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Urethroplasty Post-operative Instructions

Pain

There will be discomfort in the area of the surgery.  If you have a buccal mucosa graft done, usually the mouth hurts more than the groin. You will go home with Norco/Vicodin which is a narcotic pain medication which should only be required for the first two to three days -- because the narcotics will cause sleepiness and constipation it is best to stop or reduce them at that time if you can.  After this, using Tylenol and or ibuprofen (Advil/Motrin) as directed on the packaging should be sufficient.  The pain should continue to get better on a daily basis; if it doesn't please call us. Do not exceed 4000mg of Tylenol or 2400mg of ibuprofen in a day.


Bladder spasms

You may notice bladder spasms which can present as sharp sudden pains in the area of bladder (just above the pubic hair) or the tip of the penis.  This is usually because the foley catheter irritates the bladder. You may feel like you have to urinate even though the bladder is fully drained. You will be given a prescription (see below) of a medication to be taken as needed, which can help with these. It is important to take the bladder spasm medicine because occasionally these bladder spasms can get intense enough to cause you to urinate around (rather than through) the catheter and this rush of urine can damage the urethroplasty work.
 

Mouth

If you had a buccal graft, you will notice some tightness and discomfort in one side of your mouth that may limit how much you can open your mouth.  This should improve over the next several weeks. It may also be difficult to brush your teeth on the side from which we took the graft; that is why we have prescribed a mild hydrogen peroxide mouthwash to help keep your mouth clean for the first week.

 

Urination

You will have the foley catheter in your penis to drain your bladder until your follow up with Dr. Elliott.  This will not generally restrict your activities, but you should be careful if you are driving such that it does not become a distraction.  You should apply the bacitracin antibiotic ointment (see below) to the tip of the penis twice a day.  This also helps the catheter slide in and out to minimize discomfort that can happen with nighttime erections. You may notice a little blood, small amount of white discharge, or caking at the tip of the penis with the catheter in place.  This is normal but it can irritate the tip of the penis so it is best to wash this off with a warm washcloth.

 

Erections

You will likely get nighttime erections and these can be painful due to stretching of the penis so soon after surgery. The erections won’t damage your surgery; in fact, they can be good because they bring in blood supply and that helps with healing. There are no good medicines for preventing or treating these erections, or the pain they cause. One thing that does help is keeping the urethral opening on the tip of the penis clean of any scabs or dried mucous (by wiping with a warm washcloth) and keeping it lubricated with antibiotic ointment. These measures will help the catheter slide in the penis during the erection so it doesn’t tug on the urethral opening. One piece of good news is that the pain from the erections usually makes them go down.
 

Diet

You may return to your normal diet that you were taking before surgery. If you had a buccal graft used as part of your surgery, you may find soft food like yogurt and smoothies more comfortable for the first couple of days, but there are no specific restrictions.
 

Activity

You can return to your normal level of activity as you are able, based upon your level of pain. Your activity level will likely improve after your dressings and catheter are removed about 5 days after surgery. Walking and lifting won’t hurt the urethroplasty site but use good judgment: if something hurts then don’t do it. Most people take about 2 weeks off from work. Depending on whether you have an active job or a desk job you may be able to then go back to work while the catheter is still in. We leave this up to you based on your pain level. If you go back to work, don't expect to be at 100% until after the catheter comes out.


Restrictions

You should not drive or drink alcoholic beverages while you are taking narcotic medications (see below).  You should not shower, soak in a tub or pool until the catheter and dressings are removed about 5 days after surgery.  After that, you should shower daily, with the dressing off.


Wound Care

Mouth (if you have a mouth incision) -- The stitches will dissolve in about a week. You will be given a mouth wash to keep the incision clean (see below).

Penis (if you have a penis incision) -- The stitches will dissolve in about 3 weeks. Your penis is wrapped with a gauze pad and a "Coban" which is like an ACE wrap. There may be stitches to help the Coban stay in place; leave the dressing there until we remove it in clinic. Do not shower until the dressing is removed because we do not want this to get wet. Instead, you can take a sponge bath. This lightly compressive dressing helps prevent bleeding. We will remove this dressing in the clinic about 5 days after surgery and we will teach you to re-wrap it. After that you can shower daily with the dressing off and then re-wrap it after your shower. Repeat this daily – remove the dressing, shower and re-wrap – until 2 weeks after surgery. After that, leave the wound open to air and the penis unwrapped.

Perineum (if you have a perineum incision) -- The area behind the scrotum is called the perineum. The stitches are all dissolvable. You will not need any specific bandage on this area, but you may find wearing a small pad (gauze, tissue paper or a sanitary napkin / "maxi pad") in your underwear can help protect from blood staining your underwear. The blood spotting should be no more than quarter-sized per 24-hour period. If you notice more drainage or if it becomes foul-smelling, please give us a call. This area may remain numb for a few months as the nerves heal. Avoid activities that could aggravate the nerves in the perineum by putting pressure on them (bike-riding, horseback riding).

 

Medications


1.  Vicodin/Norco – this is a narcotic pain medication which you should only need for two to three days after surgery. 
2.  Tolterodine (Detrol) or oxybutynin (Ditropan) – this is a bladder spasm medicine which you should take on a daily basis to block the strong urge to pee.
3.  Bacitracin Ointment – this is an antibiotic ointment which will help with discomfort from the foley catheter
4.  Ciprofloxacin  - this is an antibiotic pill to take the morning of foley catheter removal
5.  Senna-S or Colace – this is a stool softener.  The surgery, pain medications, and anticholinergic medications can lead to constipation.  You can stop this or reduce it if you are having loose stools.  Other over the counter solutions such as prune juice, miralax, fiber products, senna, and dulcolax can also be used.
6.  Peridex – if you had a mouth (buccal) graft you will also have this mouth rinse to use every two hours while you are awake, until it is gone to help prevent infection and promote healing.

 

Follow-up


Your follow-up appointment in Dr. Elliott’s clinic is 5 days after surgery at which time we will cut the stitches and remove the penis dressing. We will then teach you how to rewrap the penis. After that 5 day visit we will ask you to remove the dressing once a day immediately before showering and then replace the dressing after your shower. We will have another visit a couple of weeks later to inspect the healing of the surgery site.  


Contact Us with Questions

University of Minnesota:

1.  Nursing phone helpline at the Urology clinic (8A-5P M-F): 612-625-6401

2.  Meghan Howe is Dr. Elliott's nurse in the Urology clinic. Her direct line is: 612-713-9649
3.  If after hours, call the clinic line at 612-625-6401 and you will be connected with the Urology resident on call. If that fails, then call 612-273-3000 and ask to speak with the Urology resident on call. 

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