My prostate surgery experience – and report on progress/ recovery for the first two weeks

Date of robotic prostatectomy: Monday 7 August 2017 – reached the ward at 9 pm. Discharged from hospital at around 4 pm on Wednesday 9 August.

DAY 0 7 AUGUST Monday

I was prepared for surgery at around 2:30 p.m. and rolled into the operating theatre at around 3 p.m. I do not know when the surgery took place but I remember that I was in the recovery area and complaining that I was very cold. I remember being a bit angry, nevertheless I must have recovered reasonably well so they rolled me into my room in the ward at around 9 p.m. By then I could sense what is going on and was half awake. My wife left after about 2 hours.

A nurse kept coming and looking after me every half an hour or so during the night. That night I felt like being in a straight jacket. I had a strong feeling that I needed to urinate but that was because the catheter was not being fully accepted by the body. There was very little pain. That must have been because of the strong painkillers administered during anaesthesia.

DAY 1 8 AUGUST Tuesday

The strong urge to urinate that urge subsided but was replaced by bladder spasms that showed up as short painful bursts towards the tip of the penis. These spasms started reducing later that day. By evening they had come down quite substantially. (These spasms come again towards the end of the third day after surgery, but only very sporadically.  The main issue was the passing of gas – which did not happen that day. Bloating and severe pain were key symptoms that day. Lots and lots of painkillers. Liquid diet (apple juice, orange / lemon flavoured jelly, lemon sorbet, black tea without milk). Was given a shower today as part of catheter replacement. Doctor visited once in the morning.

DAY 2 9 AUGUST Wednesday

Took a shower today as part of catheter replacement. Gas started at around 12 noon on the third day with small farts. It extended throughout the afternoon till late evening for a total of around 20 farts. Each fart provided great relief.  Doctor visited once in the morning.

Reached home. Mostly liquid diet.

DAY 3 10 AUGUST Thursday

The main issue of the day was passing stools. It was a complete surprise to me that even a strong laxative like dulcolax does not work. By now I had taken at least four tablets of Coloxyl, 6 spoons of Agarol, 4 tablets of DeGas + one sweet laxative + a 250ml bottle of prune juice, 3 tablets of probiotics and 6 capsules of Metamucil.

The main reason why stools are not moving is the use of painkillers. In particular Endon stops the movement of the intestines. So I decided to cut down as many painkillers as possible on the afternoon of Thursday.

Diet: started  light khichri – 3 big bowls, including one cup of diluted yoghurt liquid and some additional is yogurt mixed with khichdi , one bowl of chicken soup, and 8 small  leaves of lettuce. I had my first cup of tea with milk on the late evening of Thursday.

DAY 4 11 AUGUST Friday

I noticed strong pain from the spot where the artery had been used to monitor blood pressure.  The pain became very acute on Friday. The pain is insistent.

Finally at about 8:45 a.m. I started feeling some activation in my lower bowel. In addition to previous laxative in intake, I took a magnesium tablet with water + more Coloxyl.

By 10:30 am a lot of  pressure started building and I sat on the toilet. Unfortunately nothing came out. After straining, two tiny “rocks”. Straining was impossible given overall pain levels, so I stopped.

Finally my wife brought this (an anema). I applied it and went without any delay to the toilet and sat there waiting. It just took a minute for the bowels to move freely.  I lay down for about 35 minutes and again pressure started building. Did this twice. These were my first stools for over 5 days.

At around 3 p.m. – around 3 hours after the motion, I felt a somewhat normal urge to eat food. I went down and had rice, rajma and cauliflower sabzi. I felt much better now, although I have continued to take Panadol throughout the day.

Spoke with the anaesthetist about the arm pain.

DAY 5 12 AUGUST Saturday

From mid-morning, motions were natural (around three times) – with reasonable comfort.  The pain in the arm and the rest of the pain is continuing- taking Panadol as per normal dose. Pain around 7 out of 10 (compared to around 8 out of 10 most of the first few days).

