How to Take Care of Your Urinary Catheter
There may be normal yellowish sticky substance found in small amount around urethral meatus/catheter. There is no need to worry about it.
There may be some whitish flakes in the urinary tube. This is due to phosphate crystals and is a normal finding. Do not worry.
Because of the urinary catheter, there may be some crampy feeling or urgency to pass urine. There may also be brief pelvic or rectal pressure. This is a normal response of bladder to the presence of urinary catheter and is called bladder spasms. It can also occasionally cause urine to squirt out of penis.
If there is small amount of leak around catheter but the catheter tube is draining well, then do not worry. However, if there is a lot of leak around the catheter and the catheter tube is not draining at all, then the catheter might be blocked and you should inform the doctor.
Some urine can normally come out around the urinary catheter, especially while passing stools.
The urine bag should always be kept below body level
The tip of penis (urethral opening at the site of entry of urethral catheter) should be cleaned with soap and water twice daily. Rinse well.
Avoid sudden jerk/tug of catheter. Take care while turning in bed or changing positions.
A latex (yellow) catheter can be safely kept for 3 weeks before need for change. A silicone catheter (transparent) can be kept for a longer period.
To empty urine bag, open the stop-cap and drain urine into commode. Do not disconnect tube from catheter to drain the bag. Securely close the stop-cap at all other times. Measure the urine in a measured bottle if advised by the doctor.
For emergency, call your doctor or visit the hospital emergency
How to Take Care of Your PCN Tube
Avoid sudden jerk/tug of catheter. Take care while turning in bed or changing positions.
Get regular dressing of the PCN tube (once every 2-3 days or earlier, if soiled). During dressing, ensure that the tube does not accidentally get pulled out (if doing dressing at home).
There may be some whitish flakes in the PCN tube. This is due to phosphate crystals and is a normal finding. Do not worry.
The PCN tube may get kinked on turning towards the same side. If the tube is not draining, look for kinks or sharp bends.
The urine bag should always be kept below body level.
In case of a permanent PCN tube, get it regularly changed by your doctor.
To empty urine bag, open the stop-cap and drain urine into commode. Do not disconnect tube from catheter to drain the bag. Securely close the stop-cap at all other times. Measure the urine in a measured bottle if advised by the doctor.
In case of fever (with chills), pulled-out tube, non-drainage of the tube or blood in tube, call your doctor or visit the hospital emergency.
For emergency, call your doctor or visit the hospital emergency
How To Do Kegel Exercises
What are Pelvic Floor Muscles
These are a hammock shaped group of muscles, supporting your bladder, uterus and rectum and help in control of urine flow
Like any another muscle, these can be strengthened with regular exercises
Find your Pelvic Floor Muscles
While passing urine, try to stop your urine stream
Squeeze your anus and pull it inwards as if trying to hold passing gas
Do Pelvic Floor (Kegel) Exercises
Tighten and hold your pelvic floor muscles for a count of 10 seconds (count - One Hundred One, One Hundred Two, One Hundred Three … till One hundred ten). Now relax it for another 10 seconds. This is one set of exercise.
Plan to do at least 20 sets of exercise 3 times in a day. Perform 20 sets in mornings, 20 in afternoon and 20 in the night. Perform these sets either in standing position, sitting on a chair or lying down position with legs straight.
Start with a lesser number and gradually increase the number of sets as muscles develop.
Be consistent with the exercise. It takes at least 6 weeks to see measurable improvement and needs continuous exercise to maintain it.
The best part is that Kegel exercises can be done anywhere and without need for any special equipment.
Do not
Hold your breath during contractions
Push down. You should squeeze the muscles to pull them up
Tighten the muscles in your stomach, buttock or thighs
Forget to relax your muscles between each squeeze for a count of 10
Video link - drdevanshuurology.com -> resources -> for patients -> educational videos
How to Make a Voiding Diary
A Voiding Diary (also called Frequency-Volume Chart) is a record of your fluid intake and urine output according to time.
The doctor may ask you to make a voiding diary to assess your fluid intake. This will help him in determining whether the reason for your complaints might be low or high fluid intake.
The Voiding Diary will also help in documenting the actual frequency of urination and the number of nocturnal voids. It also helps to record how often you have that “must go” urgency feeling and if & the amount of urine leaked.
You can make a voiding diary before your first visit to the doctor. This will be helpful in evaluation of your symptoms and their effect on your quality of life. Or you make it on your follow up visit after the doctor asks you to.
