WHAT IS NEEDED FOR THE FIRST CONSULTATION:

You will need to bring

1. your pertinent medical history,
   
   
2. PSA reports
   
   
3. MRI CT scan reports
   
   
4. and or Bone Scan reports
   
   
5. and your glass pathology slides of your biopsy
   
   

You can get you pathology slides from the physician who performed the biopsy.

WHAT TYPE OF TREATMENT IS AVAILABLE

Your treatment will depend on the degree and variation of your cancer. The treatment options that will be discussed with you during your consultation are:

• Radical Retropubic Prostatectomy (surgical removal of your prostate, lymph nodes and seminal vesicles through an incision in your abdomen)
  
• Expectant Management
  
  
• Radiation Therapy,(external beam)
  
  
• Brachytherapy (seed implant) and expected management.

SCHEDULING SURGERY

If you choose to have surgery, you will be able to schedule that date on the same day as your consultation. Lee Chromo or Sandy Wlajnitz will schedule your surgery and give you all the information you will need regarding blood donation, pre-op visit and local accommodations.

THINGS YOU WILL NEED TO KNOW PRIOR TO COMING TO JOHNS HOPKINS FOR YOUR SURGERY:
Please Read Carefully

1. One to three days before admission to the hospital, you will be seen in the Outpatient Center for preoperative evaluation. You will not be admitted to the hospital on that day, but rather will be admitted on the day of your surgery. Instructions for the night before your surgery will be given to you at the time of your preoperative evaluation in the Outpatient Center
   
   
2. You should know that, except for medicines that have been approved by pre-arrangement with your physician and with me, you should not eat or drink anything after midnight on the day prior to your operation unless told to do so in your pre-op visit by the nurse or physicians assistant .
   
   
3. Do not take aspirin or similar anti-inflammatory medicines such as Motrin while donating blood and prior to surgery, because they can increase the risk of bleeding during and after your surgery.
   
   
4. Blood donation is entirely optional. If you decide to donate blood, I would be grateful if you would arrange to donate your own blood (autologous blood transfusion) for surgery. It has been found that this is actually safer than asking for volunteers among your friends or members of your family. You can donate one unit of blood each week for two weeks prior to surgery.
   
   
5. Take iron tablets during the time that you are donating blood. You should begin taking the supplement the day before your first donation and continue until the day of your pre-op visit. You should take 325 mg of ferrous sulfate (generic iron supplement) three times a day, or 65 mg of elemental iron, three times a day. You can get any iron supplement from your local drug store

CLEAR LIQUID DIET

THESE ITEMS ARE ALLOWED:

• Water
  
  
• Clear Broths
  
  
• Chicken broth
  
  
• Beef broth
  
  
• Juices
  
  
• Apple juice or cider
  
  
• Prune juice
  
  
• Grape juice
  
  
• Grapefruit juice
  
  
• Cranberry juice
  
  
• Tang
  
  
• Hawaiian punch
  
  
• Lemonade
  
  
• Kool aid
  
  
• Sodas
  
  
• Tea
  
  
• Coffee
  
  
• Clear jello (without fruit)
  
  
• Popsicles (without fruit/without cream)
  
  
• Italian ices
  
  
• Salt, pepper, and sugar may be used.
  
  

THESE ITEMS ARE NOT ALLOWED:

• Milk or Cream Any soups other than clear broth
  
  
• Milkshakes Oatmeal
  
  
• Orange or Tomato Juice Cream of Wheat
  
  
• Cream soups

CHECK LIST OF THINGS YOU NEED TO DO:

SAME DAY SURGERY PATIENT INFORMATION

In the past we have admitted patients to the hospital one day before their operation and have used this day to perform a comprehensive medical evaluation and laboratory test to make certain that they were well enough to undergo a surgical procedure. Insurance companies will no longer authorized you to be admitted on the day prior to surgery, and now require that you be admitted on the same day of the surgery. Unfortunately, because your insurance company will not permit you to have this preoperative day, we feel it is essential for you to have a thorough evaluation performed by your family physician prior to your operation here.

Thus, we are asking you to have a complete physical examination and Electrocardiogram by your family physician within one month of the scheduled date of your surgery. Please make an appointment with your family physician and bring the attached letter. (Click here to download letter in pdf format). We would like the completed form and EKG results returned by your family physician two weeks before your scheduled surgery, faxed to The Pre-operative Evaluation Center at 410-955-9453. This is in an effort to avoid any significant delays upon your arrival to the Pre-operative Evaluation Center.