The level of pain in the arm increased + one can see that it is swollen.

DAY 6 13 AUGUST Sunday

The swelling in the left arm increased and one could see a patch of blue down the left-hand side of the forearm. A couple of relatively  smooth motions.  I was able to go to the garden and harvest some lettuce and rocket. Able to bend slightly without acute pain. I also sat for about 10 minutes at the dining table and had my lunch. This is the first time I sat in a chair (apart from the trip via the car from the hospital) since before the surgery. Did not take shower on Saturday but did so on Sunday.

DAY 7 14 AUGUST Monday

Main thing today is the pain in the left arm which will need painkillers. In anticipation of you need to go early in the morning for removal of catheter I had taken Agarol on Sunday night. I had a motion in the morning at 6 a.m. Pain in the stomach is milder than before. If needed I could potentially sit for 10 to 15 minutes now without severe pain

Got the catheter  removed. The first step was the removal of the dressings on the wounds. My dressings are mostly dry. After that an antibiotic injection was administered on my bottom. Then came the removal of the catheter. The catheter removal started in innocuously but very quickly became extremely painful leading me to scream. The nurse then stopped and again restarted soon because it is better to remove the whole thing completely and then allow complete rest. The total time taken to remove the catheter was not more than 1 minute or so (most likely in 10-20 seconds). During this period was unbelievably excruciating pain. But there was no choice about it.

After the catheter was removed l kept lying down for a few minutes as the pain slowly subsided. After that I put on a continence pad that I had taken with me. (During the process of putting on the bed itself, some leakage occurred.) I was then told to go out and drink water for about 1 hour and then I will be tested for whether my bladder is being adequately cleared. I was then called in and asked to try to urinate but nothing came out. All the water probably went into the pad. The nurse administered an ultrasound test and confirmed the bladder had been emptied. She declared me fit to go home and hope that I would be able to get some control fairly soon.

Upon returning home I was tired and lay down for around 45 minutes. Upon getting up I realised that I might have some urine still in the bladder and not everything was therefore leaking away.

There was at least some control while lying down. However, the situation was still very painful and I realised that I needed to be very slow and gentle in trying to get my bladder up and running. My doctor had already told me that the bladder becomes very lazy after the surgery and takes time to return to its original level of control. I was also told by my physiotherapists to only undertake very few pelvic floor exercises in the initial days.

The good thing is that my ability to walk is returning to normal.

A lot of pain in the penis continued throughout the day.

I started (very gently, and only  a couple of times) my pelvic muscles.

At that point I was able to have around 100 ml of toilet in one go in the toilet. After that the normal leakage started again.

The only real downside is the acute increasing pain in the wrist area which is making it very difficult to move around so I have took my second painkiller for the day.

On the first day I used four nappies of which one was half-used (at the nurse’s – I threw away a half-soiled one before starting out for the journey home).

Fifth bag I wore at night. At 11:45 pm I had a good flow ( I had been lying down before that) – of nearly 250 ml, I think. That showed that the bladder was able to retain urine while lying down.

DAY 8 15 AUGUST Tuesday

Sixth bag disposed at 2:35 am that night. There seemed to be rudimentary bladder control but the fifth bag was getting wet and I wanted a dry bag. Before replacing the bag, had a bit of direct urination – maybe around 100 ml – but with pain.

Plus pain in arm at night, so took two Panadols.

I stopped counting bags since I’d need to closely monitor weight of uncontrolled urine from day 2 after catheter (ie from 16 August). I’ll be counting these as at 8 am sharp each day (i.e. the pads for 16 August will be counted and weighed at 8 am on 17 August).

Went to see the doctor at 12:15 pm. Confirmed that the swelling in the left forearm is not dangerous (not an aneurysm) and should heal over the next week or so. I should expect some pain for another 10 days or so.