The Voiding Diary should be made for a minimum of 3 days for it to be properly representative of your complaints.
How and what is to be recorded in the Voiding Diary:
Time of Day: One diary should be used for a 24-hour period. Please mark your waking and bedtime in the sheet. Then, start recording all fluid (water, tea, milk, juices etc) according to time slots given during that 24-hour period
Fluid intake: Record all the fluids (in ml) according to time slots during the 24-hour period
Toilet void: Note the amount of urine (measured in ml) you pass in the toilet according to the time
Urine drained via catheter: If you use a catheter to drain urine (either altogether or after passing urine), then note it in this column (in ml) according to time. Leave it blank if you do not use a catheter
Leak: Tick this column if you leak at a particular time and note the amount leaked (drops, mild, moderate, severe)
Pad changes: Tick this column when you change your pad. Put ‘D’ if the pad is dry and note (mild, moderate and severe) if the pad is wet. Leave the column blank if you do not use a pad
Please find the Voiding Diary attached below for download (along with a Sample diary)
How to Manage with a DJ Stent
DJ stent is an internal tube placed from your urinary bladder to the kidney. It helps in draining the urine from kidney to the urinary bladder in case of any obstruction along the path (stone, stricture or external compression) or after any ureteral surgery or injury. It also helps in passively dilating the ureter.
DJ stent is usually kept for two to six weeks, although it can be kept for a maximum of usually 3 months. Special long term stents (silicone stents) may be changed yearly and metallic stents may be kept for life.
Take following precautions and care after placement of DJ stent:
Do not strain to pass urine
Avoid excessive physical activity like long walk/jogging/running/etc
There may be some amount of discomfort/heaviness on the side of the stent, especially while passing urine. This is normal and due to reflux of urine into kidneys
While passing urine, try to go and pass urine 10 minutes after first voiding. If some amount of urine has refluxed back, it will come out
There may be slight burning sensation/urgency while passing urine. This is normal
Few drops of blood may come out at the end of urinary stream. This is normal
Remember to get it removed as advised. A forgotten DJ stent may cause stone formation and infection, leading to kidney damage
For emergency (fever with chills or excessive bleeding), call your doctor or visit the hospital emergency
How to Prepare for Prostate Biopsy
Prostate biopsy is usually done to obtain tissue from the prostate for evaluation of raised PSA or prostatic nodule on digital rectal examination
Prostate biopsy is usually performed by inserting a smooth probe inside the rectum
It is a short day-care procedure and you will be discharged on the same day unless required otherwise
Before recommending prostate biopsy, the doctor will prescribe you some blood and urine tests which you should review with him
In case you are on blood thinners, do let your doctor know because they will need to be stopped 5-7 days before the biopsy unless specifically asked to continue by your doctor
Your doctor will prescribe you oral medications to empty your bowel one night before the procedure and an enema may be given on the morning of the procedure
You will also be prescribed antibiotics to be started before the procedure. These reduce the risk of urinary infection
During the procedure, you will be made to lie on your side or on your back with legs folded. The procedure is usually done under local anesthesia. A lubricant jelly will be inserted into your rectum to make the insertion of the biopsy probe pain free and comfortable
Multiple tissue pieces will be taken from the prostate with a biopsy needle. During biopsy, you might hear a snap as the doctor fires the needle and there might be slight pinching pain. The procedure is usually over in a few minutes.
You will be kept under observation for a few hours and will usually be discharged after you are able to pass urine.
There might be some blood in your stools, urine or semen for a few days after the procedure. This is normal.
The doctor will prescribe you painkillers and antibiotics after the procedure.
The biopsy report is usually available in 7-10 days.
In case of fever or excessive bleeding after biopsy, review immediately
For emergency, call your doctor or visit the hospital emergency
How to Prepare for Intravesical Mitomycin Therapy
Intravesical mitomycin therapy is given in patients who have previously undergone endoscopic surgery for bladder tumor. Only those patients with complete removal of the tumor are given this therapy. Your doctor will let you know if you need this therapy.
Intravesical mitomycin therapy is given in induction (weekly six doses) and maintenance (monthly doses for 1 year or weekly 3 doses at 3/6/12/18/24/30/36 months as decided by your urologist) regimen parts.
Along with intravesical therapy, you will also undergo regular check cystoscopy (endoscopic evaluation of the urinary bladder) to make sure that your tumor has not come back
WHAT HAPPENS ON THE DAY I GET MITOMYCIN?
