Urology–

Dr. Payne's Instructions for Patients

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Stanford Hospital Urology Clinic

Post-Operative Instructions Following Vaginal Surgery

Diet: Please eat and drink what you like. It is not uncommon to have a poor appetite after surgery. It is not a cause for alarm as long as you keep up some food intake. It is important to have a healthy fluid intake, 6-8 glasses per day. Although all liquids are OK, water is the best as some patients find juices and caffeinated fluids irritating to the bladder. There is no advantage in drinking huge amounts of fluid as it will cause frequency.

Pain: Post-operative pain varies widely from person to person. In any case, we expect you to have good pain control. At discharge you will be given a prescription for a mild narcotic (Vicodin). The maximum dose of Vicodin is 8 tablets per day. It is also OK to use anti-inflammatory medications like Motrin, Naprosyn, etc. along with or instead of the Vicodin. If the Vicodin is too strong the pills can be cut in half. If pain control is inadequate or you need additional medication please call.

Bowel Function: We typically begin using stool softeners in the immediate post-operative period. The change in activity and diet can lead to constipation. Pain medication can be another problem in this area. If you do not have a normal bowel movement within the first few days of your surgery please take a gentle laxative such as Milk of Magnesia or Senekot. Anything that you have used in the past with success is OK. It is important to avoid straining for a bowel movement.

Vaginal Bleeding: It is common to have some vaginal bleeding for 10-14 days after surgery. After the first 1-2 days it is typically only spotting on a pad. If it is much heavier you should decrease your activity level and call us.

Vaginal Discharge: There are stitches inside the vagina from the operation. These will all dissolve, but it may take a full 6 weeks. In the meantime, your usual vaginal secretions can collect on the stitches. This can cause bacteria to grow leading to discharge, odor, and itching. The best prevention is to soak in a tub several times per week so that water gets inside the vagina and keeps the area clean. Avoid using any strong soaps which may contain chemicals that will irritate the tissues.

Normal Activity: It is important to be active, walk, and breathe deeply to prevent blood clots and pneumonia. It is OK to go up and down stairs carefully. Remember that your body is using much of your energy in the healing process so is normal to feel tired. Plan to take naps and get extra sleep. You will not be able to do all of your usual tasks so it is wise to plan for assistance from friends and family, particularly in the first week.

Prohibited Activity: Heavy lifting (more than about five pounds), exercise (no treadmill, golf, aerobics, etc.), vaginal intercourse. There is no exact time frame for resuming full activity. For simple incontinence surgery, it is probably OK to resume all activities after 3-4 weeks. For more complex reconstruction for prolapse it is best to wait at least 6 weeks. Complete wound healing does not occur for up to 9 months so be careful about lifting and straining activities after surgery for prolapse.

Driving: It is fine to ride in a car but you should not drive until you have adequately recovered. Your reflexes may be slowed by post-operative pain or pain medication. A good rule of thumb is that if you have not needed any pain medication for 3-5 days then you are probably safe to drive.

If you have disability papers please fill out your portion completely, then give them to Dr. Payne's secretary.

If you have any medical questions or concerns please call Dr. Payne's nurse at (650) 725-5540. Leave your question on the answering machine; remember to speak clearly and slowly--give your name and call back number. For a night or week-end emergency please call (650) 723-6661 and ask for the on-call Urology resident.

Care of Your Foley Catheter Suprapubic Tube after Surgery

Terms

  • Suprapubic tube (SPT): A catheter placed into your bladder through the lower abdomen to facilitate emptying of urine and bladder retraining
  • Plugging/Clamping: Blocking the end of the catheter so urine does not drain out of it
  • Voided urine: the amount of urine you are able to eliminate on your own
  • Residual urine: the amount of urine left over in your bladder after you have urinated

Your bladder is a muscle. It works by expanding to store urine and then contracting to empty. It is common for the bladder to function inefficiently after pelvic surgery. In some cases the bladder functioned poorly beforehand and the surgery is intended to improve the function. In others, swelling and pain impair bladder function. Retraining is achieved gradually; for this reason the SPT was placed during the operation. It should be more comfortable than other means of managing this temporary problem. You will learn to manage the SPT during your hospitalization so that you will be able to do it by yourself at home. Please talk with your nurse regarding any questions you may have.