The doctor also gave me a pill + prescription for Cialis to take everyday to keep the penis oxygenated with blood otherwise it would shrink. He gave me a blood test recommendation for PSA to be taken 4 days before the appointment.

Observation re: continence: While I’m able to accumulate some urine in the bladder while lying down, it is literally impossible to do so while sitting or standing or walking, at which stage the entire urine drips into the pad.

DAY 9 16 AUGUST Wednesday

Woke up mid-night with a lot of pain in wrist/forearm. Had no choice but to take 2 panadol + 1 Celexi + 1 Endone.

Virtually no bladder control during the day – exactly as on the first two days. Some control while sitting on a chair or lying down, but the moment one gets up one has to rush to toilet. Zero control while standing/ walking. Also, a lot of pain while passing urine after retention (after sitting/ lying down).

Received instructions to get a urine test on Friday.

The penis continues to be very painful. Possibly some injury by the catether. I need to urinate after getting up from the bed/ chair and each time there is a lot of pain.

The bladder has absolutely no control except while laying down. But once one goes to the toilet, there is a dribble that goes on for a long time instead of a proper flow.

Took anticipatory Endone etc before sleeping.

DAY 10 17 AUGUST Thursday

Went to the toilet twice last night. Both times around 200ml or more came out. Pain was there but somewhat manageable. Bladder seems to be becoming a bit more active but not easily able to clear, takes a long time.

Remained largely painless most of the day. Able to sit for longer duration at the PC. But incontinence remains a BIG issue. Also some pain in the penis while clearing any accumulated urine (while sitting/ lying down). A bit better than yesterday.

Doctor confirmed via email that the internal sphincter had been REMOVED during surgery. I now only have the external one.

DAY 11 18 August Friday

Most pains have subsided to manageable levels. Did not take any pain killer the whole day yesterday and last night.

During the night when going to toilet (thrice), penis was sore towards the head, around one inch from tip. Had to lie down since could not walk or sit. This is almost certainly due to catheter – since the pain is specific and not general. Clearly some part of the urethra was injured during catheter insertion (and maybe that’s why I had such acute shooting pain while it was taken out).

My research on the internet shows that this pain can take months to heal. Nothing be done about it.

I started drinking a LOT of water during the day in a systematic manner, to ensure that (a) the bladder learnt once again what it is to be full and (b) to soothe pain in the urethra. Pain seemed to somewhat come under control later during the day.

I’m largely pain free now (90 per cent). I can even sit on a chair largely pain free (which is what I’m doing as I write this). And as far as general health is concerned, I’m in pretty good shape and should be mobile (including driving car) from next week.

The issue now is managing severe incontinence. This can often take a long time to improve (some cases need further surgery after a year or so). This is a very bothersome but not life threatening issue. I’m reading up a lot on this (including the medical literature) so I’m aware of all relevant information and options to fix this issue.

I’m therefore moving on from the post-surgery record. I’m going to focus on incontinence etc. – and that will require keeping a daily record – but not here.

Note: I’ll keep updating this BY EXCEPTION (i.e. if something other than continence emerges that’s worth remembering)

DAY 12 19 August Saturday

Unbelievable pain in the penis (the same spot – where catheter injury probably occurred) at night. The pain also forced less than full evacuation, which caused trouble. Was forced to stand for nearly 15 minutes to have a drip flow that finally relieved the bladder. Forced to take painkiller after this in order to sleep.

The pain seems to have broadly resolved by the morning, with normal flow resuming. I suspect the pain will continue for a few more days till the healing is completed.

Continuously leakage as on the first day. No change whatsoever

20 August 2017 Sunday – Went for a 20 minute walk in front of the house today but most of the day after that was spent in dealing with acute pain in the front portion of the penis, likely from the catheter. Spasms at 2:40 pm in the day while standing in the kitchen. Acute and sustained pain in the penis.

