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      MEDICATIONS TO AVOID BEFORE SURGERY

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      Medications Which May Cause Bleeding

      Many common medications including prescription drugs and over the counter medicines are strong anticoagulants and may cause bleeding problems in normal individuals undergoing surgery. Please review the following list to see if you are taking any of these medications which need to be discontinued for up to seven days before your surgical procedure. This list is not a complete listing but show many of the common drugs which may contain aspirin or other anti-inflammatory medication or other blood thinners.

      DO NOT STOP TAKING any medication including those on the list below without first consulting your doctor. Inform your doctor if you are taking any prescription or over the counter medications obtained in another country as they may contain some of the listed medications.

      If you must take something for a headache or other minor aches or pains you may take acetaminophen unless directed otherwise by your doctor.

      AGGRENOX

      DAYPRO

      NAPROSYN

      ADVIL

      DOAN'S PILLS

      NORGESIC

      ALKA SELTZER

      DRISTAN

      NUPRIN

      ALEVE

      DURAGESIC

      ORUDIS

      ANACIN

      ECOTRIN

      PABIRIN

      A.P.C

      EMPRAZIL

      PANALGESIC

      ASCRIPTIN

      EMPIRIN

      PEPTO BISMOL

      ASPERGUM

      ENTERIC ASPIRIN

      PERSANTINE

      ASPIRIN

      EQUAGESIC

      PERSISTIN

      BAYER ASPIRIN

      ETODOLAC

      PLAVIX

      BC POWERS

      EXCEDERIN

      RELAFEN

      BUFF-A-COMP

      EXCEDERIN PM

      ROBAXISAL

      BUFFADYNE

      FELDENE

      SINE-AID

      BUFFERIN

      FIORINAL

      SINE-OFF

      BUTALBITAL

      IBUPROFEN

      SINUTAB

      CHERACOL CAPS

      INDOCIN

      STENDIN

      CLINORIL

      KETOROLAC

      SUPAC

      CONGESPIRIN

      LODINE

      SYNALGOS

      COPE

      MEASURIN

      TOLECTIN

      COROCIDIN

      MIDOL

      TORADOL

      COUMADIN

      MONACET

      TRENTAL

      DARVON

      MOTRIN

      VANQUISH

       

       

      VITAMIN E


      This is a sample list, meant to be used as a guide. Consult with your doctor for specific instructions on when to discontinue these medications.


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      ARTIFICIAL URINARY SPHINCTER (AUS) INSERTION

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      About the Procedure:

      In some men who have significant incontinence, the placement of an inflatable artificial urinary sphincter may be required. This procedure is usually performed under general anesthesia and takes between 2 and 3 hours. It can be placed through an incision at the base of the penis, or in the skin behind the scrotum (the perineum). Patients usually go home on the day of their surgery. Once the sphincter is in place and functioning, the patient releases the sphincter and empties the bladder by depressing a button hidden in the scrotum. Once urination is complete, the sphincter automatically closes, keeping the urine in the bladder and keeping the patient dry.

      While the sphincter is designed to provide continence, it will not be ready for use until 6 weeks after its insertion. It should only be activated by your doctor. You should not expect to be dry immediately following your procedure. If you are dry immediately after the procedure, notify your doctor, as this may be a sign that the sphincter has been activated before it is ready for use.

      For more information regarding AUS insertion, click here.


      Preparing for the Procedure:

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Make arrangements for someone to drive you home on the day of your procedure.


      After the Procedure:

      Some patients will require a catheter for a few days after their procedure. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.

      While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house. It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements. Decreasing your activity and increasing fluids will usually make the urine clear. Men with a catheter may notice pink discharge at the tip of the penis—this is normal. Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.

      On the second day after your surgery, it is OK to shower, but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, and the stitches will dissolve and their own and do not need to be removed. Avoid any strenuous activity, exercise, or heavy lifting for 4 to 6 weeks after the procedure. You should abstain from sexual intercourse for 6 weeks following the procedure.

      It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).






