Diet:

• Eat clear liquids such as jello, broth, or juices (no soda or carbonated beverages) until you are regularly passing gas without difficulty or until you have a good bowel movement. You may then resume a regular diet. Avoiding gas-producing foods, such as beans and broccoli is still recommended.

Activity Level:

• It is good for you to walk around.
• Do not sit in one place for long periods of time
  -When you do sit you may benefit from sitting on a donut shaped pillow since the area operated on is right where you sit.
• Absolutely no biking, motorcycling, or horseback riding for 2 weeks.
• You can do as much walking and stair climbing as you can tolerate.
• You may take a shower 24 hours after surgery. No tub baths, swimming or hot tubs for four weeks after surgery.
• Do not drive while taking pain medications.

Skin:

• You will have 6 port sites (small incisions) that will have surgical staples over them.
• Band-Aids may come off in 24 hours.
• Once your dressings are off, it is not uncommon to have a very small amount of drainage from where your dressings were. Your staples will be removed at your first follow-up appointment.
• It is normal to have some bruising of the skin on your abdominal wall. This can develop anywhere from 1-5 days out from surgery. Although it can look scary it is rarely anything to worry about and resolves in a few weeks.

Urinary Catheter (also called a Foley catheter):

• During surgery you will have a urinary catheter placed in your bladder. A urinary catheter is a tube carrying urine from your bladder to the outside of your body into a bag. This urinary catheter will stay in place for about 1 week  to aid in the initial healing process where the bladder was sewn to the urethra
• There is a balloon on the end of the catheter that prevents it from falling out of the penis. At home, the catheter should drain into a large bag. When you want to go out, you can wear a smaller bag under your pant leg.
• Putting antibiotic ointment (ie. Neosporin) on the tip of your penis a few times a day while the catheter is in place can help to reduce the discomfort at the tip of the penis that some patients experience.
• It is normal to have urine leak around the catheter as well as through it so be sure to wear pads in your underwear even with the catheter in place
• It is also normal, especially as you become more active, to have so blood in the urine. If you see blood in the urine be sure to hydrate yourself well to flush any clots out.

Caring For Your Foley Catheter:

To Emtpy the Collection Bag:

• Wash your hands.
• Remove the stopper on the small bag, or open the clamp on the large bag, and drain the urine. (DO NOT TOUCH THE END OF THE DRAINAGE SPOUT).
• Replace the stopper, or re-clamp the drainage spout.
• Wash hands.

To Change Your Collection Bag:

• Wash your hands.
• Empty the collection bag.
• Carefully (without pulling on the Foley catheter) disconnect the catheter from the drainage tube. Connect the catheter and the new drainage tube. (DO NOT TOUCH THE OPEN END OF THE CATHETER OR THE DRAINAGE TUBE).
• Wash hands.

To Care For Your Collection Bag:

• Wash gently in warm (not hot) water.
• Rinse with a solution of 1 tablespoon of vinegar in 1 quart of water.
• Leaving the drainage spout open, hang the collection bag to air dry.

To Help Prevent Infection:

• Wash the area around the catheter at least twice every day, and as often as needed to keep the area clean and dry. Use soap and water.
• NEVER pull on your catheter to try to remove it yourself.
• Apply antibacterial ointment (ie. Neosporin) to the tip of the penis where it meet s the catheter three or more times a day to lubricate the catheter and improve its comfort and reduce the risk of infection while it is in place
• Tape the catheter or attach the Velcro strap to your thigh for comfort.
• Keep the drainage tubing free of kinks and loops.
• ALWAYS keep the collection bag below the level of the bladder.
• Drink at least eight (8) large glasses of water every day.

Notify Us Immediately If:

• Urine stops draining from your catheter into the drainage bag
• There are clots in your urine
• You experience bladder spasms that are not relieved with pain medication
• Temperature over 101 F

Urinary Control Rehabilitation

Kegel Muscle Exercises- Tips to get you started

Pelvic muscle exercises strengthen the group of muscles called the pelvic floor muscles. These muscles relax and contract under your command to control the opening and closing of your bladder. When these muscles are weak, urine leakage may result. However, you can exercise them and in many cases, regain your bladder control.

To achieve the best results when performing these exercises, imagine yourself an athlete in training. You need to build the strength and the endurance of your muscles. THIS REQUIRES REGULAR EXERCISE.

It is recommended that you starting doing Kegel exercises six-eight weeks prior to surgery.
Begin by locating the muscles to be exercises:

• As you begin urinating, try to stop or slow the urine WITHOUT tensing the muscles of your legs, buttocks, or abdomen. This is very important. Using other muscles will defeat the purpose of the exercise.
• When you are able to stop or slow the stream of urine, you know that you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.

TIPS

• You may squeeze the area of the rectum to tighten the anus as if trying not to pass gas and that will be using the correct muscles.
• Remember NOT to tense the abdominal, buttock, or thigh muscles.

Now you are ready to exercise regularly:

• After you have located the correct muscles, set aside time each day for three to four exercise sessions (morning, midday, and evening).
• Squeeze your muscles slowly and try to hold them tight for 10 seconds. Then, relax the muscles slowly. This contraction, 10 second hold, and relaxation make one "set."
• You'll want to do 10-20 "sets" 3-4 times a day
• When your pelvic floor muscles are very weak, you should begin by contracting the muscles for only three to five seconds. Begin doing what you can and continue faithfully. In a few weeks, you should be able to increase the amount of time you are able to hold the contraction and the number of exercise sets you are able to do. Your goal is to hold each contraction for ten seconds, to relax for ten seconds, and to complete 10-20 sets in each of the three to four exercise sessions per day.
    In the beginning, check yourself frequently by looking in the mirror and placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh, or buttock muscles move. If there s movement, continue to experiment until you have isolated just the muscles of the pelvic floor. 
• Your bladder control should begin to improve in three to four weeks. If you keep a record of urine leakage each day, you should begin to notice fewer instances of bladder leakage.
• Exercise your pelvic muscles regularly for a lifetime to improve and maintain bladder control.
• Pelvic muscle exercises also improve orgasmic function. Whether you are doing pelvic muscle exercise to improve or maintain bladder control or improve orgasmic function, or both, they must be done faithfully. Make them part of your routine.
• Use daily activities such as eating meals, watching the news, stopping at traffic lights, and waiting in lines as clues to do a few pelvic muscle exercises