21 August 2017. At 7:50 am sat on the computer. Debilitating strong and pulsating pain in penis tip started again. Could not walk, was forced to lie down. Even then it did not go away quickly. Took around 10 minutes to subside.  A kind of bladder spasm, it seems.  I suspect these spasms are caused whenever the urine gets concentrated and starts hurting the joint between bladder and urethra. Drank a lot of water as well to keep the urine diluted.  At 9 am the pain started again although it was not as bad as the first time full stop first to lie down. Did a short 25 minute walk later in the day.

22 August –  Today is Tuesday and I have increased the walk to a total of 40 minutes (two rounds near the house). Each time I go for these walks I come back and check whether even the slightest amount of urine is being held by the bladder. Unfortunately till today, Tuesday, there has been not the slightest to retention of urine while walking. Massive spasming started again at around 3:40 p.m. today. Took the strong anti inflammatory medicine

23 August Wednesday – Walked only 15 minutes today. because I started feeling pressure in the intestines – possibly some gas. However upon lying down there was no gas. Nevertheless the pressure went away after about half an hour. Further, catheter pain is still causing problems. It took me 20 minutes to eliminate urine it came in drops continuously for 20 minutes there was no stream. This has happened periodically over the past few days. Then again the stream starts off after some time and I forget about this event. Is it possible that there is some blockage inside the bladder or urethtra?

24 August Thursday– 51 minute walk at Ruffy Lake. Started driving on Thursday when I went first to Ruffy Lake Park.

25 August Friday – Went twice to toilet last night. Stream continues to be very thin. Takes 10 minutes to empty bladder (which is not full anyway but gives signal). 49 minute walk at Ruffy Lake

26 August Saturday: Drove for 50 minutes today (to Thomastown) + 50 minute walk today (around the house)

27 August Sunday: Sharp but short spasms in penis while walking at Ruffy Lake Park today. Had to slow down. Time taken 45 minutes – an improvement. No urine held while walking.

28 August 2017. First visit to physio after surgery. Each time I get up I’ve been going to the restroom to void. My physio has suggested I avoid that, as it will give my bladder a bad habit. On the other hand, isn’t it better to let the bladder start using its own muscles to void whenever that is possible? How will the bladder remember to void if everything is allowed to leak?

29 August: Walking uphill is much easier than walking downhill. So while walking downhill I have started working on the grass where possible. That is much easier. I’m trying to hold the pelvic floor a little bit while walking even though I know it’s not going to work at this stage. Having said that, it appears that I did succeed in holding around 10 millilitres of urine in my bladder even while walking. It appears that there is at least some attempting made by the bladder to hold and so there is a spurt of urine every few minutes.

30 August: I was hoping that the during today the walk I was able to hold at least something, and it seemed that my muscles were fighting the bladder, but in the end was just around 5ml that came out. 98 percent leaked out.

1 September The pain in the penis might have reduced comma but there is heaviness and a sense of something happening between the legs, such as dripping. Definitely nowhere close to normal. Same thing around 42 minutes walk, constant sensation of dripping, and less than 2 ml retained. Just a few drops.

3 September – It appears i am able to hold urine for short periods.

4 September: Learnt very useful things from the new physio.

5 September Did not do any walking on Monday.

6 September: At night, when there is some accumulation of urine, it is generally difficult to pass the urine. The stream is very slow, and there is still some pain inside the urinary canal. This was extremely bad in the early days, I recall nearly 20 minutes taken to void, but now it takes 4-5 minutes

8 September: At night the urine stream was very noticeably thin at “full” flow. Took nearly 6 minutes to clear.  During the day it is generally not possible to know whether the stream is thin since most of the time it is dripping away into the pad.

Wrote to the doctor who fixed a fresh surgery for 11 September.

11 September: Admitted at 12:15. Surgery at around 3 pm. The second surgery was much less traumatic than the first one. The anaesthetist did not put the arterial monitoring system – which was a big relief. Further, during the recovery area, I did not feel freezing cold as I had felt the last time.