      BLADDER BIOPSY

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      About the Procedure:

      A bladder biopsy is done during a cystoscopy in order to obtain a tissue sample from the lining of the inside of the bladder. During the cystoscopy, your doctor will pass a small forceps through the cystoscope in order to obtain the tissue sample
      (no incision is made in the skin). It is not painful, and usually takes about 15 to 20 minutes. It is usually done using only local anesthetic, but some cases may require sedation or deeper anesthesia (ask you doctor).

      Preparing for the Procedure:

      The preparation for a bladder biopsy is similar to that for a cystoscopy. Additionally, your doctor may ask you to stop taking blood-thinning medication for a few days prior to your procedure.

      After the Procedure:

      You may experience temporary burning and possibly a small amount of blood in the urine. Don't be alarmed - these will usually clear within 24 hours.

      If you develop fever, chills, or heavy bleeding, notify your doctor immediately.





      CIRCUMCISION

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      About the Procedure:

      Circumcision is the surgical removal of the foreskin—the tissue covering the head of the penis. During a circumcision, the foreskin is freed from the head of the penis (glans), and then removed. The remaining cut ends of the skin are then sutured together using stitches that will dissolve by themselves. Circumcision can be done using just local anesthetic, but sedation or deeper anesthesia may be required in some cases (check with your doctor). The procedure usually takes about one hour.

      Preparing for the Procedure:

      If you are to get sedation or general anesthesia for the procedure (check with your doctor), do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      After the Procedure:

      There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

      Make arrangements for someone else to drive you home after the procedure if you are to have sedation or general anesthesia.

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      CYSTOSCOPY

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      About the Procedure:

      Cystoscopy is a diagnostic procedure during which you bladder and urethra are examined with an instrument called a cystoscope. The instrument has a light and a fiber optic lens, and allows your doctor to directly view the lower part of your urinary tract. The cystoscopic exam is one of the most commonly performed urological procedures. It is brief, very safe, and simple and provides the doctor with immediate, valuable diagnostic information.

      The best way to prepare for your cystoscopy is to RELAX. For most of us, the thought of an instrument, even a small one, being placed into the urethra is naturally somewhat freighting. However, with the use of a local anesthetic, most patients experience only mild discomfort. When other procedures, such as biopsies, are performed through the cystoscope, an intravenous sedative may also be needed. Your cystoscopy may be performed either in a hospital or an outpatient facility.

      Preparing for the Procedure:
      As we said, it's best to not be too concerned about the procedure. RELAX - and you'll probably find that you worried needlessly.

      Just before the procedure, you'll be asked to empty your bladder. A urine sample may be obtained. You'll then be asked to remove your clothing, and you will be given a gown or drape to use.

      Men undergo cystoscopy either lying on their back, or with their legs in stirrups, depending on the type of cystoscope being used. Women will have their legs in stirrups, similar to the gynecologist's office. Once you are comfortable in the exam table, a betadine solution will be used to cleanse the genital area. Then, xylocaine jelly will be applied as a local anesthetic.

      The procedure itself takes no more than 3 or 4 minutes. Once the cystoscope is inserted, your bladder will be filled with sterile irrigating fluid, allowing the doctor to distend your bladder and see the walls more clearly. As the bladder fills, it is normal to start to feel the urge to urinate. Tell the doctor when this occurs.

      During the Procedure:
      Another test sometimes done with a cystoscopy is called a cystometrogram.This test is done when the doctor suspects a possible problem with the nerve or muscle function of the bladder. It is particularly important in evaluating the patient with incontinence.A cystometrogram is performed by placing a soft rubber catheter into the bladder and draining out the urine. Through the catheter, the bladder is filled with either water or carbon dioxide gas. As the bladder fills, the doctor will be able to evaluate the muscle strength and nerve function of the bladder.

      After the Procedure:
      You may experience temporary burning and possibly a small amount of blood in the urine. Don't be alarmed - these will usually clear within 24 hours. If you develop fever, chills, or heavy bleeding, notify your doctor immediately.


