juice may also help. You can also increase the roughage in your diet. You may be prescribed Colace, which is a stool softener, not a laxative. It is recommended that you DRINK AT LEAST 6-8 GLASSES OF WATER A DAY TO ENHANCE THE EFFECTIVENESS OF COLACE. Should constipation become a problem, call your physician whose number is on the back of this pamphlet.
  • If for any reason you need to collect a urine specimen, you will need to put a catheter into the stoma. Do not give a urine sample from the pouch.
  • Simple skin irritation can be treated with karaya powder or Stomahesive Powder. Your E.T. nurse will speak to you about this in more detail. If skin irritation continues or appears with severe itching or pimples, this may indicate a yeast infection. Call your E.T. nurse right away should this occur when you are at home.
  • If you notice a decrease in the amount of urine from your stoma, it may be that it needs to be irrigated. If this occurs, you should call your doctor or an E.T. nurse for further instruction.
  • The E.T. nurse will give you instructions in detail about supplies that you will be getting at home.

Stoma Care for ileal loop:

  • Wash hands before and after emptying the stoma bag. Empty the bag when it is one-third full. Otherwise it will get too heavy and can become disconnected from the wafer.
  • At night, connect the stoma bag to a drainage bag. During the day, wear the stoma bag and empty it frequently. Every morning, rinse the night collection bag with equal parts water and vinegar to prevent growth of bacteria as well as decrease odor. Place the tip of the collection bag in a container that will help keep it clean.
  • Refer to the instructions for care of the stoma you receive from your nurse.

Reasons to call your doctor:

  • The incision becomes red or swollen
  • The skin around your incision feels warmer than elsewhere and is slightly red.
  • There is drainage or pus from your incision or your incision comes open.
  • The skin around the stoma becomes red and itchy and does not improve with soap and water cleansing.
  • The stoma begins to look dark and not a healthy reddish pink.
  • The urine becomes bloody or you begin to pass clots.
  • There is a decrease in urine from the stoma along with feeling “fullâ€Â.
  • Nausea and vomiting occur
  • You have chills or temperature greater than 101 degrees
  • You experience severe pain that is not relieved by pain medication.
  • If you have chest pain or shortness of breath.

 

Cystectomy and Neobladder/Indiana Pouch [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.  They will need to review laboratory blood tests, radiology studies done and your pathology.  It is very important to bring in your pathology glass slides from an outside facility for our Ochsner pathologists to review.  Your doctor may order additional radiological imaging.  After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  You will meet with one of the surgery schedulers to set up a surgery date.

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and urine culture

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and Plavix

You will meet with an ostomy nurse prior to surgery to mark the stomal site.

Golytely Bowel Preparation and 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.

You will need to drink 3-4 liters of Golytely until the watery stool is clear and free of solid matter. It is important to drink 8 ounces every 10 minutes, and rapid drinking of each portion is preferred over drinking small amounts continuously. The solution is more palatable if chilled before consumption. Do not eat or drink anything after midnight the night before the surgery.  The bowel prep should be completed by 9pm the night before surgery.

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.

  • 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
    • Gator Aid
  • Tea (you may add sweetener, but no cream or milk)
  • Coffee (you may add sweetener, but no cream or milk)
  • Clear Jello (without fruit)
  • Popsicles (without fruit or cream)

What to expect after - Cystectomy/Neobladder?

Irrigation
Your Neo-bladder should be irrigated 3 times a day when you go home with saline. While in the hospital, it will be done more frequently. Your nurse will have hands on instruction with you about proper technique for this procedure and will review it with you till you are comfortable doing it yourself.
You will need sterile saline for irrigation at home. The fluid MUST be STERILE. DO NOT USE TAP WATER. Tap water often has microbacteria in it that can cause infection if it is instilled directly into your new bladder. Your nurse will give you a bottle of sterile saline to take home with you, and you will have several liters sent to your home by the home care nurse.
If you have any pelvic discomfort or cramps, or if the catheter is not draining freely, you must irrigate immediately to prevent any blockage of the catheter that could be caused by the mucus that collects in the new bladder.

The following procedure should be used when irrigating the catheter.