We would also like to remind you not to take any aspirin or other aspirin type products such as NASAIDs, or any other pain medication except Tylenol ® for at least 10 days prior to surgery. Aspirin and other pain medications (except Tylenol ®) interfere with normal blood clotting and this might result in increased bleeding at the time of surgery.

We regret the additional inconvenience and expense generated by your insurance company. However, we feel that any policy short of this will not provide you the safety that we were once able to guarantee patients when they are admitted preoperatively for evaluation.

PRE-OPERATIVE FORMS

Pre- operative Evaluation
Patient History

BLOOD DONATION & TRANSFUSION OPTIONS

The Johns Hopkins Blood Donor & Therapeutic Center
Phone: (410) 955-6528
The Johns Hopkins Hospital Outpatient Center
Fax: (410) 955-0247

The Johns Hopkins Blood Donor & Therapeutic Center has provided this information to help patients and their families understand autologous and directed blood donation options that may be available to patients who need a transfusion.

AUTOLOGOUS BLOOD DONATION:

What is autologous donation?
An autologous (au-tol-o-gus) transfusion is one in which blood is collected from a patient before surgery, and then transfused back to that patient during or after surgery. This is the safest blood because it eliminates the risk of infectious disease, transfusion reactions and the development of antibodies.

Who qualifies for autologous donation?
If a patient is having elective surgery that will require a transfusion, they should ask their doctor about donating their own blood. Even patients who are unable to donate as volunteers may still be able to donate for themselves.

How much blood can be donated?
The patient’s surgeon must provide an order, which will indicate the amount that can be donated.

How often can patients donate at The Johns Hopkins Hospital?
If donating at The Johns Hopkins Hospital, donations can be made every three days. However, weekly donations are preferred if time permits. The last donation must be made at least 72 hours prior to surgery. Please note: Donation intervals at outside facilities may be different.

How long can the blood be stored?
Blood donated at The Johns Hopkins Hospital can be stored for 35 days. However, outside donations facilities may have different expiration times depending on the preservative used.

What if more blood is needed?
Autologous blood will be stored until it outdates and then it will be discarded. It cannot be used for other patients.

What if the autologous blood is not needed?
Autologous blood will be stored until it outdates and then it will be discarded. It cannot be used for other patients.

Is there a charge for this service?
Yes. Charges for processing will be billed to the patient’s hospital bill, even if the blood is not used. Most health insurance companies usually cover these fees since this is the safest method of transfusion.

How can patients make arrangements to donate at The Johns Hopkins Hospital?
The surgeon should fax an order to (410) 955-0247. Then the patient should call (410) 955-6347 to schedule appointments.

Can patients who live outside of the Baltimore area donate anywhere else?
If the patient lives more than 50 miles away, he /she may make arrangements to donate with their local American Red Cross or community blood center. Please note the following regarding local blood donation:

1. The patient should locate a facility that is willing to collect and ship the blood, and then schedule appointments to donate.
   Note: Each facility will have different requirements about donation intervals, product expiration times and processing periods, so the patient should check withy them about their policies.
   
   
2. The patient must contact the Program Coordinator at (410) 955-6528 to advise us that we are expecting blood from an outside facility. It is NOT the responsibility of the doctor’s office or the donation facility to advise us about donation arrangements.

What should patients do to prepare for donation?

1. We recommend patients take an iron supplement to increase their blood count and maintain their ability to donate. We suggest 325 milligrams of ferrous sulfate three times a day or 65 milligrams of elemental iron, three times a day, after meals until the day before the surgery.
   
   
2. Eat a good meal and drink plenty of fluids prior to each donation.

DIRECTED BLOOD DONATION:

What is a directed donation?
A directed donation is one in which relatives and /or friends, specifically chosen by a patient, donate blood that is reserved for that patient’s surgery or transfusion.

Are directed donors any safer than volunteer donors?
There is no medical evidence that directed donors are any safer than volunteer donors.

Are there any disadvantages to directed donation?
Risk factors may be increased if the donor feels pressured to donate by friends or relatives. This could increase the patient’s risk of exposure to disease if the donor does not provide accurate information during the screening process.

Can all of the patient’s blood requirements be met by directed donation?
Only the need for packed red cells can be provided from directed donors. Other blood products, such as platelets and plasma, must come from the volunteer bank supply.