      DIAGNOSTIC FOR MALE INFERTILITY (Testis/Epididymis Biopsy)

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      About the Procedure:

      A testicular biopsy is a test to remove a small sample of tissue from one or both testicles and examined under a microscope to evaluate a man's ability to father a child. It is not usually done to detect cancer of the testicles. It involves an incision in the scrotum and then into the testicle itself. The procedure is usually done under sedation or deeper anesthesia and takes about one hour to complete.

      Preparing for the Procedure:

      If you are to get sedation or general anesthesia for the procedure (check with your doctor), do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      You should bring an athletic supporter or snug jockey shorts to wear home after the procedure.

      After the Procedure:

      There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for two weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

      Make arrangements for someone else to drive you home after the procedure if you are to have sedation or general anesthesia.


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      HYDROCELE REPAIR

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      About the Procedure:

      Hydroceles may require surgical repair if they cause symptoms, such as growing large, or causing pain or discomfort. An incision is made in the scrotum, and the hydrocele sac is cut out, removing the tissues that create the fluid that surrounded the testicle.

      Preparing for the Procedure:

      If you are to get sedation or general anesthesia for the procedure (check with your doctor), do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding.To determine which  blood-thinning medications should be avoided, ask you doctor.

      You should bring an athletic supporter or snug jockey shorts to wear home after the procedure.

      After the Procedure:

      There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

      Make arrangements for someone else to drive you home after the procedure if you are to have sedation or general anesthesia.


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      PENILE PROSTHESIS INSERTION

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      About the Procedure:

      For some men with erectile dysfunction, the insertion of an rigid or inflatable penile prosthesis may be an option. A mechanical device is inserted into the penis through a small incision at the base of the penis, and when an erection is desired, it is achieved by depressing a pump hidden within the scrotum. Once the erection is no longer desired, the device can be “deflated” by depressing the same button. The procedure is performed under general anesthesia and usually takes between 2 and 3 hours. Most patients go home the day of the procedure.

      While the penile prosthesis is designed to create an erection, it will not be ready for use until 6 weeks after your procedure and should only be activated by your doctor. This will allow the incision and tissues time to heal, allowing the device to be used safely and without discomfort.

      To learn more about IPP insertion, click here.


      Preparation for the Procedure:

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Make arrangements for someone to drive you home on the day of your procedure.


      After the Procedure:

      On the second day after your surgery, it is OK to shower, but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, and the stitches will dissolve and their own and do not need to be removed. Avoid any strenuous activity, exercise, or heavy lifting for 4 to 6 weeks after the procedure. You should abstain from sexual intercourse for 6 weeks following the procedure.

      It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).


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      PROSTATE BIOPSY

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      About the Procedure:
      Transrectal prostatic ultrasound is a diagnostic tool which allows the urologist to examine the prostate gland in great detail. It is an excellent way to guide specifically directed biopsies of the prostate. Transrectal ultrasound is done by inserting a slender probe into the rectum to visualize the prostate and adjacent structures. Once the prostate has been thoroughly examined, local anesthetics can be injected. The ultrasound is then used to guide the slender needle which will remove a very small piece of tissue to be examined by the pathologist. Multiple biopsies can easily and safely be obtained in this fashion. Patients can experience slight discomfort but is it is usually not painful. You should inform your doctor if you have experienced any prior rectal problems including hemorrhoids, fissures or any type of prior rectal surgery.

      Preparation for the Procedure:
      Your doctor will provide with you specific instructions regarding a mild bowel prep to be performed prior to the procedure. If you are given antibiotics take these exactly as you are instructed. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood thinners, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. To determine which  blood-thinning medications should be avoided, ask you doctor.

      After the Procedure:
      After your biopsy you may temporarily notice a small amount of blood in your urine, stool or semen. This is a very common occurrence and not a cause for alarm. If you should develop heavy bleeding or are unable to urinate then you should call your doctor immediately. If you experience fever or chills anytime after the exam, notify you physician immediately. Take any antibiotics that are prescribed to you for the entire course of treatment. Your physician will give you information at the time of the biopsy for the procedure for obtaining the results of the biopsy.

