Throw us a bone

by Donna Canada, RN, CURN

Recovery from prostate cancer can be a long process but there is a lot of help available.

People recovering from cancer benefit from adopting a "survivor" attitude. Lance Armstrong and others become advocates to share their cancer experiences and ease the journey for others. Survivorship involves skills that continue to improve over time. After the initial phases of diagnosis and treatment decision-making, it's time to think about being your own advocate. Set aside time to reflect on new priorities in your life along with new goals.

It may be helpful to keep a notebook of your prostate cancer journey and recovery, which might include copies of pathology reports, imaging tests, PSA results, current medications, drug allergies, medical/surgical history as well as your own recovery journal. A binder can be organized with dividers and inserts filed by date—set up this information to suit your own needs and preferences. Your journal, if well organized, can be very handy when seeing a new physician or if you are seeking another opinion.

In terms of prostate cancer treatment, there are three major goals to consider:

1. To be cancer free
2. To regain urinary continence and
3. To prevent impotency and restore sexual function and/or intimacy.

Take the time to grieve any losses and strive to become the best version of the "new" you, a survivor. I am writing from the unique perspective of a urology nurse and wife of a survivor. Recent research shows that the spouse may experience even more distress than the survivor himself. We all need to face this terrible situation together with patience, hope, knowledge and resiliency.

Quality of Life Issues After Prostate Surgery

How to manage your Foley catheter:

The Foley catheter is a medical device dreaded by most males. All types of prostate removal require a Foley catheter to remain in place for one to three weeks. You should receive discharge instructions on how to take care of your catheter. The catheter plays an important role in the period of healing immediately after surgery.

During radical prostatectomy a small section of the urethra that is contained within the prostate is removed. The length of this section varies depending on the size of the prostate gland. The Foley catheter allows this newly resected tissue to rejoin and heal. It is necessary to provide this conduit for the urine to exit the bladder during the healing process. The catheter is carefully placed by your surgeon. Do not allow any untrained person to tamper with the catheter until it is removed on your follow up visit. If you have any problems, questions or concerns with your catheter, make certain that you contact your urologist.

How to make living with a Foley catheter less unpleasant

The following suggestions may make the immediate post-operative period with a Foley catheter more tolerable:

• Use a Velcro-secured catheter leg strap to anchor the lower end near the Y in the tubing to prevent pulling and tugging when the catheter is secured to a leg bag or bed bag.
  
  
• Maintain unobstructed urine flow by keeping the catheter and collecting tube free from kinking.
  
  
• Keep the collection bag below the level of the bladder at all times. Do not rest the bag on the floor.
  
  
• Empty the collection bag regularly using a separate, clean collecting container. Avoid splashing and prevent contact of the drainage spigot with the collecting container.¹
  
  
• The type and location of the urinary drainage device can vary:
  • Leg bags attach to the upper thigh or lower leg.
  • Bed bags hook onto the bed or chair or can be carried when held at or below the bladder.
  • Belly bags have an anti-reflux valve and can be worn just above the bladder with a waist belt. The belly bag can give the wearer increased mobility, comfort and extra security without worries about the catheter being accidentally pulled out. The penis can be positioned and supported upward and held secure by snug brief-type underwear without the problem of tugging downward or moving about during activity.
    
    
• Gently wash the glans penis around the Foley catheter with mild soap and water daily to reduce the chance of infection. According to the latest CAUTI (catheter associated urinary tract infections) guidelines by the CDC: "Do not clean the periurethral area with antiseptics while the catheter is in place.¹
  
  
• Apply a lubricant to the tip of the penis where the Foley exits the urinary opening to prevent the rubber/latex from dragging against tender skin with movement. Be certain to ask your physician which lubricant he approves.
  
  
• When you return to your physician for your follow up visit and Foley catheterremoval, take along the following items:
  • A male guard (moderate protection pad) to insert in brief-type underwear.
  • A Ziploc bag with baby wipes and an additional guard or disposable absorbent adult brief.

Living with a Foley Catheter is no fun but following some of these suggestions will make the experience more tolerable.

References:

1. SUNA 2010 Clinical Practice Guideline Prevention and Control of Catheter Associated urinary Tract Infection. Available at: http://www.suna.org. Accessed Feb.2, 2010.
2. Eastham et.al. Risk Factors for urinary incontinence after radical prostatectomy. J urol 1996;156L1707.
3. U.S. Dept of Health and Human Services,1996, Clinical Practice Guideline number 2 (Update). Rockville, MD Agency for health Care Policy and Research.Publication No. 96-0682.
4. Ellsworth et al. 100 Q & A about Prostate Cancer, 2007, 184,185,187,189.
5. Hulme Janet a. Beyond Kegels s 2nd Edition Phoenix Publishing Co. 2002; 124,11,120,72,73.
6. Sandhu J.S. Nat Rev Urol.7, 222-228 (2010);doi1038/Nrurol.2010.26.
7. Newman D, Wein A. Managing and Treating Urinary Incontinence, Second Edition, Health Professionals Press-Baltimore, MD. 2009, 234,235,371,459.
8. Mayo Clinic. Kegel exercises for men: Understand the benefits. Available at: http://www.mayoclinic.com/health/kegel-exercises-for-men/MY01402. Accessed on June 9. 2011.
9. Bernier F, Sims TW. Management of clients with urinary disorders. Medical-surgical nursing: Clinical management for positive outcomes (8th ed. P 727-778). St Louis, MO. Elsevier Saunders; 2009.
10. Ribeiro LH. Gomes CM et al. Prostate Cancer. Journal of Urology 184: 1034-9,2010.
11. Bauer et al. Contemporary Management of post prostatectomy incontinence. European Urology (volumes 59 issue 6 page(s) 985-996 EOI: 10.1016/j.eururo.2011.03.020) European Urology 2011/03/18. Available at: http://www.ncbi.nlm.nih.gov./pubmed/20518761. Accessed on June 9, 2011.
12. Bioderm. Liberty 3.0. Available at: http://www.bioderm.us/index.php?option=com_content&view=article&id=52&Itemid=168. Accessed June 9, 2011.
13. SeekWellness. Afex for managing male incontinence. Available at: www.seekwellness.com/male_incontinence/afex.htm. Accessed June 9, 2011.
14. Omni. URINCare. Available at: www.urinCare.com. Accessed on June 9, 2011.
15. NIH consensus conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993: 270 (1): 83-90.
16. Mulhall. Saving Your Sex life. Munster, IN: Hilton Publishing Company. 2008.
17. International Journal of Impotence Research. 2008:20, 121-126.
18. Nature Reviews. Urology. Volume 6, August 2009. p.424.
19. Urologic Nursing. December 2007:27:6-563.
20. Albaugh. Urologic Nursing. May-June 2010;30-3.
21. Raina R, PahlajaniG, Agarwai, Zippe C. The early use of transurethral alprostadil after radical prostatectomy. BJU Int. 1998;100;1317.
22. Burnett AL. Erectile dysfunction following radical prostatectomy. JAMA 2005;293(21).
23. J Urol 1997; 158 (4): 1408-1410.
24. Walsh PC, Worthington JF. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, Second Edition. New York: Wellness Central; 2007.
25. Moyad M. Promoting Wellness for prostate Cancer patients, 3rd edition, Ann Arbor: Ann Arbor Editions, 2010:93-104.
26. Radiation Oncology, Division of Nursing, James Cancer Hospital and Solove Research Institute, Patient Education Handout, The Ohio State University Medical Center.
27. Bostwicket al. Complete Guide to Prostate Cancer. Atlanta: American Cancer Society; 2005:306-308.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted June 2011