Is a doctor’s approval needed for directed donation?
The patient’s physician must provide the Donor Center with an order for directed donation. Only the number of units requested by the doctor can be drawn.

What are the requirements for directed donors?
All donors must be compatible with the patient. All donors must also meet the standard volunteer donor qualifications established by the FDA and the American Association of Blood Banks.

How do patients and/or donors find out their blood type?
If blood type is not already known, the patient/donor must be typed prior to donation to determine compatibility. This can be done through the patient/donor’s physician. It may also be done at Express testing in the Outpatient Center with an order from the physician. It cannot be done at the Donor Center.

Are there any restrictions?
Some patients may have special protocols that limit or restrict directed donation. In such cases, directed donation may not be possible. In addition, men are not permitted to donate to women who they have had (or plan to have) children with due to possible transfusion reactions and future pregnancy complications.

How much time is needed for directed donation?
If donating at The Johns Hopkins Donor Center, donations should be made at least 72 hours prior to the expected transfusion to allow time for processing. Therefore, this procedure cannot be done on an emergency basis.

How long can blood be stored?
All directed donations must be irradiated, which reduces storage to approximately 28 days. Donations made at outside facilities may have different expiration times.

What if the directed donation is not needed?
Directed donations are kept until they outdate and then they are discarded. They are never used for other patients.

Is there a charge for this service?
Yes, fees for processing and testing will be billed to the patient’s hospital bill, whether or not the blood is used. Some insurance companies may not cover these fees.

How can patients make arrangements for directed donation at The Johns Hopkins Hospital?
First, the physician should fax an order to the Donor Center at (410) 955-0247. Then, the patient should call (410)955-6347 to coordinate arrangements. The patient (or a representative for the patient) must complete a consent form which lists approved donors and their blood types before donors can be scheduled.

Attention Community Blood Centers:
When shipping products directly to The Johns Hopkins Hospital, use the flowing address to insure delivery:
The Johns Hopkins Hospital – Transfusion Medicine Lab
600 North Wolfe Street, Carnegie Building, Room 656
Baltimore, Maryland 21287

Instructions to the Patient
===================

Patients/donors who live more than 50 miles away from the hospital may make arrangements to donate blood at the American Red Cross or a community blood center. The following steps should be followed to be sure we receive the blood in acceptable condition in time for surgery:

1. The patient/donor should locate a facility in their area that is willing to collect the autologous or directed units and ship them. This will usually be an American Red Cross facility or a community blood center. The collection facility should be licensed by the FDA to ship over state lines.
   
   
2. Each facility will determine what paperwork is needed to schedule donation appointments. Some facilities will accept The Johns Hopkins Hospital order;, others will require the surgeon complete special paperwork.
   
   
3. Donation intervals and product expirations will vary depending upon the facility. Each facility will recommend a donation schedule based on the date of surgery and number of units requested.
   
   
4. Depending on the facility, the patient/donor may have to pre-pay for shipping. However, processing fees should be billed via the Red Cross or American Association of Blood Banks. Billing and shipping instructions are provided below for the American Red Cross and community blood centers.
   
   
5. Please remember that it takes approximately one week to receive blood from most outside facilities. Also, some facilities will ship units one at a time, while others may hold units and ship them all together.
   
   
6. If the Johns Hopkins Hospital has not received the blood by two days prior to surgery, the blood Program Coordinator will contact the collection facility to check the status of the units. However, it is still the responsibility of the collection facility to get the blood here in time for surgery.
   
   
7. the patient must contact the Blood Program coordinator at (410) 955-6528 to provide information about donation arrangements. If we are not advised of outside donation arrangements, the blood may not be ready for surgery. (It is NOT the responsibility of the surgeon or the collection facility to advise us of arrangements. The patient must call us directly.)
   

Instructions to American Red Cross Facilities
==================================

1. American Red Cross facilities should bill processing fees and ship through the Chesapeake and Potomac (Baltimore) Region of the Red Cross. (Note: Shipping fees must be pre-paid.)
   
   
2. Units should be shipped so that they arrive at lest 48 hours prior to surgery.
   
   
3. Please contact the American Red Cross Hospital Services Department at (410) 764-4640 prior to shipment to provide shipping and air bill information.
   
   
4. Please contact Hospital Services at 410- 764-4640 if there are any questions about how to bill and ship via the American Red Cross.

