The following is a detailed account of my personal experiences dealing with prostate problems and associated surgeries. The writing is longer than I expected, but I suspect patients about to undergo these surgeries (and concerned relatives and friends) might appreciate knowing what it might be like. I say "might be like" because everyone's experiences will be different. Hopefully this story, and the other help pages here, will provide some useful information.

In early 2007, I had a urinary tract infection that was easily treated with antibiotics. My family doctor also requested an ultrasound of the bladder and kidneys that seemed to show a bladder irregularity; so he referred me to a urologist (who was also a surgeon).

The urologist conducted a scope procedure to look at the bladder from the inside. This short out-patient procedure did not need anesthetic and the scope was momentarily uncomfortable when going in and coming out, but not painful. The results indicated that the urethra was constricted by an enlarged prostate, consequently a TURP operation was scheduled. Such was expected to resolve the problem of weakening of the urination stream over the prior few years.

I was naturally apprehensive about having this (or any) operation. I referred to the provided TURP pamphlet and the potential for some bleeding and side effects. I then searched the web for more information, and with that knowledge was reassured that side effects were likely minimal.

The potential side effect of some stress incontinence was the thing most concerning to me; and I decided to do Kegel exercises before surgery, to speed regaining control later. {More things I did are detailed on the Continence Help page -- see link at left.)

This was to be out-patient surgery. The day before surgery, I reported to the Thunder Bay hospital (which has the imposing title of Thunder Bay Regional Health Sciences Centre) for registration at Admitting, and then a series of tests for blood, urine, blood pressure, and ECG -- which are all part of routine pre-surgical screening for the safety of the patient. A nurse took a detailed medical history and briefed me on use of a catheter. In less than an hour I was off to home to mentally prepare for surgery the next day.

The morning of the operation, I reported directly to the 3rd floor for surgery. A representative of the CCAC (Community Care Access Centre in Thunder Bay) interviewed me and arranged for a nurse to visit me at home afterwards to ensure I was all right and knew how to maintain and change a catheter. There would be no personal charge to me for this assistance.

A natural coward about operations, I elected to have general as opposed to local anesthetic. Such would be administered through an IV (intravenous) line inserted into the back of my left hand. The operation was early in the morning and I woke up some hours later with a catheter attached.

The catheter was a substantial rubber tube that came out from the bladder and had three branches. The primary tube led to a large catheter bag. The second tube was attached to a bag high on a pole, that had water flowing into the bladder to flush it. The third tube had a plastic plug; it was where a small quantity (perhaps 50 ml.) of water had been injected to inflate the balloon at the top of the catheter, and thus hold the catheter from coming out by accident.

The IV was still attached and being used to administer an initial dose of antibiotic.

After perhaps a couple of hours awake and drinking two or three glasses of ice water, the flushing was disconnected and the second tube was plugged. The catheter large bag was switched to a much smaller leg bag, that was strapped to my leg, and thus gave me back mobility. Once I proved I could take a short (perhaps 50 foot) walk, the IV was disconnected and I was discharged to home that same day. The subject of clothing is covered elsewhere in the hospital section on the Cancer Facilities page, but loose boxer style undershorts are best when leaving with a catheter.

And yes I needed someone, my wife in this case, to drive me home. And to pick up the prescription for the antibiotic tablets to be taken as directed by the physician until all were used. I also received a prescription for pain medication but did not need it. For me, a couple of regular acetominiphin tablets were enough to overcome any discomfort, and that was rarely needed. But it was comforting to know that a slightly stronger painkiller could be available if necessary.

That same evening the CCAC nurse visited and took a long medical history, along with blood pressure and pulse and temperature. She carefully instructed us on detailed procedures for catheter care. The need was emphasized to remain hydrated and drink many glasses of water or dilute juice daily to flush out the system. (The actual number of glasses per day varies with the information source but typically most suggest about 8 or more.) It was important to do no stressful work or lifting for at least the next 6 weeks. She reviewed that small clots or small amounts of blood might appear in the urine and discolour it pink/brown from time to time. But heavy bleeding or a blocked catheter would indicate an immediate need to go to the hospital ER (Emergency Room/Department). She also provided contact numbers should any problem arise.

And one did.

The next morning the catheter became plugged. Believe me, you soon know it is plugged as the abdomen swells and strong pain ensues; in my case pain also spread to the left kidney area. Off to the ER. Now in much more pain, they gave me an IV and some strong pain medication. The pain was reduced but was still pretty bad. Attempts to flush out the catheter blockage did not succeed, and they finally had to remove that catheter and insert a new one. Almost instantaneous total pain relief, and off to home with a prescription for a stronger antibiotic.

The CCAC had made the appointment for catheter removal at the hospital four days after the operation. Removal there by a nurse was quick and painless. She provided me with a pad (against possible incontinence) and I then walked out of the hospital and my wife drove me home. Wearing a pad requires close fitting brief style undershorts to keep it in place.

During the next couple of weeks, all traces of blood or clots disappeared, and I was feeling great. Strength of stream was better than it had been for the last 20+ years. Any incontinence (see more about Continence Help on the page at left) was minimal and quickly disappeared.