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      PROSTATE CRYOTHERAPY

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      About the Procedure:
      Used primarily in the treatment of prostate cancer, cryotherapy is a procedure during which, under general anesthesia, small needles are passed through the skin behind the scrotum (the perineum) and into the prostate. The prostate (and the cancer within) is then frozen, destroying the prostate cancer cells. This is done by your doctor under the guidance of ultrasound to ensure that the freezing treats the entirety of the prostate and cancer. The procedure usually takes between 2 and 3 hours, and you should expect to spend one night in the hospital. You will be sent home the next day with a catheter in your bladder to be removed by your doctor in 7 to 10 days.

      Preparation for the Procedure:

      Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, Italian ice, or chicken broth.

      Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Additionally, your doctor may have prescribed for you an enema, which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.



      After the Procedure:

      In addition to being sent home with a catheter in you bladder, there will be a dressing over the procedure site in your groin (perineum). This can usually be removed the day after you arrive home (the second day after surgery). After that, it is OK to shower, but baths and soaking in tubs should be avoided for 2 weeks following the procedure. Avoid heavy lifting, exercise, and strenuous activity for 4 to 6 weeks following your procedure.

      You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.

      While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house. It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements. Decreasing your activity and increasing fluids will usually make the urine clear. You may notice pink discharge at the tip of the penis—this is normal. Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.



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      RADICAL RETROPUBIC PROSTATECTOMY

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      About the Procedure:

      This procedure is performed primarily in the treatment of prostate cancer, and it involves the removal of the entire prostate and the seminal vesicles, and, occasionally, the lymph nodes in the pelvis. This procedure is performed through a 10 to 15 centimeter vertical incision, just below the belly button. The procedure usually takes 3 to 4 hours, under general anesthesia, and you should expect to spend at least one to two nights in the hospital.

      Preparing for the Procedure:

      Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, Italian ice, or chicken broth.

      Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Additionally, your doctor may have prescribed for you an enema which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.


      After the Procedure:

        General:

        • You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks.
        • The catheter should only be removed by your Urologist
        • Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed
        • If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.
        • Unless instructed otherwise, avoid taking aspirin, anti-inflammatory medications (ibuprofen, etc.), or blood thinners until you are seen in the office
        • Do not use any rectal suppositories or enemas
        • Remove the dressings from all incisions on the second day after surgery and leave the incisions open to air
        • Contact the office immediately you experience any of the following:
          • Swelling of one or both legs
          • Chest pain
          • Shortness of breath
          • Fevers higher than 100.5° F
          • Catheter stops draining

        Activities:

        • You can and should walk around freely (rest in bed only when tired)
        • You may climb up and down stairs slowly
        • You may shower with the catheter, but do not soak in a tub or take baths
        • You should not drive until you catheter have been removed (it is ok to ride in a car) or if you are taking narcotic pain medication
        • Avoid strenuous activity, exercise, and heavy lifting (more than 20 lbs.) for 4 weeks after your surgery
        • No bicycle or horseback riding for 8 weeks after surgery

        Diet:

        • You may eat your usual diet when at home
        • In addition to the pain medication, you should take the prescribed stool softener to prevent constipation
        • If you do not have a bowel movement within 3 days of your surgery, begin taking over-the-counter milk of magnesia twice daily until your fist bowel movement
        • Limiting the narcotic pain medication will help decrease constipation

        Catheter care:

        • While at home, keep the catheter connected to the large drainage bag
        • It is OK to use the smaller drainage bag if you plan on going out of the house
        • It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements
        • Decreasing your activity and increasing fluids will usually make the urine clear
        • You may notice pink discharge at the tip of the penis—this is normal
        • Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.

        Common Problems:

        • Leakage around the catheter:
        • This is a common problem often related to bladder spasms (leakage may be accompanied by the urge to urinate or lower abdominal pain/cramping). If urine is still draining through the catheter tubing, as well as around it, use absorbent pads to stay dry. Increase you fluid intake and decrease your activity—the spams should pass
        • If the spasms are severe, call the office and a medication to help control them can be prescribed.

        Scrotal/Penile swelling:

        • Swelling of the penis and/or scrotum is not unusual and should improve with time. It may help to elevate the scrotum with a soft towel behind the scrotum while seated or lying down

        Incision opening:

        • If an the skin of an incision should open, you may clean it with hydrogen peroxide and apply a clean gauze to cover it twice daily.