Instructions to Community Blood Centers
===============================

1. Before shipping, please call the Transfusion Medicine Department at (410) 955-6580 to provide information about shipping, including the method of shipment and the air bill identification number.
   
   
2. Units should be shipped so that they arrive at lest 48 hours prior to surgery.
   
   
3. Fees for processing and shipping should be billed through the American Association of Blood Banks, National Blood Exchange. The Johns Hopkins does not accept direct billing from the facility.
   
   
4. Units should be shipped to the following address:
   The Johns Hopkins Hospital – transfusion Medicine Lab
   600 North Wolfe Street, Carnegie Building – Room 656
   Baltimore, Maryland 21287
   

Click here to download Blood Donation Form

POSSIBLE RISKS AND COMPLICATIONS OF SURGERY

• bleeding
  
• infection
  
• impotence
  
• incontinence
  
• rectal injury
  
• penile shortning
  

All surgery carries some risk, the above complications/risks are minimal and treatable. Speak with your physician to get specific information on each.

DISCHARGE INSTRUCTIONS

Please call Dr. Partin’s nurse, Robin Gurganus at 410-614-6926 with a progress report one week after your catheter is removed.

CATHETER REMOVAL: Your catheter should be removed 10 days after surgery. You will find enclosed, instructions to remove your catheter. If you choose to have your local urologist remove your catheter, please call Dr. Partin’s office the day you get home from the hospital, to give Leslie, Dr. Partin’s secretary, your physicians contact information.

NOTE: PLEASE TAKE ANTIBIOTICS (one pill twice a day) STARTING THE DAY BEFORE CATHETER REMOVAL.

CATHETER CARE

While at home I would like you to have your Foley catheter connected to the large bedtime drainage bag most of the time. The leg bag should only be used occasionally if you plan to go out of the house. Drink 4-6 glasses of water in a 24-hour period. This helps keep your urine clear. It is normal for your urine to be pink tinged to bloody during the next 2 weeks, especially with walking and bowel movements. Increasing fluids will usually make the urine clear again. If your catheter is not draining, make sure that it is not kinked. This can happen, particularly where the tape is located. If there are no kinks and the urine is not flowing, please notify our office immediately. Sometimes a blood clot can occlude the opening in the bladder and the catheter needs to be irrigated. You may notice a pink colored mucus type discharge at the tip of your penis. This is normal. You can use a warm soapy washcloth to cleanse the area 3 times a day and then apply antibiotic ointment.

Leaking around the catheter - This is very common, especially when you’re up walking around. The tip of the catheter is not in the lowermost part of the bladder; the balloon that holds the catheter in the bladder elevates the tip of the catheter away from the bladder neck. For this reason, when you are up walking around you may have leakage around the catheter. This can usually be managed through the use of diapers or other absorbent materials. If your catheter stops draining completely, lie down flat and drink a lot of water. If, after 1 hour there is no urine coming through the catheter, it is possible that your catheter has become obstructed or dislodged. At that point call me (see below). If we ask you to go to your local emergency room to have your catheter irrigated, do not let them remove your catheter without talking to me or one of my colleagues first.

DIET

You may eat and drink whatever you wish. You may wish to increase your fresh fruit and vegetable intake to keep your stools soft. If you do become constipated take mineral oil and milk of magnesia. Alcohol consumption in moderation is acceptable . Do not have an enema--for the first 3 months after surgery your rectal wall is thin and you may injure yourself

AMBULATION

After you are discharged from the hospital you must avoid heavy lifting and vigorous exercise (calisthenics, golf, tennis vigorous walking) for a total of 6 weeks from the day of surgery. It takes at least 6 weeks for firm scar tissue to develop in both your incision and in the areas where you underwent surgery. If you engage in strenuous activity before that time you might disrupt the delicate connection between your bladder and urethra; this could lead to long-term problems with urinary control or a hernia in the incision. I prefer having you sit in a semi-recumbent position (in a reclining chair, on a sofa, or in a comfortable chair with a footstool) the first weeks you are home. This accomplishes 2 goals: 1) it elevates your legs, thereby improving drainage from the veins in your legs which will reduce the possibility of clot formation (see below); and 2) it avoids placing weight on the area of your surgery in the perineum (the space between the scrotum and the rectum). You may take off the support stockings after the Foley catheter is removed and you may drive after the Foley catheter has been removed.. You may ride in a car at any time.