A restriction not to do heavy work or lifting more than 10 pounds was in place for the first 6 weeks. I was strongly advised to pay careful attention and not to strain anything.

Five weeks after the TURP operation, I went to my urologist/surgeon for a follow up visit. I looked forward to spending no more time in waiting rooms, and a lot of summer left to do outdoor projects without physical limitations.

In his office, he looked me in the eye and said they had found prostate cancer cells in the scrapings from the TURP. I had a PSA level of 4.6 and the cancer cells were evaluated with a Gleason Score of 7. He stated that this news would be a shock to me and that I would have difficulty concentrating on what he was saying. Very true. Like being hit on the forehead with a log.

He reassured me that there was a range of effective treatment options. He would prefer that I take time to absorb the news and take a comprehensive prostate cancer book home with me; there I was to inform my wife, and start to study my options. He would make an immediate appointment for me with a physician specialist at the Cancer Clinic to discuss their options for treatment; afterwards I would come back to him and discuss surgical options in detail. It would then be my choice as to how to proceed.

In hindsight, my surgeon's direct just-the-facts approach and advice to carefully read and think about it before making any decisions was bang on.

That evening, I told my wife and together we read the book provided. Shock was soon replaced by a sense of relief and hope through gaining a deeper understanding of my options and a good likelihood of successful treatment. We carefully wrote out a list of questions so that we would not forget to ask any during visits with the doctors.

We also agreed that for all future discussions with doctors on this subject, we would go together to ensure all questions we both might have would be answered.

The appointment at the Cancer Clinic began with a nurse doing another comprehensive medical history and taking vital signs. These folks are really thorough at every step of the process. A meeting between my wife and I and the doctor followed. Many questions I now had (after reading the book and searching the internet) were fully discussed. I asked this doctor -- who specialized in radiation and other non-surgical treatments -- for his frank advice. He said, at my relatively young age of 62 and the medical diagnosis to date, that surgery would be his personal first choice. Surgery had the highest chance of being successful given my particular situation, and radiation or other treatments could follow if necessary. On the other hand, radiation first would not normally be followed by surgery due to potentially heavy internal scarring of the prostate and its immediate area from the radiation.

Back home and more reading. (See the Useful Links page for some websites I visited, and the Reference Books page for book titles recommended.)

Then back to the urologist, this time with my wife, to ask more questions and confirm that I wanted surgery.

It was very clear from our information that the probability of having prostate cancer is higher when a near relative has it. I advised my brother and sons that they should start regular testing through their doctors.

About three months after the TURP, I was now scheduled for a nerve-sparing radical retropubic prostatectomy where the prostate, along with the seminal vessels and some neighboring lymph nodes, would be completely removed through an incision in the lower abdomen.

The day before the operation, I again had an appointment for an interview with a nurse at the hospital and underwent the same tests as listed previously for the TURP. Before leaving the hospital, I purchased a week's parking pass which was good for that day and the next complete 7 days. (This pass is a real bargain compared to daily rates if your spouse or someone is going to visit daily.)

Personal preparations for this operation were a bit more involved than the simple no food or water after 10 PM the day preceding the TURP.

This time there was to be a very specific fluids-only diet for the entire day before the operation, and then nothing after 10 PM. And two standard enemas I purchased at a pharmacy were to be self-administered by early that evening on a time schedule provided by the hospital. Administering the enemas was simple to do; I just followed the instructions on the box.

Early on the morning of in-patient surgery, I reported to Admitting at the hospital to make arrangements for my stay, which was likely to be somewhere in the 5 to 7 days range depending on how quickly I recovered. (My surgeon was to evaluate my post-operative progress and determine the actual discharge date.)

Now up to the 3rd floor for surgery. I had to put on a pair of stretchy full length hose to help prevent blood clots in the legs, and these were kept on throughout my hospital stay. An IV was put into the back of my left hand, and a back-up IV connection was put into the left forearm in case it was needed. I took general anesthetic and eventually woke up in my new room. While the TURP had not caused significant pain, this one really hurt. Most of the pain was centered on the incision line in my abdomen, which was covered by a large taped bandage.

I felt truly hooked up. An IV pole held the bag for a fluid drip into my hand. This was to keep my body hydrated, since I was not allowed to drink anything that day. I was restricted to moistening my lips with a tiny sponge on a stick, dipped sparingly in water.

A catheter led to a large bed/overnight type bag hooked near the bottom of the IV pole.

A bulb (Jackson-Pratt drain) was attached to a short tube coming out of my abdomen just right of the incision bandage. This was to catch any fluids that might otherwise collect in the abdomen after the surgery.

Serious pain relief the first day after surgery could have been by nurse injection as required, or by a personally administered morphine pump. My IV got a pump attached, and a thin cable leading to the control button was hooked to the bed. And there was of course an emergency cord and button to summon a nurse if needed. Yes, felt like being the center of some kind of cable junction in a sci-fi movie.