It is important for you to keep accurate records of the amounts you urinate on your own and the amount of residual urine in your bladder after urinating. Those numbers will help us determine when the catheter may be removed. Usually it is removed after you are urinating 80-90% of the urine in your bladder on your own.

Void Trial Instructions

When you go home after surgery:

  1. Keep the SPT plugged during the day.
  2. When you feel the need to urinate, go to the bathroom and try to urinate using the measuring container given to you at the hospital. Record that amount as "voided urine". Dump the urine out in the toilet. If you are not successful at getting some urine out within one or two minutes, proceed to the next step.
  3. When you are finished urinating or finished trying, unplug the catheter and let the residual urine flow out, again into the measuring container. Record that amount as "residual urine". Re-plug the catheter and dump out the leftover urine. Repeat steps 1-3 throughout the day as often as you feel the need to urinate.
  4. At night, connect the catheter to the large drainage bag given to you at the hospital. Leave the drainage bag connected to the catheter overnight. Empty the drainage bag in the morning and plug the catheter. Resume daytime care as in steps 1-3.
  5. Please call Dr. Payne's nurse at (650) 725-5540 to report your progress after the first 2 days at home. She will guide you in the bladder retraining process. Once we have determined you are adequately emptying your bladder, we will set up an appointment to remove the catheter here in the office. This is a brief, painless procedure.

General Supra-Pubic Tube Care

  1. A dressing has been placed around the SPT insertion site to protect your clothing from any leakage. If you are not experiencing any leakage from around your catheter, it is ok to leave the dressing off.
  2. There should be a slight, steady tension applied to the SPT. Be sure it is pulled snuggly against your skin and is secured with a sturdy tape. This tension will help prevent the leakage of urine from around the catheter.
  3. No special care is needed at the SPT site other than gentle daily cleansing with a warm washcloth. Be sure to dry the area thoroughly. If the SPT site becomes reddened or irritated, apply a light layer of an antibiotic ointment such as Polysporin or Bacitracin 1-2 times per day. These products are available over the counter at most drug stores.
  4. We recommend showering only for the first 5 days following your surgery. After 5 days we do recommend soaking in a tub of warm water to help promote healing in the vaginal area as well as to aid in general hygiene. Do not worry about getting the SPT site wet

If you have any questions or concerns regarding your care or care of the SPT please call Dr. Payne's nurse at (650) 725-5540. Leave your question on the answering machine; remember to speak clearly and slowly--give your name and call back number. If there is an emergency at night or on the week-end please call (650) 723-6661 and ask for the Urology resident on call.

Urodynamic Testing

Stanford Center for NeuroUrology 300 Pasteur Drive, Room A260, Boswell Building Stanford, CA 94305

A urodynamics study is a series of tests that evaluate the function of the lower urinary tract (bladder and sphincter). Bladder pressure, urine flow and muscle activity are monitored as the bladder fills and empties. These measurements are made by a small catheter placed through the urethra into your bladder, and a catheter in your rectum. Urodynamic testing is performed to establish or confirm a clinical diagnosis, to assess the severity of a problem, and/or to assess response to a treatment (i.e. medication, surgery, biofeedback).