INCISION

Your staples should be removed 5-10 days after surgery. You can come back to the Johns Hopkins Urology clinic or have them taken out by your local physician. Your drain will be removed prior to your discharge in most cases. You may shower the day your drain is removed. Do not take tub baths until your catheter is removed. Do not use a hot tub or swim in the ocean for 3 weeks. You may swim in a pool at 3 weeks with common sense. Many patients develop some drainage from the incision after they go home. This can either be clear fluid (a seroma) or a mixture of blood and pus. In either instance it usually can be treated simply. Obtain some hydrogen peroxide and Q-tips; soak the Q-tip in the hydrogen peroxide and place it through the opening in the wound. This will keep the opening patent until all the material has drained. I suggest that you shower in the morning washing this area thoroughly (you cannot hurt it). After your shower use the Q-tip and then place a dressing over the site. Repeat the Q-tip and dressing before you go to bed that night.

PROBLEMS

Clots in the legs - During the first 4-6 weeks after surgery, the major complication that occurs in 1-2% of men is a clot in a vein deep in your leg (deep venous thrombosis). This can produce pain in your calf or swelling in your ankle or leg. These clots may break loose and travel to the lung producing a life-threatening condition know as pulmonary embolus. A pulmonary embolus also can occur without any pain or swelling in your leg; the symptoms are chest pain (especially when you take a deep breath), shortness of breath, the sudden onset of weakness or fainting, and /or coughing up blood. If you develop any of these symptoms or pain/swelling in your leg, call me. Also, you should immediately call your local physician and go to an emergency room and state that you need to be evaluated for deep venous thrombosis or pulmonary embolism. If the diagnosis is made early, treatment with anticoagulation is easy and effective.

Urinary Tract Infection - Urinary tract infections are not uncommon following placement of a catheter and removal. They can be manifested in several ways. Before the catheter is removed the urine may become permanently cloudy (see below) or you may develop some painful purulent drainage around the catheter. This suggests that you may have a urinary tract infection. Please call me and I may prescribe an antibiotic. Also, it is not unusual for some bacteria to be present in the urine. For this reason, many urologists will place you on an antibiotic for a few days after the catheter has been removed.

Urinary sediment - It is not uncommon for there to be some sediment in the urine. This can be manifested in a number of different ways. Old clots may appear as dark particles which occur after the urine has been grossly bloody. With hydration these will usually clear spontaneously. Also, the pH (acidity or alkalinity) of the urine changes throughout the day. After a meal the urine often times becomes alkaline. There are normal substances in the urine. If you see these periodically do not be concerned. This a normal phenomenon. However, if the urine is persistently cloudy this suggests that an infection may be present (see above).

Pain - Abdominal pain is common, but it is not located where you would expect it, i.e. in the midline. Rather it is either on one side or the other of the midline (it rarely hurts equally on both sides). The pain is from irritation of the abdominal muscles during surgery; sometimes it is where the drainage tubes exited. It will resolve spontaneously. Try to avoid activities that bring it on. You may also experience some discomfort in your penis and scrotum. Please note it is very normal for both the penis and scrotum to be SWOLLEN and DISCOLORED for about 1-2 weeks.

URINARY CONTROL

Problems with urinary control are common once the catheter is removed. Do not become discouraged. Urinary control returns in 3 phases:

• Phase I - you are dry when lying down at night;
  
• Phase II - your are dry when walking around;
  
• Phase III - you are dry when you rise form a seated position.

This is the last component of continence that returns. Everyone is different and, for this reason, I cannot predict when you will be dry. To speed up your recovery, practice stopping and starting your urinary stream every time you void. To do this, you must stand up to urinate. When you stop your stream you feel a tightening in your scrotum (this is the Kegel exercise). Perform these exercises every time you urinate. When you practice the exercises at times other than when you void, try not to fatigue the sphincter muscle. You can do these Kegel exercises each time you feel you are leaking. Just as you shut off the stream when voiding, try to stop the leak. Until your control returns completely wear a pad or disposable diaper. You can obtain Depends, an adult diaper, from your local grocery store. There are also many other urinary control pads on the market you can try. Do not wear an incontinence device with an attached bag, a condom catheter, or a clamp unless I talk to you about this. If you do, you will not develop the muscular control necessary for continence. Until your urinary control is perfect avoid drinking excessive amounts of fluids. Also, limit your intake of alcohol and caffeine; both will make the problem worse. If you develop a red, painful rash you may have a fungal infection, especially if you were treated with antibiotics. This usually responds well to treatment with Lotrimin cream, a non-prescription formulation that can be purchased over the counter. Again I emphasize that urinary control takes time. Do not get discouraged.