  • Wash your hands
  • Draw up 40 to 60 cc of sterile saline in the syringe provided for you
  • Hold the tip of the catheter upright between the thumb and first finger. Place the tip of the syringe into the catheter.
  • Gently inject the sterile saline into the catheter. Do not force the fluid in as this can cause discomfort.
  • Gently withdraw the fluid from the catheter with the syringe. Watch for mucus. (mucus is what you want to see.)
  • This process may be repeated several times. Once you can no longer withdraw mucus, you may stop for that particular irrigation. However, you still must irrigate three times a day.
  • After you have completed each irrigation, wash the tip of the syringe with soap and hot water. Cleanse the tip with alcohol and recap it.
  • Clean your syringe after each irrigation with a small amount of the sterile saline and store your supplies in a clean place.
  • If you go home with the suprapubic catheter, your nurse will show you how to irrigate both of these.

Activity

  • You should continue walking when you return home, gradually increasing the distance. Walking will help you to build strength and prevent blood clots from developing in your legs.
  • Take planned rest periods during the day. The best gauge is your own body and how you feel.
  • You may walk up and down stairs when you return home, but take them slowly. Plan activities so you need only go up and down several times a day. Again, you will gradually build up to your pre-op routine as you regain your strength.
  • Avoid heavy lifting, greater than 15 pounds, or strenuous activity for about 4 weeks. Heavy lifting can cause increased abdominal pressure which can put a strain on your incision and could create a small hernia. If you need to brace yourself to pick something up, it is too heavy.
  • Avoid bending. This is tiring and also increases abdominal pressure. If you must pick something up, bend at your knees (not at your waist) and stoop to pick up the object.
  • Do not drive while you have tubes and drains in place.  A good rule is to not drive till you are pain free. This is because when you are having pain, it will change the way you would react to something. Take car breaks every couple hours for extended trips. Get out of the car and walk around.
  • Do not drive any motorized vehicle, or sign legal documents while taking narcotic pain medications. The narcotic medication may cause alteration in visual perception and impair judgment.

Bathing
Gently wash your incision with soap and water. Pat dry. You may take a shower but do not tub bath until full healing of the incision.
If you have white strips called "steri-strips" on your incision, they should fall off in about seven days. If they do not fall off, you may remove them.

Diet
Return to normal eating habits. A well balanced diet is encouraged to promote healing.
Drink fluids on a regular basis to assist in flushing mucous from the urine. The mucous is produced by the piece of bowel that was used make the neobladder. Drinking fluids will keep the mucous thin and prevent plugging of the stoma. It is best to drink as much as 8 glasses of water a day.

Special Considerations:
Avoid constipation. If you do become constipated, there are alternatives to consider. You can increase the roughage you take in your diet. Drinking prune juice or orange juice is also good. You can take an over the counter laxative of choice if you need to such as Metamucil, milk of magnesia or Miralax. You may be prescribed Colace which is a stool softener, not a laxative. With Colace, it is recommended that you drink at least 6-8 glasses of water to enhance the effectiveness of Colace. Should constipation become a problem, call your physician at 504-842-4083. Even though part of your bowel has been used to create a new bladder, it will still continue to produce mucus for some time. You may take this type of medication for as long as a year.

REASONS TO CALL YOUR DOCTOR

  • The incision becomes red, swollen, open, or there is pus-like drainage
  • The skin around the incision is warmer than elsewhere
  • There is an abnormal odor to your urine (Mucus is normal)
  • There is decreased or absent urine output for 2 hours
  • The catheter becomes dislodged
  • Nausea, vomiting or diarrhea occur
  • You experience severe pain that is not relieved by pain medication.
  • You have chills or temperature greater than 101 degrees
  • You have difficulty irrigating the urinary catheter before it is removed
  • Chest pain or shortness of breath
  • Swelling in your legs

 

Cystoscopy [Show]

Description:  Cystoscopy is a minimally invasive procedure that urologists often perform in clinic to evaluate the inside of the urethra and bladder.  The openings for the ureters (tubes that connect the kidney to the bladder) and prostate (in men) can also be directly visualized. 

This procedure is most commonly performed in cases of hematuria (blood in the urine), recurrent bladder infections, urinary difficulty, problems with the prostate and to evaluate other abnormalities of the urethra or bladder.