Erectile Rehabilitation Program

General

It is important to remember that regaining erectile function takes time after prostate surgery. Nerve tissue, even when spared by your surgeon, takes time to recover from the inflammation and scarring that can occur after surgery. You should try to remain patient, and remember that this will be an ongoing rehabilitation program that will last for 6-12 months. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.

Your Two Part Customized Program

Our erectile rehabilitation program is made up of two components; (1) the use of Cialis and (2) the use of the ErecAid vacuum device. This combined therapy has been specifically designed to take advantage of both active and passive rejuvenation of your erectile tissue.

Part (1)

Cialis 5mg/day will be prescribed for two months and should be taken every day on an empty stomach just before bedtime. The reason for this is that during your sleep cycle your brain stimulates nighttime erections. Immediately after surgery it is unlikely that you will have rigid nighttime erections, however, taking Cialis at night on an empty stomach allows for improved blood flow to the penis during these stimulation periods.

This improved blood flow has been shown to have some significant benefits to the recovery of your sexual function. Specifically, following this regimen has been proven to reduce scarring in your erectile tissues and retain the smooth muscle necessary for erections to occur. Four weeks after surgery you will have healed up enough to attempt sexual stimulation. Although not many patients are able to achieve erections satisfactory for sexual activity and climax this early after surgery, seeing "some action" at this point is your goal and is expected to improve over the next 6-12 months. The use of Cialis is the "active" part of your rehabilitation regimen because it involves your body actively pumping good oxygenated blood to your penis.

Most insurance companies provide very poor coverage of this medication. We will try to help with free samples when we have those available.

Part (2)

The "passive" portion of your erectile rehabilitation program involves the use of the Osbon ErecAid device. At approximately 4 weeks post-operatively, you will begin using your ErecAid device each day to passively pump good oxygenated blood into your erectile tissues and holding it there for 10 minutes. This device uses a vacuum mechanism to pull healthy blood into the erectile tissue of your penis helping to stretch out these tissues and keep them healthy. You have been provided with an instructional DVD on the use of this device and will be scheduled to meet with the Osbon ErecAid Clinical Specialist right here at our office. This specialist will act as your "personal trainer" for this portion of your erection rehabilitation program. The purpose of this consultation is to focus on the correct use of the ErecAid device and maximizing the results of your erectile rehabilitation program. 

How will all this help me?

1. Recent clinical studies have demonstrated that penile rehabilitation through the use of Cialis and exercise programs following prostate surgery can significantly enhance the ability of the patients to regain their pre-surgery sexual function.
2. If you don't use it, you lose it! After prostate cancer treatment, many men see a decrease in penile length AND girth. With this program, you are more likely to avoid these side effects. It's important to maintain a healthy penis during this phase in order for the penis to function properly in the long run.
3. Playing an active role in your recovery process is critically important to maximizing your chances of achieving the best outcome possible 

Helping you to Maximize your Insurance Re-Imbursement

Cialis – If your insurance covers only a minimum number of pills per month, let us know and we will write a new prescription for 20mg pills that can be split into four doses, thus decreasing your out-of-pocket expense.

Osbon ErecAid - Generally, there is excellent insurance coverage for the ErecAid system. Medicare and many private insurance companies reimburse for the ErecAid system.

If you have Medicare Part B coverage (non-HMO), Medicare will cover 80% of the allowable amount, set by state, for the ErecAid. You are responsible for the 20% co-pay for DME. You may also be responsible for any deductible not yet met for the year. Additionally, many secondary insurances may reimburse the 20% co-pay directly to you. Timm Medical will take assignment of your Medicare benefit when you purchase a Manual Osbon ErecAid system. The Osbon Clinical Specialist that you meet with will file a claim directly to Medicare on your behalf. You may not file on your own.

Timm Medical does not accept assignment for the Automatic Osbon ErecAid system or if you are covered by a Medicare HMO. If you are purchasing an Automatic system or have a Medicare HMO as your primary coverage, your Osbon Clinical Specialist will file a claim to your insurance carrier on your behalf and they will reimburse you directly for any benefit covered by your plan.
Many private insurers cover a portion of the ErecAid system cost. Timm Medical will file a claim, on your behalf, without taking assignment of your benefit. In this situation, you pay for the device in full and receive reimbursement directly from your insurance company based on your plan's coverage. We recommend you contact your insurance company to determine the benefits coverage by asking about reimbursement for CPT code L7900 – out of network benefits. Many HMOs may require you to obtain an authorization prior to purchasing the ErecAid and may direct where you may purchase the device.

We realize insurance coverage may be confusing and are here to assist you with any questions you may have. For all questions regarding re-imbursement please contact Timm Customer Service at 1-800-438-8592 between 7:30 am and 6:00 pm Central Time or the Timm Reimbursement Department at 1-800-438-2221 between 8:30 am – 4:00 pm Central Time.

Please bring some form of payment to your meeting with the Osbon Clinical Specialist (i.e. Check, Credit Card). This will allow your specialist to assist you in obtaining the ErecAid device. YOU WILL NOT BE CHARGED FOR YOUR VISIT WITH THE OSBON CLINICAL SPECIALIST.