Do not drink for at least 4 hours before your therapy. This is to make sure your bladder is not full. You can sip a little liquid to keep your mouth moist. You can have your breakfast.
Do not take any diuretic medicine (water pills) before your appointment. You can take diuretic medicine 4 hours after your therapy. Other medicines may be taken before therapy with a sip of water, if needed.
Let your doctor know if you have any urinary burning, fever or blood in urine. The doctor may need to evaluate you for an UTI and withhold therapy that day.
You will be made to lie down on the examination table. A catheter will be placed into your bladder to empty any residual urine and instil the mitomycin.
The medicine should remain in your bladder for two hours for best results. If you must urinate before two hours, let your doctor know as to how long you were able to hold the medicine.
Urinate after two hours. Avoid splashing urine in the urinal. Men may need to sit for the same. Completely empty your bladder. Wash your hands and genital area with soap and water after urinating.
For emergency, call your doctor or visit the hospital emergency
How to Prepare for Intravesical BCG Therapy
Intravesical BCG therapy is given in patients who have previously undergone endoscopic surgery for bladder tumor. Only those patients with complete removal of the tumor are given this therapy. Your doctor will let you know if you need this therapy.
Intravesical BCG therapy is given in induction (weekly six doses) and maintenance (monthly doses for 1 year or weekly 3 doses at 3/6/12/18/24/30/36 months as decided by your urologist) regimen parts.
Along with intravesical therapy, you will also undergo regular check cystoscopy (endoscopic evaluation of the urinary bladder) to make sure that your tumor has not come back.
WHAT HAPPENS ON THE DAY I GET BCG?
Do not drink for at least 4 hours before your therapy. This is to make sure your bladder is not full. You can sip a little liquid to keep your mouth moist. You can have your breakfast.
Do not take any diuretic medicine (water pills) before your appointment. You can take diuretic medicine 4 hours after your therapy. Other medicines may be taken before therapy with a sip of water, if needed.
Let your doctor know if you have any urinary burning, fever or blood in urine. The doctor may need to evaluate you for an UTI and withhold therapy that day.
You will be made to lie down on the examination table. A catheter will be placed into your bladder to empty any residual urine and instil the BCG.
The medicine should remain in your bladder for two hours for best results. If you must urinate before two hours, let your doctor know as to how long you were able to hold the medicine.
Urinate after two hours. Avoid splashing urine in the urinal. Men may need to sit for the same. Completely empty your bladder. Wash your hands and genital area with soap and water after urinating.
After urinating and washing your skin, pour two cups of bleach (Clorox/Harpic bleach or equivalent) into the toilet. Let the bleach and BCG mixture stay in the toilet for 15-20 minutes before flushing. Flush the toilet. (Remember: BCG is a weakened – not dead – bacteria. It is important to kill the bacteria so it won’t affect others)
Repeat above steps each time you urinate for the next six hours. You should plan to stay home and use the same toilet for those six hours.
Drink at least 250 ml (8 oz) of liquid every hour for those six hours to help flush the bladder well.
WHAT ARE THE SIDE EFFECTS OF BCG AND WHAT DO I DO ABOUT THEM?
Burning micturition and frequency of urination: increase your fluid intake. Avoid caffeine and alcohol. Burning and frequency may get worse during the treatment. The doctor may prescribe you some medications to help with these symptoms.
Low-grade fevers (up to 100 F), fatigue, aching, and flu-like symptoms: You may take a Paracetamol 500 mg tablet to help relieve these symptoms. Drink as much fluid as you can to keep the urine clear. Rest. These symptoms occur because the BCG stimulates your immune system.
Blood in the urine: Irritation of bladder wall caused by the BCG leads to bleeding that can turn your urine red. Drink plenty of fluids to keep your urine clear and to prevent blood clots from forming in the bladder. Bleeding most often resolves.
If you have a fever over 101 F, chills, rash, continuous bleeding, prolonged cough, specific joint pain, or if any of the above symptoms last longer than 48 hours, you need to contact your doctor or visit the hospital emergency at the earliest. More severe symptoms often indicate a serious reaction to the BCG and may require admission.
ARE THERE ANY PRECAUTIONS I NEED TO TAKE REGARDING SEX?