How to prepare for cystoscopy: In the clinic setting, you are allowed to eat prior to the procedure.  You can take all of your home medications prior to the procedure.
You should notify your doctor ahead of time if you feel you may have a urinary tract infection.  Cystoscopy is not usually performed when the urine is infected.

How is this test performed?
You will be positioned on the procedure table lying on your back.  For females, you may be asked to bend your knees and relax them out towards the side.  For males, you will be asked lie with your legs straight. 

Your genital area will be gently cleaned with a special sterile cleaning solution.  A numbing gel, Lidocaine Jelly, will be used for local anesthesia.  Finally, a sterile drape will be used.

The small flexible camera will be advanced through the urethra and into your bladder. Sterile fluid will flow through the flexible tube to assist in visualization of the inner lining of the urethra and bladder. You may choose to watch the images on the video screen. 

What to expect during and after cystoscopy?
Some individuals may feel a burning sensation when the numbing gel is inserted into the urethra.  This is mild and will subside.

You may feel the gentle flow of the sterile fluid as the cystoscope is advanced into your bladder.  You may feel as though you need to urinate near the completion of the procedure.


Some individuals experience a mild burning with urination following the procedure for approximately 24-48 hours.  This is normal and expected.  We recommend drinking plenty of water to dilute the urine.  This will help with the burning sensation.

You may notice a small amount of blood in your urine after the procedure.  You will be given an antibiotic following the procedure for prevention of infection, unless you are already on antibiotics.

Call the Ochsner Urology clinic at 504-842-4083 if you develop a fever of 101 degrees Fahrenheit or higher, chills, persistent bleeding, or cannot urinate.

 

Extracorporal Shock Wave Lithotripsy (ESWL) [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.   After review of your laboratory blood tests and imaging studies your doctor will discuss all treatment options and their risk and benefits.  If you doctor feels you are a candidate for this procedure, you will meet with one of the surgery schedulers to set up a surgery date. 

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and Urine culture

Preparation before surgery:
You should not eat or drink anything after midnight the evening before surgery. 
You should notify your doctor if you feel you might have a urinary tract infection before the day of surgery.

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and
Plavix. 

How is the surgery performed?
This surgery can be performed with general anesthesia or with intravenous sedation.  You will be positioned on a table over a water filled cushion.  The kidney stones will be visualized on x-ray.  High energy shock waves will be delivered to the kidney stone and fragment it into many small pieces or dust, that will be easier to pass. 

A ureteral stent, an internal drainage tube between the kidney and bladder, may be placed prior to the procedure in patients with large kidney stones.

What to expect after surgery?
You may continue to pass stones for days to weeks after surgery.  You should strain your urine with a strainer and bring in all stone fragments for analysis.  You may have mild pain as the stones pass through the urinary tract.  You will be scheduled for a follow-up x-ray the day of your post-operative visit.

Medications:  You will be discharged with a pain medication, stool softner and medication to relax the ureter (Flomax or Uroxatral).  You doctor may also give you an antibiotic or a medication for bladder spasms.

Activity:  You should avoid any strenuous activity for 4 weeks after surgery.  You should not drive in the first 24 hours after surgery. 

Diet:  It is extremely important to drink plenty of fluids after surgery, especially water.  A regular diet is permitted, but foods high in fiber are best and will help your bowel function return to normal. 

You may experience some discoloration of your urine with increased activity.  You may also have some bruising on your side.  You may have some discomfort, but the pain should not be severe.

Problems:  You should call your Ochsner urologist for any problems at 504-842-4083.  The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, chest pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting, diarrhea or if your catheter stops draining or falls out. 

 

Laparoscopic or Open Nephrectomy and Partial Nephrectomy [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.  They will need to review blood laboratory test and any radiology studies done.  After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  You will meet with one of the surgery schedulers to set up a surgery date.

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and
Plavix

Bowel Preparation
Do not eat or drink anything after midnight the night before surgery.  You may be asked to drink one bottle of Magnesium Citrate, from your local pharmacy, the evening before surgery.  Drink only clear fluids for one day prior to the date of your surgery. 

  • Surgery typically lasts 2-4 hours. 
  • Hospital Stay is typically 1-2 days.
  • You will usually have a Foley Catheter for 24-48 hours.

