Bladder Foley catheter

Post Catheter Removal Instructions

You have been enthusiastically anticipating the removal of the urinary catheter after your robotic radical prostatectomy. However, upon its removal, this enthusiasm can be quickly replaced by a feeling of frustration. Now that the bladder is able to fill, urinary leakage (particularly when standing up, coughing, sneezing, bearing down, etc.) will be a new experience for you. TIME, PATIENCE and KEGEL REFLEX practice are all important to your physical and emotional recovery. Remember that your urinary control will improve with time and patience will allow you to be a happier person while you are learning to coordinate your pelvic floor contractions to improve to a pad-free status. Stress urinary incontinence is a temporary side effect of the surgery. By 1 year, >90% of patients are no longer using a pad!

  • After the catheter removal, you may note a little blood in the urine. There may also be some burning during the first few times you urinate. You will be given Bactrim DS or Levoflox (oral antibiotic) for 3 days following your catheter removal. If the burning persists or increases thereafter, please contact us. You may have a urinary tract infection.
  • Depending on your compliance to the Kegel exercise program given pre-operatively, urinary control can be anywhere from 0-100%, meaning no sensation to urinate with no urinary control versus full sensation and nearly complete urinary control with very little leakage. Your nighttime urinary control will improve first because you are lying down and not putting any force on a full bladder at rest. Within a few days, you should be able to get up at night and urinate normally with a good stream. Urinary leakage will be particularly troublesome when you are walking, exercising and especially when you rise from a seated position. Tightening the muscles during such activities (KEGEL REFLEX) will help minimize/prevent the leakage.
  • Resume drinking normally. However, we suggest reducing your fluid intake after your evening meal to minimize the need to wake up at night to urinate. Until your urinary control improves, you may want to limit your caffeine and alcohol intake. These fluids increase urine production, which may increase the urgency to urinate.
  • As your urinary control continues to improve, you will need to wear fewer pads per day. Eventually, you can change to a lighter pad. A ladies’ sanitary pad is usually better than wearing an adult diaper, especially in case the leakage is not heavy. It permits you to move around more comfortably and to urinate in between without having to fasten and unfasten the straps of an adult diaper.
  • Urinary control will return with time. This process can take several months. If you are discouraged, please don’t hesitate to contact us. Here is the likelihood you will be pad-free at:

POST CATHETER REMOVAL INSTRUCTIONS
Months After Surgery Percent Chance of Being Pad-free
1 20%
3 45%
6 70%
12 94%

  • If you develop a rash around your penis/groin area, you may have a fungal infection. This usually responds well to an over-the-counter antifungal cream (e.g. Itchguard). If this problem persists, please consult a skin specialist for a stronger prescription cream. To prevent a fungal infection, keep the skin area dry with regular pad change and Talc powder.
  • You may experience some perineal discomfort when sitting as well as some discomfort at the tip of the penis for a period of time. If needed, don’t hesitate to continue the use Tablet Paracetamol 650 mg or Tablet Brufen 400 mg on an as needed basis. This discomfort will improve in the upcoming weeks.
  • You may continue to increase your daily activity, including driving a car. Refrain from heavy lifting or strenuous exercises for an additional 4 weeks. Listen to your body!
  • Rarely, patients undergoing robotic prostatectomy may develop obstructive voiding symptoms (weak stream, straining to empty the bladder). Should these symptoms occur, please contact us. There is a small possibility of a narrowing in your urinary passage after the surgery, which may need a small procedure.
  • Your first PSA blood test should be done 1 month following surgery. Please schedule an appointment for a review by your surgeon with the PSA report.

To derive maximal benefits from your surgery and to live a long and healthy life, it is very important to pay attention to the other aspects of your health and wellbeing. Simple habits, if inculcated into your daily routine, go a long way to promote wellness and significantly decrease the chances that you will have any other health problem in the years to come. Some of these tips like healthy eating and regular exercise have also been shown in research studies, to decrease the chances of prostate cancer coming back after surgery…. after all is said and done, it is ultimately in your hands now!

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