12 September – Next day after surgery at the hospital.

Catheter was removed at around 6 a.m. and passed the first urine at around 8:40 am. Removal of catheter did not cause much pain this time. The nurse removed the water from the bulb then went to get a container for my urine (given incontinence) after the catheter was removed. In the meanwhile, the catheter came out on its own due to the weight of the urine bag.

Sharp pain where urine touched the cut made by the surgeon. Before release a test was conducted. Very painful while standing, walking, sitting. Almost a hobble.

Took long time to pass the first urine after two and a half hours after removal of catheter, because of the stinging pain. Around 200 ml voided. Ultrasound showed i had 43 ml still inside the bladder. Nurse said that after surgery it is acceptable for up to 100 ml to remain unvoided. And I was allowed to go home.

Nurse gave me 4 packets of Ural. Eight packets can be taken per day to make the urine less acidic, to minimise the burning pain.

Doctor said the pain would largely go away after one day. And that I should start my kegel exercises again.

13 September: Motion started only on Wednesday, and was a bit slow and difficult till Friday.

Last night the  flow started and pain reduced. The flow was greater than what it was prior to first surgery, which suggests an existing but harmless blockage in the system which had got badly aggravated by the cathether inserted during the first surgery.

After having reduced significantly last night come on the pain has come back at about 4pm on Wednesday. Also significant bleeding during urination.

15 September: Administered aloe vera liquid gel through urethra.

16 September: A big issue is that the bladder is now giving strong signals of being full (at night) even with barely 150 ml. Last night the first round was with 200ml and then I got up after 2 hours with the just 150 ml or so. The bladder should basically have capacity for nearly half a litre

My measured urine output at 6 a.m. in the morning prior to surgery was 325 ml. However I believe that my bladder can comfortably hold up to 400 ml at night. Therefore, it needs to be retrained to hold much more than it is currently holding at night.

On Saturday morning (16 September) I had a major bowel motion and pretty vigorous (too much irregularity after repeated surgeries). That caused an anal fissure to develop.  Fortunately I know the guaranteed cure for this – just directly apply a cut aloe vera leaf. Have done so once and immediate relief. Repeated thrice. Also on Sunday.

Have virtually abandoned all Kegel exercises for a week now. Unlikely to be able to resume them till the anal fissure and the penis pain from surgery has subsided.

Administered aloe vera. Each time I have administered aloe vera gel, there has been absolutely no pain whatsoever inside the urethra. I am confident that the healing properties of aloe vera are at work. When purified sesame seed oil is received from the Indian ayurvedic shop, I will also administer that oil .

Note that on 16 September I tried the glass 10 ml syringe. Its actual is pretty much the same as that of the 5 ml plastic syringe. I did use it but believe that glass is heavy for a person to use with one hand. Plastic is was slightly more comfortable. The disposable plastic is superior for the purpose at hand.

Good news? Despite urine flow being strong, not all the urine in the bladder leaks when I get up and walk. A small amount of dripping starts immediately but I am able to hold a reasonable quantity for anywhere from 5 to 15 minutes. Maybe this is a good sign?

17 September:  Second day of the anal fissure. Have been able to pass stools with a lot of care. However, there is still a fairly significant level of pain after passing stools. I had a applied aloe vera around three times yesterday and will do so today as well. Improvement in clearly there.

18 September: Things became pretty bad with anal fissure and could not attend the appointment with the surgeon. Have added coconut and finally also purchased a medicine: Proctosedyl (containing hydrocortisone and cihcocaine hydrocholoride).

19 September: Mark from Australian Catholic University called at 10:45 am today. He said his program is different to the one from Movember/beyond blue. His is focused on exercises. He will call me in a few weeks. They run a gym in ACU on Vic Parade and a supervised program of one hour is offered thrice a week.

Booked appointment with specialist reconstrictive surgeon and also with GP (so I can get a further referral).

==END==

KEYWORDS

Patient experience of prostate surgery, case study of prostate surgery,

 

sabhlok

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