SEXUAL FUNCTION

Erections return gradually. Be patient. As I told you before the operation, the return of sexual function varies depending upon the age of the patient and the extent of the tumor. There are some patients who don’t recover potency until two years after surgery. Furthermore, most patients continue to experience improvement of erections over the long term after the operation. Erections return gradually and quality improves month by month. The stimuli for erection during the first year will also be different. Visual and psychogenic stimuli will be less effective and tactile sensation will be more effective. Indeed, the major stimulus for erections during the first year postoperatively is tactile sensation. For this reason, do not be afraid to experiment with sexual activity--you can do no harm. If you obtain a partial erection attempt vaginal penetration. Lubrication of the vagina with K-Y jelly can help. Vaginal stimulation will be the major factor which encourages further erections. 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 be little emission of semen because the prostate and seminal vesicles have been removed. When erectile function returns many men complain that they lose their erections when they attempt intercourse. This is caused by a venous leak. This can be overcome by placing a soft tourniquet at the base of the penis before foreplay. The purpose of this tourniquet is to retain the blood in the penis once blood flow increases secondary to stimulation. Do not worry, the tourniquet will not impede the flow of blood into the penis. Many patients have told me that rubber bands, ponytail holders, or “erection rings” (which can be obtained from novelty stores) work. You will be given a prescription for Viagra or Cialis to begin erectile dysfunction therapy the day after the catheter is removed. Directions for use will be included with the prescriptions.

COMMUNICATION

If you have any problems while you are at home please feel free to call my nurse or myself directly. The phone numbers are (Dr. Partin’s office) 410-614-4876, (Robin’s office) 410-614-6926 (clinic) 410-955-6100. If you should have a problem during the night or on a weekend call the Johns Hopkins Hospital 410-955-6070 and ask for THE UROLOGY RESIDENT ON CALL. The paging operator will put your call through. Please be patient, these pages sometimes take as long as five to ten minutes.

LONG-TERM EVALUATION

I would like your first PSA at the 3-month interval and then yearly following surgery unless there is a problem. Thereafter you will need to be evaluated on an annual basis either by me or your referring doctor with a PSA level. I would like to receive these reports by fax (410-955-0833) at regular intervals so that I can follow your progress.

PROSTATE CANCER SUPPORT GROUPS

For information about support groups, you may contact the following:

• *American Cancer Society’s “Man-to-Man” at 1-800-ACS-2345
  
  
• Us—Too at 1-800-808-7866
  
  
• Prostate Cancer Support Network at 1-800-828-7866
  
  
• Cancer Care Counseling Line at 1-800-813-HOPE (4673)
  
  
• Schering Corp.’s “Commitment to Care” at 1-800-521-7157
  
  
• National Coalition for Cancer Survivorship at 301-650-8868
  
  
• Patient Advocates for Advanced Cancer Treatment at 616-453-1477

* Dr. Partin Recommends

FAQ’S
FREQUENTLY ASKED QUESTIONS

1. Is it safe to wait before my operation?

   The delay period of 6-8 weeks before surgery after your biopsy is recommended so that the area around the prostate and rectum can heal from the biopsy, if you have had a recent biopsy. This makes the operation easier and safer. Since prostate cancer is a slow growing tumor, this delay period is not felt to be significant.
   
   

2. Can my family donate blood for the operation?

   This is not recommended because there is no evidence that this is safer than using volunteer blood. Donating your own blood eliminates the risk of acquiring a transmitted disease and the risk of allergic reactions.

    

3. What type of anesthetic will I have?

   Most patients are given a general anesthetic. Your anesthesiologist will discuss this with you prior to the operation.

    

4. How long does the operation last?

   The operation takes approximately one hour but, in some circumstances, can take longer. Your lymph nodes will automatically be removed and sent to pathology with your prostate. There is no frozen section done.

    

5. What can I expect after the operation?

   When you wake up you will have a catheter in your penis draining the bladder and an intravenous line for fluids. You will be asked to get out of bed the evening of, or the day after, the operation and to exercise your lower legs each hour while in bed. This is to help prevent blood clots from forming after the operation.

    

6. How long will I be in the hospital?

   The hospital stay is usually one or two days. Your pathology report will be ready in 4-6 days at which time Dr. Partin will call you with the results. You should plan to wear comfortable pants to go home in, you will have a catheter in place.