        Bruising around the incision:

        • This is normal and will get better with time.

        Constipation/bloating:

        • This is common after surgery. Walking, increasing fluids, and decreasing the use of narcotic pain medications will usually help improve these symptoms. (see Diet instructions above).



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      RADICAL CYSTECTOMY

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      About the Procedure:

      In some patients with bladder cancer, removal of the bladder and the creation of an alternate drainage system for the body's urine, may be required. This urinary diversion is necessary because the kidneys will continue to produce urine even after the bladder has been removed. The bladder is removed through a vertical 10 to 15 centimeter incision in the middle of the lower abdomen (from below the belly button to the pubic bone), in a procedure that takes between 4 and 6 hours under general anesthesia. Patients are usually in the hospital for 5 to 7 days after their procedure. Depending on the type of cancer, and the needs of each patient, the urine may be diverted to a urostomy, which is a permanent drainage opening on the skin of the lower abdomen that empties urine into a bag. Alternatively, your doctor may elect to create a new bladder (a neobladder) out of part of your bowel. This may empty through the normal urinary channel (the urethra), or it may be formed into a pouch inside of the body that needs to emptied using a catheter passed through a small opening on the skin periodically throughout each day.

      There are many options to consider, and you should ask your doctor as to which form of urinary diversion would work best for you.



      Preparing for the Procedure:

      Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, Popsicles, Italian ice, or chicken broth.

      Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Additionally, your doctor may have prescribed for you an enema which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.



      After the Procedure:

      The care of your urinary diversion will differ depending on the type of procedure you have. Ask your doctor regarding specific instructions.

      In general, there will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incision at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes.

      It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).



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      ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (da Vinci® Prostatectomy)

      About the Procedure

      Preparing for the Procedure:
      Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, Italian ice or chicken broth.

      Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.
      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).
      starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.
      Additionally, your doctor may have prescribed for you an enema which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.

      After the Procedure:

        General:

        • You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks.
        • The catheter should only be removed by your Urologist
        • Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed
        • If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.
        • Unless instructed otherwise, avoid taking aspirin, anti-inflammatory medications (ibuprofen, etc.), or blood thinners until you are seen in the office
        • Do not use any rectal suppositories or enemas
        • Remove the dressings from all incisions on the second day after surgery and leave the incisions open to air
        • Contact the office immediately you experience any of the following:
          • Swelling of one or both legs
          • Chest pain
          • Shortness of breath
          • Fevers higher than 100.5° F
          • Catheter stops draining

        Activities:

        • You can and should walk around freely (rest in bed only when tired)
        • You may climb up and down stairs slowly
        • You may shower with the catheter, but do not soak in a tub or take baths
        • You should not drive until you catheter have been removed (it is ok to ride in a car) or if you are taking narcotic pain medication
        • Avoid strenuous activity, exercise, and heavy lifting (more than 20 lbs.) for 4 weeks after your surgery
        • No bicycle or horseback riding for 8 weeks after surgery

        Diet:

        • You may eat your usual diet when at home
        • In addition to the pain medication, you should take the prescribed stool softener to prevent constipation
        • If you do not have a bowel movement within 3 days of your surgery, begin taking over-the-counter milk of magnesia twice daily until your fist bowel movement
        • Limiting the narcotic pain medication will help decrease constipation

        Catheter care:

        • While at home, keep the catheter connected to the large drainage bag
        • It is OK to use the smaller drainage bag if you plan on going out of the house
        • It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements
        • Decreasing your activity and increasing fluids will usually make the urine clear
        • You may notice pink discharge at the tip of the penis—this is normal
        • Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.

        Common Problems:

        • Leakage around the catheter:
        • This is a common problem often related to bladder spasms (leakage may be accompanied by the urge to urinate or lower abdominal pain/cramping). If urine is still draining through the catheter tubing, as well as around it, use absorbent pads to stay dry. Increase you fluid intake and decrease your activity—the spams should pass
        • If the spasms are severe, call the office and a medication to help control them can be prescribed.