You may or may not have a small extra drain from the abdomen, called a Jackson Pratt Drain, JP. 

Pain Control: You may have mild discomfort at the small incision sites.  You will be given a pain medication prior to discharge home.  Many patients use Tylenol over-the-counter shortly after surgery for managing their mild discomfort. 

Showering:  You may shower as soon as you get home.  Tub baths, hot tubs and swimming are discouraged for at least 2 weeks after surgery.  Your incisions can get wet and should be patted dry.  The small adhesive strips placed across the incision will fall off themselves or can be peeled off after 7 days. 

Incisions:  The incisions will be closed with suture and small adhesive strips will be placed on top of the incision site.  The suture will dissolve themselves over the next 4-6 weeks.

JP drain:  If you are discharged with a JP drain, you will be instructed on proper care.  It is import to strip and record the drain output every 4 hours.

Activity:  No heavy lifting greater than 10-15 pounds or exercising should be done prior to 6 weeks after surgery.  No driving is recommended for at least 2 weeks after surgery.  Walking is encouraged and should be done multiple times daily.  Walking helps build your strength and helps prevent blood clots from developing in your legs.  Climbing stairs is permitted after surgery and should be done with caution. You should not drive while you are under the influence of narcotic pain medications.

Diet:  It is extremely important to drink plenty of fluids after surgery, especially water.  A regular diet is permitted, but foods high in fiber are best and will help your bowel function return to normal. 

Bowel Function:  Sometimes after surgery, the intestines are a little slow to return to normal.  You may experience some constipation, bloating or gas pains.  You will be discharged with a prescription for an over-the-counter stool softener, Colace.  You may also use mild laxatives, such as milk of magnesia or Mira-lax.  If you have not had a bowel movement after several days, you may use a laxative suppository.  Narcotic pain medications can cause constipation and should be minimized after surgery if not needed.

Medications:  You will be discharged with a prescription for a stool softner and a pain medication.  Your doctor may prescribe an antibiotic depending on your personal circumstances.  You can resume all previous medications unless specifically told not to.  You should not resume blood thinners for at least a week after surgery, unless otherwise instructed.

Problems:  You should call for any problems to 504-842-4083 (8a-5p) and 504-842-3000 (after hours).   The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting or diarrhea.

 

Laparoscopic Robotic Assisted Prostatectomy [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.  They will need to review your PSA values, any radiology studies done and your pathology.  It is very important to bring in your pathology glass slides from an outside facility for our Ochsner pathologists to review.  After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  You will meet with one of the surgery schedulers to set up a surgery date.

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and
Plavix

Bowel Preparation
Do not eat or drink anything after midnight the night before surgery.  You may be asked to drink one bottle of Magnesium Citrate, from your local pharmacy, the evening before surgery.  Drink only clear fluids for one day prior to the date of your surgery. 

What to expect after Robotic Prostate Surgery

  • Surgery typically lasts 2-4 hours. 
  • Hospital Stay is typically 1-2 days.
  • You will have a Foley Catheter, a urinary drainage catheter for 5-10days.

You may or may not have a small extra drain from the abdomen, called a Jackson Pratt Drain, JP. 

Pain Control: You may have mild discomfort at the small incision sites.  You will be given a pain medication prior to discharge home.  Many patients use Tylenol over-the-counter shortly after surgery for managing their mild discomfort. 

Showering:  You may shower as soon as you get home.  Tub baths, hot tubs and swimming are discouraged for at least 2 weeks after surgery.  Your incisions can get wet and should be patted dry.  The small adhesive strips placed across the incision will fall off themselves or can be peeled off after 7 days. 

Incisions:  The incisions will be closed with suture and small adhesive strips will be placed on top of the incision site.  The suture will dissolve themselves over the next 4-6 weeks.

Catheter:  You will have a Foley catheter for 5-10 days.  This catheter is used to help the anastamosis, joining of the bladder and urethra, after surgery.  It will allow urine to drain continuously from the bladder to the bag.  You will be instructed on its use and emptying the bag prior to discharge.  You should notify your doctor immediately is the catheter stops draining or falls out.