There was no danger of overdosing with the morphine pump, as the dose pumped each time was limited; an electronic timer prevented more than one dose in so many minutes no matter how many times the patient pushed the button. After the first couple of hours, the pain was generally manageable and I rarely pressed the button.

A nurse advised that it was not wise to be macho and avoid taking pain relief when I did need it. I found that I really needed it only when about to sit up and swing the legs down to get out of bed. With that incision, this twisting and leg movement hurt. (And the same when returning to bed and lying back down.) The nurses coaxed me on the best technique to do this using the side bed rail and bed raising mechanism for support. (After release from hospital, one of the PSA Group [Prostate Support & Awareness Group] members said it was also easier if you do not hold your breath while doing these movements. That advice was too late for my hospital stay, but proved helpful for anytime I got in/out of my bed or a chair at home.)

Another problem in getting up was arranging the IV line, and catheter tube, and Jackson-Pratt bulb so nothing got caught or pulled. The IV line in the back of my hand could really sting if tugged by a sheet or whatever. It frequently started to sting even when not tugged and, if I had had a choice, I would have prefered the IV to be in my lower arm. But I did not get to choose.

Also provided was a blue plastic breath gadget. Staff insisted that at least once per hour you had to take a deep breath, then blow into the mouthpiece as long as possible. While the blowing was strong, a white mini ping-pong-like ball floated up in a vertical tube. You had to do this 10 times in a row. Just when you were getting the hang of this, the nurse would adjust a dial to make the "game" more difficult. Of course this was not a game. These exercises improve your lung activity and blood oxygen levels, and help prevent catching pneumonia. Very serious stuff.

I later asked what happened to this plastic device upon patient discharge, and was told I could keep it if I wanted -- as otherwise it would be tossed out. Since all the good reasons for using it in the hospital were valid at home, I took it with me and used it every day until the catheter was removed.

Physical exercise in the hospital was vital to getting better quickly. By day two I was taking at least three walks with my pole. At first I went around (and around) the halls in the ward for perhaps 10 minutes or so. As my strength improved, the walks got longer in duration and distance. When the main corridor was less crowded (evenings after visitors left, or on weekends) such walks were more pleasant.

Walks were also vital towards getting drink and eventually food. Until the patient first passes gas, no drinks are allowed. By day three I had not succeeded so I was allowed ice chips to crunch and swallow. Success. The next day I could have water to drink. Then liquids like apple juice were added. Eventually soft stuff like really horrid gelatine (definitely not Jello brand) were taken and amazingly, appreciated. And on the final fifth day, some real food like Rice Krispies and French toast. Man they tasted good now.

The IV had been disconnected once I proved to be sufficiently hydrated by just the water I was drinking. The Jackson-Pratt bulb came out on day 4. I anticipated such might be painful but it was not. (Others reported experiencing slight pain, but removal is over in seconds.)

On day 5 (a Sunday), my surgeon came in on his day off and assessed my progress as good to go. He had been totally supportive and watchful of my progress during the entire stay. Some days he came early in the morning and again late at night. Truly a dedicated and caring fellow.

So back home. Yippee. Exercise continued despite the inconvenience of the catheter. A good tip from one of the guys at the PSA Group was to avoid the tiny leg bag (which needed frequent emptying) unless going somewhere by car. While at home, I used the overnight bag and kept it in a handled bucket. Everywhere I went, like up and down the driveway or yard, my little red bucket went too. It is also a great safety feature in case a bag ever leaked. Mine did not leak, but having the bag safely in the bucket was reassuring, particularly while sleeping.

Fifteen days after the operation, I went back to the hospital's Ambulatory Care department and the catheter was removed. (I wore roomy boxer shorts while the catheter was still in, and took a pair of briefs with me to the hospital to change into after catheter removal; snug fitting briefs better support a pad.)

So three months later comes a blood test for PSA level and a follow up with the surgeon. The PSA was now undetectable. Immense feeling of relief.

But my stream had been getting weaker and it was assessed that scar tissue at the neck of the bladder was interfering. My studies had prepared me for this possibility after a prostatectomy. Apparently if it happens, 3 to 4 months is a likely time frame to appear. (Some patients get a problem with scar tissue blockage after many months or even several years, but the majority in my PSA group never had this problem.)

Within three days he had me back in for an outpatient procedure. Same preparations at the hospital as for the TURP described near the start of this webpage. (The TURB is similar to a TURP, but with no Prostate involved -- just the Bladder.) Short catheter use for three days, and the stream became strong.

And now hopefully freedom to do more active things, and try to forget about the operations other than when doing daily Kegel exercises. (See the Continence Help page at left.) Of course, there will be follow up PSA testing forever, but the time between tests will lengthen so long as test results remain good.

So far so good. I have passed a year since the prostatectomy and my follow-up PSA tests have been clear. So now the PSA tests go from three-monthly to semi-annual intervals. But as each test comes due, I still feel some anxiety about the upcoming results. Other cancer survivors report this anxiety is pretty common around test time. They suggested that I try to be a bit fatalistic and put it out of my mind. I still am a bit anxious at test time but fairly successfully do not think about cancer the rest of the time. And enjoy life every day.

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