        Scrotal/Penile swelling:

        • Swelling of the penis and/or scrotum is not unusual and should improve with time. It may help to elevate the scrotum with a soft towel behind the scrotum while seated or lying down

        Incision opening:

        • If an the skin of an incision should open, you may clean it with hydrogen peroxide and apply a clean gauze to cover it twice daily.

        Bruising around the incision:

        • This is normal and will get better with time.

        Constipation/bloating:

        • This is common after surgery. Walking, increasing fluids, and decreasing the use of narcotic pain medications will usually help improve these symptoms. (see Diet instructions above).



      SHOCK WAVE LITHOTRIPSY

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      About the Procedure:

      Many stones in the kidney or ureter (tube between the kidney and bladder) can be treated with a noninvasive treatment known as shock wave lithotripsy or SWL. This procedure uses high energy shock waves to break up urinary stones into sand like particles. During the treatment, shock waves are focused precisely on the stone. Up to 3,000 shock waves are administered to the stone causing it to disintegrate. These smaller fragments of stone can then be passed in your urine with little discomfort. The procedure is performed under sedation administered by your anesthesiologist and takes approximately thirty minutes. Unlike other treatments, no incisions or catheters are required. Patients are usually able to return to the comfort of their own home within an hour or two following the procedure.

      Preparing for the Procedure:

      If your doctor has recommended SWL for your stone then there are a few things you should know. Your doctor?s office will provide you with information regarding the date, time and location of your treatment. You will be required to have a preoperative history and physical as well as laboratory work completed several days prior to your procedure. You will be asked to bring all of your x-rays and CT scans with you including your most recent KUB x-ray. You will not be allowed to eat or drink anything after midnight the night before your procedure. Check with your doctor about taking heart medicines or medications for diabetes or high blood pressure on the morning of the procedure. You may be instructed to take these medicines with a small sip of water. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood thinners, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Your doctor will use a real time x-ray called fluoroscopy to precisely locate your stone during the treatment. For this reason it is important to follow a few simple procedures to minimize the amount of gas or stool in the bowel which might make visualization of your stone more difficult.

      1. Take only clear liquids on the day prior to the procedure. Acceptable liquids are tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice or chicken broth.

      2. Do not drink carbonated beverages such as sodas or sparkling water on the day before your procedure.

      3. Do not chew gum or eat hard candy the day prior to your treatment.

      4. Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy.

      5. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood thinners, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. If you are unsure about which medications may cause bleeding, click here or ask your doctor.

      After the Procedure:

      The recovery period following SWL is usually only a few days. The small stone particles are passed from your body in the urine over the next several days or weeks. You should drink plenty of liquids, especially water in the days and weeks following the procedure. You will be asked to strain your urine following the procedure and bring the small pieces of gravel to your doctor for analysis. You may experience some discomfort when passing larger fragments. You will be provided with a prescription for pain medicine to take if you need it. In the unlikely event you experience more severe pain or a fever you should call your doctor at once. You will typically have another x-ray several weeks later and you will need to bring this x-ray and the preoperative x-rays to your doctor’s office to be sure the stone has completely cleared.




      "SLING PROCEDURE" FOR INCONTINENCE

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      About the Procedure:

      In both men and women with certain types of incontinence, the insertion of a sling—a mesh tape that provides support to the urethra—may provide an improvement in symptoms. This procedure is performed under sedation or general anesthesia on an outpatient basis—most patients are able to go home the day of the procedure—and takes 1 to 2 hours to perform. While some patients may require a catheter for a few days after the procedure, most will urinate normally immediately after the procedure, beginning in the recovery room.

      To learn more about the procedure click here (for men) or click here (for women)


      Preparing for the Procedure:

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Make arrangements for someone to drive you home on the day of your procedure.

      After the Procedure:

      Some patients will require a catheter for a few days after their procedure. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.
      While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house. It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements. Decreasing your activity and increasing fluids will usually make the urine clear. Men with a catheter may notice pink discharge at the tip of the penis—this is normal. Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.
      On the second day after your surgery, it is OK to shower, but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, and the stitches will dissolve and their own and do not need to be removed. Avoid any strenuous activity, exercise, or heavy lifting for 4 to 6 weeks after the procedure. You should abstain from sexual intercourse for 6 weeks following the procedure.
      It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).


      TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) – TRADITIONAL AND LASER

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      About the Procedure:

      Some men with lower urinary tract symptoms as a result of an enlarged prostate or BPH will require a surgical procedure to reduce the size of the prostate. This is not done through an incision in the skin, but rather by passing a telescope into the penis while the patient is under general or spinal anesthesia. Using the telescope, a heated element is used to remove the excess prostate tissue. After this traditional method, you should expect to stay in the hospital for at least one night with a catheter in you bladder. Some patients may go home with the catheter, but most will have it removed the next day to try to urinate without it.
      Alternatively, a laser (KTP or “greenlight” laser) can be used instead of the heated element to remove the excess prostate tissue. Some of the benefits of this procedure include decreased blood loss, and the possibility of going home the same day of your surgery, sometimes without a catheter.


      Preparing for the Procedure:

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      Make arrangements for someone to drive you home on the day of your procedure.


      After the Procedure:

      Some patients will require a catheter for a few days after their procedure. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears.
      While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house. It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements. Decreasing your activity and increasing fluids will usually make the urine clear. Men with a catheter may notice pink discharge at the tip of the penis—this is normal. Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation.
      After your surgery, it is OK to shower, but baths and soaking in a tub should be avoided until the catheter is removed. Avoid any strenuous activity, exercise, or heavy lifting for 4 to 6 weeks after the procedure.
      It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).


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      URETEROSCOPY AND LASER LITHOTRIPSY

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      About the Procedure:

      This treatment involves the use of a very small, fiber-optic instrument called a ureteroscope, which allows access to stones in the ureter or kidney. The ureteroscope allows your urologist to directly visualize the stone by progressing up the ureter via the bladder. No incisions are necessary but general anesthesia is used.

      Once the stone is seen through the ureteroscope, a small, basket-like device can be used to grasp smaller stones and remove them. If a stone is too large to remove, a laser, spark-generating probe or air-driven (pneumatic) probe can be passed through a channel built into the ureteroscope and the stone can be fragmented.

      A straightforward case is complete once the stone has been shattered appropriately. However, if extensive manipulation was required to reach and/or treat the stone, your urologist may choose to place a stent within the ureter to allow the post-operative swelling to subside.

      Preparing for the Procedure:

      Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

      Bring any copies of films or CDs of any radiology studies (X-rays or CT scans) with you on the day of your procedure.

      Make arrangements for someone to drive you home on the day of your procedure.


      After the Procedure:

      Most patients will be discharged home on the day of their procedure without a catheter in their bladder. If your doctor has left a stent in your kidney, you may experience an increased urge to urinate, as well as increased frequency of urination. Additionally, some patients experience mild to moderate discomfort in their back or lower abdomen, especially during urination. Finally, some blood in the urine may appear after the procedure, as well as some burning with urination. These symptoms are normal and may last as long as you have the stent in your body. Your doctor may prescribe you medication to help lessen these symptoms, so it is important to take the medications prescribed to you. Increasing your fluid intake will also help dilute the urine and lessen these symptoms.

      It is very important to follow up with your doctor to schedule to have the stent removed, as leaving the stent in for prolonged periods of time may lead to infections, further stone formation, and/or permanent kidney damage.


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      URODYNAMIC TESTING

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      About the Procedure:

      Urodynamics testing is a series of procedures designed to provide information about a bladder problem. They can measure the bladder's ability to hold and release urine and usually involve placing a small catheter into the bladder. It provides a more advanced way to check bladder function, and it does not require anesthesia. You may be asked a series of questions about the sensations you feel in your bladder during the test to help you doctor better understand your problem. The procedure usually takes approximately 15 minutes and may be combined with a cystoscopy or other procedures.

      Preparing for the Procedure:

      The most important thing to do is to relax. The testing is most accurate when we can recreate your symptoms during the test. The procedure will not be painful, and by staying relaxed, you can help ensure that the information obtained during the test is as accurate as possible.