You should allow some slack on catheter, such that you do not feel a tugging or pulling sensation.  It is important that the bag  is situated such that your urine drains to gravity.  You will be given a leg bag for daytime activities outside the home which can be concealed under you clothes.  A larger drainage bag will be used for nighttime and when lounging around.  This bag can be worn while you are in the shower.

You may have discomfort at the tip of the catheter.  Your doctor may recommend cleaning the tip of the catheter gently with soap and water.  You may also apply a triple antibiotic ointment, Bacitracin, from your local pharmacy to the tip of the penis around the catheter for lubrication.

Occasional you may notice some red-tinged discharge around the catheter or in the urine.  This is normal and usually happens with increased activity or straining.

You should not drive with a Foley catheter. You can climb stairs with caution with a catheter. 

Activity:  No heavy lifting greater than 10-15 pounds or exercising should be done prior to 6 weeks after surgery.  No driving is recommended for at least 2 weeks after surgery.  Walking is encouraged and should be done multiple times daily.  Walking helps your body gain strength and prevents blood clots from developing in your legs.  Climbing stairs is permitted after surgery and should be done with caution.  You should not drive while you are under the influence of narcotic pain medications.

Diet:  It is extremely important to drink plenty of fluids after surgery, especially water.  A regular diet is permitted, but foods high in fiber are best and will help your bowel function return to normal. 

Bowel Function:  Sometimes after surgery, the intestines are a little slow to return to normal.  You may experience some constipation, bloating or gas pains.  You will be discharged with a prescription for an over-the-counter stool softener, Colace.  You may also use mild laxatives, such as milk of magnesia or Mira-lax.  If you have not had a bowel movement after several days, you may use a laxative suppository.  Narcotic pain medications can cause constipation and should be minimized after surgery if not needed.

Medications:  You will be discharged with a prescription for a stool softner, antibiotic and pain medication.  You can resume all previous medications unless specifically told not to.  You should not resume blood thinners for at least a week after surgery, unless otherwise instructed.

Problems:  You should call your Ochsner urologist for any problems at 504-842-4083.  The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, chest pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting, diarrhea, drainage from your incision or if your catheter stops draining or falls out. 

You may have some swelling of your scrotum after surgery.  This is harmless and could last for up to a week.  You may also experience a crampy feeling, called bladder spasms, for several days to weeks after surgery.  Occasionally, during one of these episodes urine may leak around the catheter.  Should bladder spasms become a problem, your doctor may give you a medication.  If you are given medications such as Oxybutinin, Ditropan, Detrol, Enablex or Vesicare, you should stop this medicine at least 24 hours prior to removal of catheter. 

SPECIAL CONSIDERATIONS AFTER CATHETER REMOVAL
Urinary Recovery
The catheter will be removed in clinic. When the catheter is taken out, you may experience minimal discomfort for a few seconds. Until urine control returns completely, it may be helpful to wear an incontinence pad. Problems with urinary control are common once the catheter is removed.  It is normal to experience leaking at first.  Do not become discouraged.  Urinary control may return in three phases:

  • Phase 1-You are dry when you are lying down at night.
  • Phase 2-You have periods of good urinary control in the early morning.
  • Phase 3-Urinary control lasts for longer intervals and later into the afternoon and evening.

Sexual Activity and Penile Rehabilitation
Sexual recovery is typically more gradual than urinary recovery.  The return of sexual function varies depending on your age, previous function, medical history and the extent of the tumor.  For those men who have return of erections, it is a gradual process.  Most men do not have erections sufficient for vaginal penetration immediately after catheter removal.  Erection recovery can take months or years; during this period, medications can be used to help your erections be firmer and more durable.  Many men, however, do experience improvement over the first year after the operation. 

The stimuli for erection during the first year will also be different.  Visual stimuli will be less effective, and physical stimulation will be more effective.  For this reason, do not be afraid to experiment with sexual activity.  If you obtain a partial erection, attempt vaginal penetration-this form of stimulation is a major factor to enhance further erection.  Do not wait until you have the "perfect erection" before attempting intercourse.  In addition, you should be able to have an orgasm even if you do not have an erection.  With orgasm, there will not be an emission of semen because the prostate and seminal vesicles have been removed. 

You doctor may give you medications or devices to help with achieving erections or increasing blood flow to the penis after surgery.  There will be many aids available to assist in getting an erection.   Your doctor will discuss this in detail with you.