Avoid sexual intercourse for at least 48 hours after each BCG instillation. Men must wear a condom for the entire course of the six-week treatment and for six additional weeks after treatment has ended. Women should avoid vaginal contact for one week following each treatment and for six additional weeks after treatment has ended. (Remember: BCG is a weakened – not dead – bacteria that could affect others)
How to Prepare for TURP Surgery
This booklet is designed to provide you with important information about the procedure known as Transurethral Resection of Prostate (TURP). We want you to feel well-informed and confident as you prepare for surgery and recover afterward.
What is TURP?
Transurethral Resection of the Prostate (TURP) is a surgical procedure used to treat benign prostatic hyperplasia (BPH), a condition where the prostate gland becomes enlarged, causing urinary difficulties. TURP involves the removal of part of the prostate tissue through the urethra (the tube that carries urine from the bladder).
Why is TURP Performed?
TURP is commonly used for men who suffer from symptoms of BPH, including:
1. Difficulty starting urination
2. Weak or interrupted urine flow
3. Frequent urination, especially at night
4. Urgent need to urinateInability to empty the bladder completely
Medical Evaluation: You may need blood tests, urine tests, and imaging studies.
Medication Adjustments: Inform your doctor about any medications, especially blood thinners.
Fasting: No food or drink for 6-8 hours before surgery.
Hospital Stay: Expect to stay 1-2 days post-surgery.
What to Bring to the Hospital -
1. Identification and insurance information
2. List of medications
3. Comfortable clothing
4. Personal hygiene items
Anesthesia: TURP is typically performed under spinal or general anesthesia, ensuring you are comfortable and pain-free throughout the procedure.
Procedure: A special instrument called a resectoscope is inserted through the urethra. The resectoscope has a camera to allow the surgeon to view the prostate and a small cutting loop to remove excess prostate tissue.
Duration: The procedure usually takes 60 to 90 minutes.
After-Surgery: What to Expect
Recovery in the Hospital: You will be monitored in the recovery room for a few hours after surgery. A catheter will be placed in your bladder to drain urine and any blood or clots that may be present after surgery. This will typically remain in place for 1 to 2 days, depending on your recovery. You may experience some discomfort, including mild pain, swelling, or bleeding, which is normal during the initial recovery phase. Most patients stay in the hospital for 1 to 2 days after the procedure.
During your stay, the medical team will manage your pain, help with catheter care, and monitor your overall recovery.
Pain Relief: You may experience mild to moderate discomfort after the procedure. Pain relievers such as acetaminophen (Paracetamol) or ibuprofen may be recommended. In some cases, stronger medications might be prescribed.
Bladder Irrigation: You may experience frequent urges to urinate or feel like your bladder is not emptying completely. This is normal as your body heals.
Blood in Urine: It is common to have some blood in your urine after the procedure. The blood should gradually decrease over a few days to weeks.
Rest: Resting for the first few days is important. Gradually increase your activities as tolerated, but avoid strenuous exercise, heavy lifting, and sexual activity until your doctor gives you the go-ahead (usually 4-6 weeks).
Hydration: Drink plenty of fluids to help flush your system and keep the urine flowing smoothly. It also helps reduce the risk of infection.
Catheter Care: If you go home with a catheter, follow your doctor’s instructions on how to care for it. Typically, it will be removed after a few days.
Diet: Eating a healthy, balanced diet will help your body recover. Avoid alcohol, spicy foods, and caffeinated beverages, which may irritate the bladder.
After your discharge, you will have follow-up appointments with your urologist to monitor your recovery and ensure there are no complications. These appointments may include checking your urine flow and prostate health. The biopsy report of your prostate (sent during surgery) will also be checked and discussed with you.
Expected Outcomes and Long-Term Outlook -
Most men experience significant improvement in their urinary symptoms after TURP. In the months following surgery, you should notice:
Easier urination
Reduced frequency and urgency
Improved quality of life
Complications -
Blood in urine (some bleeding is normal after TURP, but excessive bleeding may require further treatment)
Infection
Urinary incontinence (rare and usually temporary)
Erectile Dysfunction (rare)
Retrograde ejaculation (semen flows into the bladder instead of out)
Persistent or heavy bleeding in urineInability to urinate after catheter removal
Severe pain unrelieved by medication
Fever or chills
Most men do not experience major sexual dysfunction, but retrograde ejaculation is common.
How long does it take to recover?
Most men resume normal activities within 4-6 weeks.
Will I need a second TURP in the future?
While TURP provides long-lasting relief, some men may require additional treatment later in life (usually 15-20 years later).