Urodynamic Instructions

Before your Test:

  1. Discontinue any bladder or prostate medications except for antibiotics 5 days prior to your test. Continue taking any other medications which have been prescribed for you. In some cases, your doctor will want to perform the tests when you are taking the medications (usually this is a second or follow-up study). If you are in doubt, please call your doctor and ask.
  2. Come in with a normally full bladder. It is not necessary to be uncomfortably full. If you are on an intermittent catheterization program, catheterize yourself as usual.
  3. EAT AND DRINK AS YOU NORMALLY WOULD. We strongly encourage you to eat prior to your evaluation. DO NOT drink extra fluid--just continue with your normal routine.
  4. If possible, try to have a bowel movement before coming in for your test.
  5. If you become ill or have an elevated temperature, please call and cancel the test. You should be in your usual state of health when your have Urodynamic testing.
  6. Your will be asked to urinate in a special toilet at the beginning of the test, so please try to come with a full bladder. The testing takes approximately 2 hours.
  7. Check in at the Urology Clinic front desk 15 minutes prior to your scheduled appointment.

After your Test:

It is common to experience slight burning on urination the first few times you void after the test. Infrequently, the urine is blood tinged. These are both due to minor trauma from the catheter and resolve quickly. There is no reason to be alarmed. If you develop a fever of 101 degrees or higher, call the Urology Clinic at 650-723-6024 during working hours. Call 650-723-3391 and ask for the Urology resident on call if the Clinic is closed.

If you have any questions before or after the test, please call the urodynamics nurse 650-725-5540. Leave your question on the answering machine; remember to speak clearly and slowly--leave your name and call back number.

Urodynamic Instructions in Spanish: Dr. Payne, Dr. Kessler, Dr. Anderson
Stanford Center for Neuro Urology, 900 Blake Wilbur Dr. Suite W2001, Palo Alto, CA 94304
(650) 723-3391

CITA PARA SUS ESTUDIOS URODINAMICOS:

FECHA: ______________________________ HORA: ___________

Los Estudios Urodinamicos son una serie de analisis que ayudan a evaluar la funcion de las vias urinarias (vejiga y esfinter). Mediante un cateter en la uretra y otro en el recto, la vejiga es llenada y vaciada; de esta manera se evalua y mide su presion, el flujo de orina y la actividad del musculo.

El objetivo de los estudios Urodinamicos es establecer o confirmar un diagnostico clinico para asesorar la severidad del problema, y para determinar el mejor tratamiento mediante medicina, cirugia, o “biofeedback” (Terapia del musculo pelvico).

INSTRUCCIONES PARA LOS ESTUDIOS URODINAMICOS

ANTES DE SUS ANALISIS:

  1. Descontinue tomando cualquier medicina para la vejiga o prostata excepto a antibioticos, 5 dias antes de su cita. En algunos casos, el doctor realizara los analisis mientras toma medicinas para la prostata y la vejiga, (generalmente ocurre cuando es su segunda cita). Si tiene dudas, por favor llame al doctor y pregunte. Continue tomando las otras medicinas que han sido recetadas por otros doctores.
  2. COMA O BEBA normalmente como acostumbra. Recomendamos haber comido algo antes de su evaluacion. NO BEBA liquido adicional – solo continue con su rutina normal.
  3. Si se siente enfermo o tiene temperatura elevada, por favor llame para darle cita para otro dia. Usted debe estar en estado de salud normal cuando venga a realizarse estos analisis.
  4. Presentese a la cita con su vejiga llena; se le pedira que orine en un inodoro (toilet) especial al comienzo de sus analisis. Repetimos, no beba liquidos extra.
  5. Planee estar aqui aproximadamente 2 horas.

DESPUES DE SUS ANALISIS:

Despues de estos analisis es comun experimentar un poco de ardor al orinar. En algunos casos, la orina pudiera mostrar un poco de sangre. Esto es debido a una pequena irritacion causada por el cateter pero esto se resuelve rapidamente, no hay razon para alarmarse. Si desarrolla fiebre de 101 grados o mas, llame a la clinica de Urologia al (650) 723-3391 durante horas de oficina. Despues de las 5:00p.m. llame al (650) 723-6661 y pida hablar con el Medico de Urologia de turno.

