What to expect after your retroperitoneal lymph node dissection (RPLND) surgery
During your hospitalization:
Immediately after the surgery you will be taken into the intensive care unit (ICU) or the recovery room then transferred to your hospital room once fully awake and alert.
- Postoperative Pain: Pain at the incision site is common, but is generally well controlled by intravenous pain medication, a patient controlled anesthesia pump or oral pain medication.
- Nausea: Nausea is common following any surgery, especially related to general anesthesia. This is usually transient and controlled by medication.
- Urinary Catheter: A urinary catheter (Foley catheter) is placed to drain your bladder at the time of surgery. This is in efforts to monitor your urine output over the first day or so following surgery. This is generally removed 2-4 days after surgery.
- Diet: Your diet will advance slowly following your surgery from sips of water to liquids to solids as tolerated. It is often the case that your appetite will be poor for several weeks following surgery. In addition, your intestinal function is often sluggish due to the effects of surgery and anesthesia. Until you are able to eat more and your intestine function returns, your intravenous catheter will provide the necessary hydration.
- Fatigue: Fatigue is quite common following surgery and should subside in several weeks.
- Incentive Spirometry: You will be asked to do some very simple breathing exercises to help prevent respiratory infections. Coughing and deep breathing is an important part of your recuperation and helps prevent pneumonia and other respiratory complications.
- Ambulation: Usually the day after surgery you will begin to ambulate with the supervision of your nurse or family member. Walking helps prevent pneumonia and blood clots in your legs. You will also have SCD's (sequential compression devices) wrapped around your lower legs to prevent blood clots and deep vein thrombosis. Walking 4-6 times per day is advised in the days immediately following surgery.
- Constipation/Gas Cramps: you may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. A teaspoon of mineral oil daily at home will also prevent constipation. Narcotic pain medication will also cause constipation, so patients are encouraged to discontinue use of narcotic medication as soon after surgery as possible.
- Hospital Stay: The length of hospital stay after radical orchiectomy is usually one day. The stay after RPLND surgery is generally 7-10 days.
What to expect after your discharge from the hospital
- Pain Control: For the majority of patients, one to two weeks of oral narcotic pain medication may be necessary after which Tylenol is usually sufficient. Again, narcotics should be minimized to avoid constipation and over sedation.
- Showering: patients can shower immediately upon discharge from the hospital allowing the incisions to get wet. Pat your incision dry once out of the shower and avoid heavy creams or lotions. Avoid baths and hot tubs for a couple weeks as these allow for more infection opportunities. In patients who have undergone an orchiectomy, internal sutures are used and they will dissolve on their own. For RPLND patients, staples are used to keep the wound together. These staples will be removed 1-2 weeks after surgery and adhesive tape will be applied and that can be removed in another 1-2 weeks.
- Activity: Walking 4-6 times per day for the first two weeks after surgery is strongly encouraged as prolonged sitting or lying can increase your risk of pneumonia and deep vein thrombosis. You can climb stairs as well but heavy lifting or exertion is off limits for up to 4 weeks after surgery. Patients may begin driving once you are off narcotic medication and have full range of motion at your waist (approx 4 weeks). Most patients can return to full activity, including work, in 4-8 weeks after surgery.
- Diet: Generally there are no dietary restrictions after hospitalization. Make sure to drink plenty of fluids, however.
- Follow-up Appointment: Patients should make a follow up appointment with their surgeon. Your surgeon will let you know when the best time for this appointment will be.
- Pathology Results: The pathology results from your surgery are usually available in 2-4 weeks. This will provide information as to the presence of cancer, location and size within the testis or lymph nodes and extent of growth. Your results will be discussed with you during a follow-up clinic appointment. At this time, the significance and prognosis of your diagnosis will be discussed.
- Long Term Follow-up: Based on the pathology report of your testis or retroperitoneal lymph nodes, you may need additional treatment, such as radiation or chemotherapy. You will need a CT scan, chest x-ray and blood work. The frequency of this testing will vary between patients.
When to call your doctor
Serious adverse effects are rare following orchiectomy or retroperitoneal lymph node dissection but it is important that you recognize these events and know when to contact your surgeon. You should contact your surgeon or primary care doctor immediately if any of the following occur:
- Worsening pain over the days following your surgery, despite the use of narcotic pain medication.
- Fevers greater than 101 degrees fahrenheit may indicate serious infection within the urinary tract.
- Nausea & vomiting.
- Chest pain or difficulty breathing.