More information about laparoscopic robotic assisted prostatectomy...

 

Laser Vaporization of the Prostate [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination and will discuss all treatment options and their risk and benefits.  Your doctor may order additional tests such as a cystscopy, urodynamics or ultrasound of the prostate.  If you doctor feels you are a candidate for this procedure, you will meet with one of the surgery schedulers to set up a surgery date. 

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and Urine culture

Preparation before surgery:
You should not eat or drink anything after midnight the evening before surgery. 
You should notify your doctor if you feel you might have a urinary tract infection before the day of surgery.

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and
Plavix. 

How is the test performed?
A small instrument is advanced through the urethra and into the bladder.  The prostate gland is visualized and the obstructing portions of the prostate are removed with a high powered laser.

What to expect after surgery?
Most patients are discharged home the same day. 

A Foley catheter is used to drain your bladder and irrigate any blood clots after surgery.  You may be discharged home with a Foley catheter depending on your individual situation.  This catheter will allow urine to drain continuously from the bladder to the bag.  You will be instructed on its’ use and emptying the bag prior to discharge.  You should notify your doctor immediately is the catheter stops draining or falls out.

You should allow some slack on catheter, such that you do not feel a tugging or pulling sensation.  It is important that the bag always drain to gravity.  You will be given a leg bag for daytime activities outside the home which can be concealed under you clothes.  A larger drainage bag will be used for nighttime and when lounging around.  This bag can be worn while you are in the shower.

You may have discomfort at the tip of the catheter.  Your doctor may recommend cleaning the tip of the catheter gently with soap and water.  You may also apply a triple antibiotic ointment, Bacitracin, from your local pharmacy to the tip of the penis around the catheter for lubrication.

Occasional you may notice some red-tinged discharge around the catheter or in the urine.  This is normal and usually happens with increased activity or straining.

You should not drive with a Foley catheter. You can climb stairs with caution with a catheter. 

Activity:  No heavy lifting greater than 10-15 pounds or exercising should be done prior to 4 weeks after surgery.  No driving is permitted while the Foley catheter is in place.  Walking is encouraged and should be done multiple times daily.  Walking helps your body gain strength and prevents blood clots from developing in your legs.  Climbing stairs is permitted after surgery and should be done with caution.  You should not drive while you are under the influence of narcotic pain medications.

Diet:  It is extremely important to drink plenty of fluids after surgery, especially water.  A regular diet is permitted, but foods high in fiber are best and will help your bowel function return to normal. 

Bowel Function:  Sometimes after surgery, the intestines are a little slow to return to normal.  You may experience some constipation, bloating or gas pains.  You will be discharged with a prescription for an over-the-counter stool softener, Colace.  You may also use mild laxatives, such as milk of magnesia or Mira-lax.  If you have not had a bowel movement after several days, you may use a laxative suppository.  Narcotic pain medications can cause constipation and should be minimized after surgery if not needed.

Medications:  You will be discharged with a prescription for a stool softner, antibiotic and pain medication.  You can resume all previous medications unless specifically told not to.  You should not resume blood thinners for at least a week after surgery, unless otherwise instructed.

Problems:  You should call your Ochsner urologist for any problems at 504-842-4083.  The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, chest pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting, diarrhea or if your catheter stops draining or falls out. 

 

Percutaneous Nephrolithotomy (PCNL) for kidney stones [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.  They will need to review your laboratory blood tests and any radiology studies done.  After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  If you are a candidate for PCNL, you will meet with one of the surgery schedulers to set up a surgery date.

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and Urine culture

Medications to Avoid Prior to Surger:
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and Plavix

What to expect after PCNL?
Most patients are hospitalized for 1-2 days after surgery.
A nephrostomy tube (tube that drains the kidney), Foley catheter (tube that drains the bladder) and an internal ureteral drainage stent are usually left in place after surgery.  The external drains may be removed prior to discharge depending on your individual situation.  For extremely large stones, you may need a repeat procedure.