      After the Procedure:

      You may experience temporary burning and possibly a small amount of blood in the urine. Don't be alarmed - these will usually clear within 24 hours.

      If you develop fever, chills, or heavy bleeding, notify your doctor immediately


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      VARICOCELE REPAIR

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      About the Procedure:

      Varicocele repair is performed to improve male fertility. It can usually be done surgically on an outpatient basis using local anesthetic, but some cases may require sedation or deeper anesthesia. A small incision is made in the lower abdomen, on the side of the varicocele. The veins that produce the varicocele are identified and cut to eliminate the swelling in these vessels. The procedure usually takes about 60 to 90 minutes.

      Preparing for the Procedure:

      If you are to get sedation or general anesthesia for the procedure (check with your doctor), do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. To determine which  blood-thinning medications should be avoided, ask you doctor.

      After the Procedure:

      There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

      Make arrangements for someone else to drive you home after the procedure if you are to have sedation or general anesthesia.


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      VASECTOMY

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      Preparation for the Procedure:

      1. On the day of the procedure, shave all the hair on the front of your scotum - from the point where it meets the body - down to the bottom. If the hair is long, scissor cut it first, then shave the area.

      2. Shower with a mild soap to remove the loose hair.

      3. You may be given an envelope containing two pills - a mild sedative, and an antibiotic. Your physician will instruct you to take both medications or possibly only take the antibiotic if you are driving your self home.

      4. Make arrangements for someone else to drive you home after the vasectomy if you took the sedative. This is important since the sedative can cause drowsiness.

      5. You should bring an athletic supporter or snug jockey shorts to wear home after the procedure.

      6. Please read all the documents and sign the authorization sheet along with your wife.

      7. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood thinners, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. To determine which  blood-thinning medications should be avoided, ask you doctor.

      After the Procedure:

      Although the vast majority of patients make a smooth, uneventful recovery from their procedure, the chances of any problem occurring can be minimized by following a few simple instructions.

      1. Go straight home after the procedure, and place a cold pack, or a zip lock bag filled with ice on the incision site over the supporter. Keep it on for 30 minutes, then off for 15 minutes. Do this for 8 to 10 hours or until you go to sleep that night.

      2. Limit your physical activity for at least one week. This means no heavy lifting, exercise, jogging, treadmill tennis, etc. If you have any question about a particular activity, ask your doctor.

      3. Remove the bandage the day after the procedure, and replace it with a clean one. After 2 to 3 days, no bandage is needed, unless having one makes you more comfortable. Be sure you use jockey shorts or an athletic supporter for one week after the procedure.

      4. Keep the area dry for 24 hours after the procedure. After that, you should shower twice a day, letting the water cleanse the incision areas. Use only a mild soap, and do not use a Jacuzzi or hot tub for one week.

      5. The skin sutures will dissolve within two weeks, and do not need to be removed.

      6. You may eat and drink after the procedure.

      7. There usually is a small amount of swelling and bruising which occurs after the vasectomy. If the bruising extends beyond the scrotum, or if the swelling under the incisions get larger than "golf ball size", call the doctor's office. A small amount of blood on the bandage in the first hours after the procedure is expected. If the bleeding continues, or if several days later, pus begins to drain from the incision site, call the office.

      8. Remember, you are NOT considered "safe", that is, the vasectomy is not considered effective until follow up semen analyses have shown the complete absence of sperm.

      9. To confirm that the vasectomy has worked, you must have one or  two semen analyses done - one at six weeks after the vasectomy, and the other at eight weeks (ask your doctor for specific instructions). The specimens should be delivered to the lab within one hour of collection. Make sure to label the specimen container with your name and the date or the lab will reject the specimen. Make sure the lab participates with your insurance company.

      10. Once your specimen has been taken to the lab, you may call your doctor's office to get the results to confirm your sterility. You need to continue to use birth control until that time..

      11. The lab fee for the semen analysis and the pathologist's fee examining the vasectomy specimens are independent of the physician's fee. These fees can be submitted to your insurance carrier.










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