Hospital Routine

On postoperative day one, pain is controlled with an epidural, and sips of liquid are begun, and hemoglobin and creatinine are checked. On postoperative day 2, the epidural is removed, and oral analgesic begun, and the diet is advanced as tolerated Catheter teaching is begun and one drain is removed in the afternoon after ambulation, if the output remains low. On postoperative day 3, the second drain is removed, and the patient is discharged on oral pain medications, a stool softener and macrodantin 50 mg per day for suppression of bacturia, while the catheter is in place.

In the event of prolonged drain output, the creatinine level is checked. If it is more than twice the serum level, the drain is pulled back and placed to gravity until drainage resolves. Mild catheter traction may also help. If drainage is lymphatic, 12 cm3 of 1/4% betadine solution is instilled through the drain and then aspirated to sclerose the lymph-atics.30'31 In either situation, patients may be discharged with the drain in place, cut short to near the skin and drained with an ostomy device for further evaluation in the office.

Postoperatively, patients return for cathether removal in 2-3 weeks without a cystogram. Early catheter removal closer to 1 week has been advocated in conjunction with a cystogram showing no or very minimal leak.32-34 Patients are encouraged to perform frequent Kegal exercises to enhance urinary control.35

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