Activity-gradually increase activity with short frequent walks, three to four times a day. Avoid strenuous activities, like sports, lawn mowing, or heavy lifting more than 10-15 pounds. Wear loose, comfortable clothing that won't pull or kink the tube or tubes. Do not drive while taking pain medication, or until your doctor permits it. Wait to resume sexual activity until after clinic visit, unless your doctor instructs otherwise.
If you are discharged with a nephrostomy tube, check the dressing often to make sure the tubing is securely taped to avoid pulling on or kinking it.

Bathing and dressing change. You should not shower for 48 hours after surgery.  Do not soak your back in a bathtub.  Change your dressing daily with gauze. 

Tube and drainage bag care.  Some patients may be discharged with a nephrostomy tube. The catheter should always be taped securely.  The drainage bag should be secured such that it never pulls on the nephrostomy tube. 
It is important to wash your hands before and after emptying the drainage bag to help prevent the spread of infection. The drainage bag should be emptied when it is less than 2/3 full and prior to bedtime.  A leg bag should only be worn during the day.  The larger Foley drainage bag can be used during the day and at nighttime. Some individuals may have a tube that is clamped without a drainage bag. 


Diet
It is extremely important to drink plenty of fluids after surgery, especially water.  Your may resume your regular diet, unless otherwise instructed

Medications:  You will be discharged with a prescription for a stool softner, antibiotic and pain medication.  You may also be given a medication for bladder spasms. You can resume all previous medications unless specifically told not to.  You should not resume blood thinners for at least a week after surgery, unless otherwise instructed.

Problems:  You should call your Ochsner urologist for any problems at 504-842-4083.  The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, chest pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting, diarrhea, severe back pain, excessive drainage from your incision or if your catheter stops draining or falls out.

 

Transrectal Ultrasound Prostate Biopsy [Show]

Description:  A prostate biopsy obtains small pieces of prostate tissue that are then examined under the microscope by a pathologist.  This test is performed by advancing a small ultrasound into the rectum.  A needle is then passed through the ultrasound 

A prostate biopsy is usually performed in patients who have an abnormal prostate exam or elevated blood levels of prostate specific antigen, or PSA.  This test allows your urologist to obtain small pieces of prostate tissue that are then examined under the microscope by a pathologist. 

How to Prepare for a Prostate Biopsy?
You must be off of all blood thinners such as aspirin, Alka-seltzer, Goodie powders, BC powders, Coumadin, plavix, heparin and Lovenox at least one week prior to the procedure.   You should also avoid ibuprofen, Aleve and Motrin.

You should eat prior to the procedure and take all of your homes medications, except for the ones listed above. 

You should notify your doctor if you feel you have a bleeding disorder or history of allergy to any medications.

You must take a Fleets enema the morning of the procedure.

You will be given antibiotics to take the day before the procedure, the day of the procedure and the day after the procedure.

How is this test performed?
You will be asked to lay on your right side with your knees pulled up towards your chest.  A small ultrasound probe will be gently passed into your rectum.  Once your prostate is visualized, local anesthesia will be injected.  You prostate will be inspected for any abnormalities on ultrasound and the size of your prostate will be measured.  A spring loaded biopsy gun will then be used to obtain the biopsies.  The specimens will be sent to the pathologist to examine under the microscope.

What to expect afterwards?
You may experience mild bleeding from the rectum, urine or ejaculate.  This is normal, expected and may last for up to a month.  You may have mild discomfort in your rectal or urethral area for 24-48 hours.

You will receive a call from the Urology Department at Ochsner in regards to your prostate biopsy results within one week.

Diet: There are no dietary restrictions

Medications: You may resume all your regular medications except for the blood thinners.  You may resume these medications 5 days after the procedure.  You may take Tylenol if your temperature is elevated less than 101 or you experience some discomfort.

Activity:  No strenuous lifting, straining, or exercising for 24 hours.  You may return to full activity the next day.

Signs and Symptoms to Report
You should call your Ochsner urologist at 504-842-4083 if you develop any of the following:

  1. Temperature greater than 101 degrees
  2. Inability to urinate
  3. A large amount of bleeding from the rectum or in the urine.
  4. Persistent or severe pain.

 

Transurethral Resection of a Bladder Tumor [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.   After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  Your doctor will have performed cystoscopy prior to scheduling of the surgery.  If you doctor feels you are a candidate for this procedure, you will meet with one of the surgery schedulers to set up a surgery date. 