    

7. How long will I be out of work?

   Convalescent periods will vary patient to patient, however; the average is three or four weeks. After major surgery it takes time to recover your strength, so be patient. It is recommended that you do not return to work until the catheter has been removed.

    

    

8. Can I ride in a car or take short trips?

   
   The answer is yes, as long as you make the trips brief. As a general rule, you should not ride in a car for longer than about ninety minutes at a time until your catheter has been removed, which will be about 10 days. You are welcome to shower when you go home with the catheter in place. Do not sit in the bathtub until the catheter comes out.

    

9. Can I drive the car when I go home?

   You should not drive the car yourself until after the catheter comes out. Then you should start slowly and only take short trips.

    

10. Is there anything I should do about regulating my bowel movements?

    It is important to make sure that you do not become constipated or strain when you are moving your bowels immediately after the operation. If your bowel movements are not loose, take one teaspoon of mineral oil at night and one teaspoon of milk of magnesia in the morning as long as is needed.

    
    

11. What if I see blood in the leg bag when I get home?

    Everyone has small amounts of blood appear in their urine during the period of healing when the catheter is still in place. Don’t be alarmed unless this is continuous bleeding or large clots appear. If you have any doubt about the amount of bleeding you are observing, please don’t hesitate to call the office (410-614-4876) or, if necessary, the emergency number (410-955-6070) and ask for the resident on call.

     

12. Is there a risk that I will develop trouble because of clots forming in my legs after surgery?

    This is a serious problem that occurs in a very small percentage of patients. Blood clots forming in the legs after surgery can cause problems because they may migrate to the lungs and cause difficulty breathing. There are some early signs that you should watch for that would alert you to the fact that this problem is developing:

    If you get pain, tightness, redness or swelling in the back of your calves or thighs, you should definitely call me or your local doctor immediately. If you have a deep blood clot you must get blood thinning medication as soon as possible.

     

13. When does the catheter come out?

    The catheter will be removed approximately 10 days from the date of the operation. If you return here to have your catheter removed, call the clinic when you get home at (410) 955-6100 and tell them that you would like to schedule a “catheter removal” visit for 10 days from the time of your surgery. If your local urologist is going to remove the catheter for you, then you should call him as soon as you get home. You will also be given instructions on taking your catheter out at home.

     

14. When should I have my PSA checked after surgery?

    You should plan to have your PSA checked three months after the date of your surgery. I would like to know the results and I would be grateful if you would fax them to me (410-955-0833). Some patients will need their PSA checked at six months and others will not. We can discuss this matter on the telephone after we get your first PSA value back and make a decision together. Please call to talk to Robin or I after you fax your PSA. Everyone needs a PSA check yearly after their operation.
    

     

15. What about urinary incontinence and regaining control of my urinary stream?

    Everyone recovers at a slightly different rate. On the day the catheter comes out, most patients will have some degree of control, although many patients do experience a variable amount of urinary incontinence. This can mean anywhere from a small amount of spotting in your underwear to a fair amount of leaking which would necessitate wearing a small pad to keep your clothes dry. Do not be discouraged if you leak initially. Some patients take up to one year to regain complete urinary control. In addition, you must understand that when you bear down, sneeze or cough, you will increase the likelihood that you will leak, particularly immediately after your surgery. The exercise that will help the most in recovering your urinary control is to interrupt the urinary stream once during voiding. This is the best exercise you can do and I encourage you to start doing it as soon as the catheter comes out.

     

16. How about the return of sexual function?

    The return of sexual function depends, to a certain extent, on your level of sexual performance prior to the surgery as well as your age and the degree to which the neurovascular bundles were spared during your surgery. All patients are somewhat different and it takes months to know whether a patient will regain sexual function after a radical prostatectomy. Don’t be discouraged if it takes several months before you begin to engage in sexual activity again. Everyone is different and you and I will stay in touch to make sure that your recovery goes as smoothly as possible.

    Alan W. Partin, M.D., Ph.D.
    Urologist-in-Chief

    
    Office: (410) 614-4876
    Clinic: (410) 955-6100
    FAX: 866-341-2834

Please call the office for any questions you may have before or after surgery. Dr. Partin or his nurse, Robin, will be happy to assist you in any way. PLEASE DO NOT EMAIL QUESTIONS.

There is no return follow-up visit other than pre-determined PSA. If you are having a problem you are always welcome to make an appointment or call the office.