Recovery

August 19, 2011 - August 21, 2011 I arrive home. Now we have to figure out how to manage the damn collection bag, where we're going to stash me and so on. We had thought of a few things before, like how to control "accidents". We got an absorbent pad for the bed from a medical supply house to put under me.

When I left the hospital, I had planned ahead for concealing the bag and wore loose sweat pants with elastic bottoms for my discharge. We drained the collection bag first and kind of folded it up, stuffing it into my right pant leg. Then I carefully inserted my foot into that pant leg. The mistake I made was first putting on underwear over the catheter. Don't do that, you'll cause pulling and possible bleeding at the head of your penis. Just go commando.

Catheter in place on right leg

The collection bag had to be drained every 3-4 hours or so. The nurse in Post-Op had said empty it when it gets about half full, and since you're also encouraged to drink plentiful fluids to aid healing, you're emptying it a lot, even in the middle of the night. The color of the collected urine is also diagnostic: clear like regular urine - good; red to dark pink - not so good. In my case, it was quite pink for the first couple of days, then started becoming more clear. This seemed correlated with movement: more movement, more pink; rest = clear. However, you are encouraged to move in recovery, at least around the house. So you are going to see a lot of pink.

The collection bag is a terrible nuisance to manage. Although we had a kit from the hospital that provided additional bags, we chose not to change bags as the process was unfamiliar to us, and you have to be very careful about hygiene and touching things. You need to keep the collection bag well below the level of your bladder. In my case, I just put it in a a 5 gallon bucket and hauled it around. That kept it off the floor and semi-protected it. This wasn't an optimal solution, and I'm not necessarily recommending it, but it worked for me most of the time. I stayed in my house until it was time to return to the urology clinic to get the catheter removed, so no one was going to see me with this thing. Most of the time I wrapped a beach towel around me and went commando to walk around.

Tissue passing about the 3rd day - normal, expected

I actually felt pretty good for having gone through surgery. I slept on and off the next couple of days. I go bored and started this blog. At one point, I wasn't paying attention to the catheter and pulled on it, injuring myself. Oh, and you will have some blood at the insertion point of the catheter, just expect it, clean it up periodically as best you can. Hygiene is important.

Boredom is maybe the biggest issue, followed by you have to think about moving around because you have this thing on you. Also, your household will be in minor chaos to accommodate your condition. I'm very set in my ways, I like structure, so this was an adjustment.

August 22, 2011 Time to get the catheter removed. It's now about 4 days since I got the catheter. I had adjusted to the discomfort of the catheter pretty well. Most people describe this as a feeling of wanting to urinate all the time. Well, gee, I'd pretty much been doing that for years by this time, so no big deal.

In the urologist's office, I asked the nurse if the catheter removal was painful. She said no. She told me to drop my pants to below knee level and lay back on the exam bed, putting a disposable pad over my genitals. "OK, take a deep breath and then let it out slowly...." It was over very quickly and the only thing I felt was, understandably, some discomfort at the head of my penis, which the catheter had irritated for a few days.

The nurse said: "You can try to urinate now, if you like. If you can, you can go home. But if your urine stream drops to a trickle by 3:00 (five hours later), come back here to the clinic. If you don't want to urinate now, that's fine also. But, again, if you can't urinate at all by about 3:00PM, come back here." I said I felt like I could go, so the nurse left the room for about 10 minutes or so. It felt strange to pee on my own after just letting the catheter do the work for a few days, and it took a bit of effort, but I passed about 100 ml of dark red urine, a little painful but tolerable. When the nurse returned, I said "Is this OK?" "Yes, that's fine. You will pass blood for a while. You're free to go." Woot!

I was very apprehensive about bathroom visits until 3:00PM. But I managed to pass a decent amount of liquid about 3 times by then, so figured I was OK. Early in the evening, I had a bit of a dribbling problem, but only once. I woke through the night about every hour and urinating, while taking some effort and causing some discomfort, gradually became easier. My stream was like a fire hose compared to what it had been before, and it was only going to improve.

August 23, 2011 I continue to slowly improve and get better results on this, the first full day after the catheter was removed. My stream looks good. Still getting some blood, but it's expected - drink more liquids to help.

It's early days yet, and things could still go wrong. You have to be careful in recovery to follow doctor's orders and not overdo and take your time, or you'll injure yourself. However, I'm hopeful that this will be a big improvement for me.

Update: August 26, 2011 Now one week after my TURP. I still see some pink at the beginning or end of the stream, but I'm seeing clear without any signs of blood about half the time. Still stings a bit to urinate, a little strange to initiate a stream. Today I felt a little spurt and out had come a minuscule clot along with a small bit of tissue. Before the procedure, I got in the habit of doing a "double void": passing urine, waiting a few moments, then trying again. I found that habit initiates a minor spurt of bleeding, so I don't do that.

I'm getting up to visit the restroom in the night much less than after the catheter was first removed. Currently, it's about every 2-2.5 hours, also mostly that interval during the daytime.


Update September 19, 2011
Now a little over 4 weeks since the TURP. By about two weeks after, the pink residue of blood completely gone. However, by the third week, I started experiencing some incontinence, especially with both a a full bladder and a need for a bowel movement. This manifested itself by getting right over the toilet bowl and I let fly with a couple of short bursts, sometimes in the bowl but a couple of times in my underwear. I think part of this is mental, anticipating.


The urologist says that this "Transient Incontinence" affects 20%-30% of patients and usually resolves in a few weeks and can occur with laughing, coughing and exercise/sports. He recommended I do Kegel exercises, which strengthen the pelvic floor muscles. Here's one link, but there are many on the web. It's early yet, might take a few weeks to see significant improvement. But, I think the Kegel exercises are helping. You have to keep on them, do them every day.


Last week, I had a disturbing experience. I started bleeding bright drops of blood from my penis. I could still urinate and over about 5 hours, and passing a few strings/clots of blood, the blood faded to pink similar to what I was experiencing before. I thought, OK, that was probably to be expected.


However, after urinating about three times previously, I started a stream and then felt a tug. The firehose then turned into a dripping faucet. Ack, I've got an obstruction! I called the Kaiser Nurse 24-Hour Advice line (what a great service) and they hooked up with an on-call ER doctor, who also thought it was an obstruction. The consensus was to monitor, give it 3-5 hours. If I felt a great deal of pressure and still couldn't urinate properly, go to the ER.

So I waited a couple of hours, until I felt I could urinate again. The stream started slowly at first then quickly changed back to my accustomed fire hose. That was a relief! I looked in the toilet bowl and saw a great deal of foam and a single, tiny dark object. Stone? I didn't even feel it pass.

Passed Prostate Stone

I sent an email to my urologist and he said what probably happened was: a scab "unroofed", causing the blood, and the stone released from under the scab, causing the blockage. He said it was likely this would recur until about the 8 week point, when the prostate should be completely healed. Stay hydrated to help pass any stones. 

Now, remember, this is unique to my anatomy. The urologist said I had the most stones of any patient he has ever seen. So, this is unlikely to happen to you unless the urologist informs you that you have a large number of calcifications or stones.