Si tiene alguna pregunta antes o despues de su examen, llame a la enfermera al (650) 725-5540. Deje un mensaje con sus preguntas en la maquina contestadora; recuerde hablar lenta y claramente – diga su nombre, deletreelo correctamente y deje su numero de telefono donde se le pueda localizar.

Urodynamic Instructions in Spanish: Dr. Comiter
Stanford Center for Neuro Urology, 900 Blake Wilbur Dr. Suite W2001, Palo Alto, CA 94304
(650) 723-3391

CITA PARA SUS ESTUDIOS URODINAMICOS:

FECHA: ______________________________ HORA: ___________

Los Estudios Urodinamicos son una serie de analisis que ayudan a evaluar la funcion de las vias urinarias (vejiga y esfinter). Mediante un cateter en la uretra y otro en el recto, la vejiga es llenada y vaciada; de esta manera se evalua y mide su presion, el flujo de orina y la actividad del musculo.

El objetivo de los estudios Urodinamicos es establecer o confirmar un diagnostico clinico para asesorar la severidad de el problema, y para determinar el mejor tratamiento mediante medicina, cirugia, o “biofeedback” (Terapia del musculo pelvico).

INSTRUCCIONES PARA LOS ESTUDIOS URODINAMICOS

ANTES DE SUS ANALISIS:

  1. COMA O BEBA normalmente como acostumbra. Recomendamos haber comido algo antes de su evaluacion. NO BEBA liquido adicional – solo continue con su rutina normal.
  2. Si se siente enfermo o tiene temperatura elevada, por favor llame para darle cita para otro dia. Usted debe estar en estado de salud normal cuando venga a realizarse estos analisis.
  3. Presentese a la cita con su vejiga llena; se le pedira que orine en un inodoro (toilet)especial al comienzo de sus analisis. Repetimos, no beba liquidos extra.
  4. Planee estar aqui aproximadamente 2 horas.

DESPUES DE SUS ANALISIS:

Despues de estos analisis es comun experimentar un poco de ardor al orinar. En algunos casos, la orina pudiera mostrar un poco de sangre. Esto es debido a una pequena irritacion causada por el cateter pero esto se resuelve rapidamente, no hay razon para alarmarse. Si desarrolla fiebre de 101 grados o mas, llame a la clinica de Urologia al (650) 723-3391 durante horas de oficina. Despues de las 5:00p.m. llame al (650) 723-6661 y pida hablar con el Medico de Urologia de turno.

Si tiene alguna pregunta antes o despues de su examen, llame a la enfermera al (650) 725-5540. Deje un mensaje con sus preguntas en la maquina contestadora; recuerde hablar lenta y claramente – diga su nombre, deletreelo correctamente y deje su numero de telefono donde se le pueda localizar.

Forms/Instructions

Directions to Stanford Hospital Urology Clinic

From Bayshore US Highway 101 North or South

  • Take the Embarcadero Road/West exit
  • Follow Embarcadero Road for about two miles
  • Cross EI Camino Real, after which the road becomes Galvez Street
  • Turn right at Arboretum Road, left on Sand Hill Road. left on Pasteur Drive and left on Blake Wilbur Drive.
  • The Blake Wilbur Clinic will be on your left, and parking is available in the structure to your right.

From Highway 280 North or South

  • Take the Sand Hill Road exit and head east
  • Turn right on Pasteur Drive and left on Blake Wilbur Drive
  • The Blake Wilbur Clinic will be on your left. and parking is available in the structure to your right

EI Camino Real North or South

  • Turn on Sand Hill Road
  • Turn left on Pasteur Drive and left on Blake Wilbur Drive
  • The Blake Wilbur Clinic will be on your left, and parking is available in the structure to your right

There is a $10.00 fee payable at the parking garage for all day parking. First 45 minutes is free. Valet parking is also available at the main entrance and the cancer center entrance for $8.00 dollars. There are no parking validations.

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