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of your scheduled surgery date.  If these studies are not done at Ochsner, the results must be faxed to 504-842-2411.  You may also need medical clearance to be given by your primary care doctor. 

The following studies are typically ordered:

  • CBC (complete blood count)
  • CMP (comprehensive metabolic profile)
  • PT/PTT (blood coagulation profile)
  • EKG (electrocardiogram)
  • Chest x-ray
  • Urinalysis and Urine culture

Preparation before surgery:
You should not eat or drink anything after midnight the evening before surgery. 
You should notify your doctor if you feel you might have a urinary tract infection before the day of surgery.

Medications to Avoid Prior to Surgery
The following medications can increase your risk of bleeding during surgery and should be avoided at least one week prior to surgery: Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx and
Plavix. 

How is the test performed?
A small instrument is advanced through the urethra and into the bladder.  The bladder tumor is visualized and removed with a small cutting loop.  The specimen will be sent for pathology for microscopic analysis. 

What to expect after surgery?
Most patients are discharged home the same day.  Other patients may have to stay overnight.

A Foley catheter may be used to drain your bladder and irrigate any blood clots after surgery.  You may be discharged home with a Foley catheter depending on your individual situation.  This catheter will allow urine to drain continuously from the bladder to the bag.  You will be instructed on its use and emptying the bag prior to discharge.  You should notify your doctor immediately is the catheter stops draining or falls out.

You should allow some slack on catheter, such that you do not feel a tugging or pulling sensation.  It is important that the bag always drain to gravity.  You will be given a leg bag for daytime activities outside the home which can be concealed under you clothes.  A larger drainage bag will be used for nighttime and when lounging around.  This bag can be worn while you are in the shower.

You may have discomfort at the tip of the catheter.  Your doctor may recommend cleaning the tip of the catheter gently with soap and water.  You may also apply a triple antibiotic ointment, Bacitracin, from your local pharmacy to the tip of the penis around the catheter for lubrication.

Occasional you may notice some red-tinged discharge around the catheter or in the urine.  This is normal and usually happens with increased activity or straining.  You may also have some bladder spasms or cramping.

You should not drive with a Foley catheter. You can climb stairs with caution with a catheter. 

Activity: No heavy lifting greater than 10-15 pounds or exercising should be done prior to 6 weeks after surgery.  No driving is permitted while the Foley catheter is in place.  Walking is encouraged and should be done multiple times daily.  Walking helps your body gain strength and prevents blood clots from developing in your legs.  Climbing stairs is permitted after surgery and should be done with caution.  You should not drive while you are under the influence of narcotic pain medications.

Diet:  It is extremely important to drink plenty of fluids after surgery, especially water.  A regular diet is permitted, but foods high in fiber are best and will help your bowel function return to normal. 

Bowel Function:  Sometimes after surgery, the intestines are a little slow to return to normal.  You may experience some constipation, bloating or gas pains.  You will be discharged with a prescription for an over-the-counter stool softener, Colace.  You may also use mild laxatives, such as milk of magnesia or Mira-lax.  If you have not had a bowel movement after several days, you may use a laxative suppository.  Narcotic pain medications can cause constipation and should be minimized after surgery if not needed.

Medications:  You will be discharged with a prescription for a stool softner, antibiotic and pain medication.  You can resume all previous medications unless specifically told not to.  You should not resume blood thinners for at least a week after surgery, unless otherwise instructed.

Problems:  You should call your Ochsner urologist for any problems at 504-842-4083.  The following are potential concerns: fever greater than 101, heaving bleeding or clots in the urine, leg pain, chest pain, difficulty breathing, chest pain, skin rashes or hives, nausea, vomiting, diarrhea or if your catheter stops draining or falls out. 

 

Transurethral resection of the Prostate (TURP) [Show]

Preoperative consultation:  Your doctor will perform a detailed history and physical examination.   After review of your history and examination, your doctor will discuss all treatment options and their risk and benefits.  Your doctor may order additional tests such as a cystscopy, urodynamics or ultrasound of the prostate.  If you doctor feels you are a candidate for this procedure, you will meet with one of the surgery schedulers to set up a surgery date. 

Prior to surgery:  You will need pre-operative lab work and studies within 30 days of y