What to expect before and after urological surgery
November 17, 2017 3:17 PM   Subscribe

I'm scheduled for surgery next month. I've never had any type of surgery before, so I'm totally in the dark in terms of what to expect, how to prepare, and what questions might be helpful to ask my doctor. Any advice?

I am a relatively healthy 47-year-old guy and have a small stricture in my urethra that is apparently causing reduced urine flow that has resulted in thickening of my bladder. Of the various options presented to me, I have decided to go with a urethroplasty since it has the best long-term prognosis. This means they will cut the stricture out of the urethra and sew the urethra back together (the incision will be in my perineum). Luckily the stricture is small enough that they don't need to reconstruct the urethra with tissue from my cheek. The surgery will last 4-5 hours, I'll be spending at least one night in the hospital, and will need to have a catheter for about 3 weeks post surgery.

I feel clueless about this, and more than a little nervous and horrified by the thought of anesthesia and people messing with that particularly sensitive part of my body. Is there anything I should be doing to prepare for the surgery? Are there questions that I might not be thinking of that I should ask my doctor? Any advice for making recovery as comfortable as possible and dealing with a catheter?
posted by nixxon to Health & Fitness (9 answers total)
I cannot speak for surgery on my urethra, but I have had several major surgeries. I don't know what you asked your doctor so not sure what you are missing, but I would ask specifics about what he expects will happen from the minute you wake up until you go home. That is, what are the mileposts he is looking for post surgery to see if it went well and if you are recovering. I would ask what you need to have done (or not done) to be released from the hospital. For many surgeries, one of the things they look for post anesthesia is being able to urinate on your own w/o a cath. So, not sure about your surgery. I personally would ask a lot of questions about when you are home and what you can and cannot do, what mileposts you should be hitting every few days to indicate the recovery is going well, and anything such as exercises you can do to help the process. Ask about the pain too. Will there be any? What level?

My general advice would be to ask as many questions as you have even if you think they are trivial, now, before the surgery because it is my experience that the most attention and time you will get from your surgeon is BEFORE the operation.
posted by AugustWest at 3:36 PM on November 17, 2017

If you are prone to nausea, mention this to your doctor and your anesthesiologist. Anesthesia can make some folks queasy, and if you are sensitive to things like motion sickness, that might be you. They can be proactive with anti-nausea meds that are helpful during immediate recovery.
posted by mochapickle at 3:42 PM on November 17, 2017 [1 favorite]

Of course, take it easy afterwards. TV and ice cream, or your equivalent. There will most likely be pain for days, if not longer. Fortunately, you won't have to get up from the sofa to go to the bathroom.

Personally I am not a fan of percoset, which seems to be a popular post-op med for pain, but can cause nausea. Maybe line up your favorite narcotic pain reliever in advance.

I would expect you'll be able to strap your urine bag to your leg and go for walks. In loose sweatpants, of course. Walk and take other exercise as much as you can for the obvious reasons. At night you'll lay the bag on the floor, or strap it to the side of the bed, as appropriate.

ETA: It's helpful to tape
the catheter tube to your leg for stability.
posted by JimN2TAW at 4:04 PM on November 17, 2017

Along with the helpful answers above, you might ask about all your medical personnel/labs being in your network (assuming you are in the States and have some coverage for this).
posted by Napoleonic Terrier at 5:28 PM on November 17, 2017

Stool softeners are your new best friend. Begin taking one a day before your procedure. Considering that they are going in through your perineum, moving your bowels may be......concerning. Ask your doctor about toileting in general- perhaps a peri bottle will be helpful? If so, get “The Mom Washer” by Frida Baby, it has an angled spout that will more easily hit ‘the spot’ than the hospital issue peri bottle will.
posted by PorcineWithMe at 5:57 PM on November 17, 2017 [1 favorite]

I had a prostatectomy, and also a minor procedure to remove scar tissue. So, some things will be similar.

Some general facts about hospitals. Stuff doesn't always happen on schedule. Nurses are very busy. Doctors are probably going to do what they want to do even if you ask for something else, and are not very sensitive to the stress felt by spouse or children. Any tests you have pre-surgery may require an enema or similar, as may the surgery itself. You will probably be held in the hospital until the doctor is certain your intestines have recovered from the anesthesia.

You should make sure your family knows the best place to wait for news after the operation. Chances are no one is going to go looking for them. I used to recommend taking a cheap Walkman type product because earphones block out the hustle and bustle while a TV increases the noise, but I guess phones serve that function now.

I would guess you will have little pain. I found it uncomfortable to walk far with the catheter. It's not a big hassle if you work with it, not against it. You will probably be on a strong, wide-spectrum antibiotic like Cipro or Bactrim.

Ask your doctor about the chances of urinary incontinence, either short term after the surgery or long term.

Good luck to you.
posted by SemiSalt at 6:10 PM on November 17, 2017

The bags the catheter drains into come in two sizes: a smaller "leg bag", which has elastic straps to go around your leg and can be worn under clothing, and a larger "night bag", which has a hook that hangs nicely off the side of a hospital bed but may not work so well at home. You can put the night bag in a small bucket or washtub and leave it on the floor next to the bed. Both bags have a drainage port at the bottom so you can empty them into the toilet. Rinsing the bags with water and white vinegar will help control any odor.

Also, don't be surprised if there is a small amount of blood in your urine after the catheter is removed. The urethral tissue is pretty tender (as I often say to my patients, we were just not really built to have a plastic tube up there). Emphasis on small amount of blood, though -- if there is enough to color the urine in the toilet, or if there are clots, call your surgeon's office right away. (I also tell my patients "You may think 'Oh, this isn't a big deal, I don't want to bother them' but for now, I WANT you to bother them.")
posted by shiny blue object at 6:56 AM on November 18, 2017

I put a large safety pin in some part of the mattress or linens, I forget exactly which, to hang the nighttime bag. The pin was still there a couple years later.
posted by SemiSalt at 3:46 PM on November 18, 2017

Back to post a follow-up in case anyone comes across this in a search.

The surgery sucked pretty badly, but was largely uneventful. I would recommend insisting on a "Stat-Lock" for the catheter, so that gravity isn't tugging on the hose that enters your body. And I opted to basically not leave the house when the catheter was installed but I could have theoretically gone to work. Although I did have the occasional catheter disaster which would have been embarrassing at work, but people would deal with it.

Also, if you have the misfortune of finding this because you have a urethral stricture, please look up and consider urethroplasty (the more invasive, but more successful surgery that I had). This is something that you want done once and put behind you, not an ongoing thing.
posted by nixxon at 8:18 PM on April 29, 2018

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