Conclusion
Thank you for taking the time to read through this information. TURP is a safe and effective procedure for relieving symptoms of BPH, and most patients experience significant improvement after surgery. It is important to follow all pre-and post-operative instructions to ensure the best possible outcome. If you have any further questions, don’t hesitate to reach out to your healthcare provider.
We wish you a smooth recovery!
For emergency, call your doctor or visit the hospital emergency
How to Prepare for TURBT Surgery
Welcome
This brochure is for patients undergoing a Transurethral Resection of Bladder Tumor (TURBT). It provides key information to help you understand the procedure, prepare for surgery, and care for yourself after.
What Is TURBT?
TURBT is a surgical procedure that removes tumors from the bladder using a resectoscope inserted through the urethra. It is used to diagnose and treat bladder cancer, particularly when it hasn't spread into the muscle layer.
Why TURBT?
- Diagnoses bladder tumors
- Removes visible growths
- Collects tissue for biopsy
Preparing for Surgery
- Pre-assessment: You may have to undergo blood tests, imaging scans, or urine tests.
- Medication: Let your doctor know about all medicines. You may need to stop blood thinners.
- Fasting: Don't eat or drink for 6 hours before surgery.
On the Day – What to Bring to Hospital
Identification and insurance information
List of medications
Comfortable clothing
Personal hygiene items
During the Procedure
- Takes 30-60 minutes
- Anesthesia: TURBT is typically performed under spinal or general anesthesia, ensuring you are comfortable and pain-free throughout the procedure
- A thin scope is used to remove tumors from inside the bladder. There is no skin cut involved
- Tissue is sent for biopsy
- A catheter may be placed to help drain urine
After the Surgery
- You will be monitored in the recovery room for a few hours after surgery.
- A catheter will be placed in your bladder to drain urine and any blood or clots that may be present after surgery. This will typically remain in place for 1 to 2 days, depending on your recovery.
- You may experience some discomfort, including mild pain or bleeding, which is normal during the initial recovery phase.
- You may stay for 1-2 days. You may notice pink/red urine.
Managing Pain and Discomfort
- Pain Relief: You may experience mild to moderate discomfort after the procedure. Pain relievers such as acetaminophen (Paracetamol) or ibuprofen may be recommended. In some cases, stronger medications might be prescribed.
- Bladder Irrigation: You may experience frequent urges to urinate or feel like your bladder is not emptying completely. This is normal as your body heals.
- Blood in Urine: It is common to have some blood in your urine after the procedure. The blood should gradually decrease over a few days to weeks.
At Home
- Rest: Resting for the first few days is important. Gradually increase your activities as tolerated, but avoid strenuous exercise, heavy lifting, and sexual activity until your doctor gives you the go-ahead (usually 4-6 weeks).
- Hydration: Drink plenty of fluids to help flush your system and keep the urine flowing smoothly. It also helps reduce the risk of infection.
- Catheter Care: If you go home with a catheter, follow your doctor’s instructions on how to care for it. Typically, it will be removed after a few days.
- Diet: Eating a healthy, balanced diet will help your body recover. Avoid alcohol, spicy foods, and caffeinated beverages, which may irritate the bladder.
When to Contact Us
Call if you notice:
- Heavy bleeding or clots
- Fever or chills
- Pain or burning with urination
- Difficulty urinating
Follow-Up Care
- Biopsy results are available in 5-7 days
- Further treatment may include intravesical therapy or repeat TURBT
- Regular bladder check-ups (cystoscopy) are required in follow-up
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Frequently Asked Questions (FAQs)
1. Is TURBT a major surgery?
No, TURBT is considered a minimally invasive procedure. It is done through the urethra without external incisions, and most patients can go home the same day or after a short hospital stay.
2. Will I be in pain after the surgery?
Some mild discomfort, burning during urination, or bladder spasms are common for a few days. Pain is usually well managed with medication and improves quickly.
3. How long does it take to recover?
Most people return to normal activities within 1–2 weeks. Heavy lifting and strenuous activities should be avoided for about 2 weeks to allow the bladder to heal.
4. Will I need further treatment after TURBT?
That depends on the biopsy results. Some tumors may require additional treatments like repeat TURBT or bladder instillations (e.g., BCG therapy) to prevent recurrence.
Conclusion
Thank you for taking the time to read through this information. TURBT is a safe and effective procedure for initial management of bladder tumors. It is important to follow all pre-and post-operative instructions to ensure the best possible outcome. If you have any further questions, don’t hesitate to reach out to your healthcare provider.
We wish you a smooth recovery!
For emergency, call your doctor or visit the hospital emergency