The Urology Service at Massachusetts General Hospital is committed to providing you with the highest quality medical care. As the patient, you and your family are the center of the team. We believe that understanding what to expect during your hospital stay can help lessen your anxiety and help speed your recovery. This informational has been designed to help you plan for your upcoming procedure by providing some answers to common questions. Please read it at your own pace.

Pre-Admission Visit

We would like to know as much as possible about you so that we can be prepared to care for your unique needs. In turn, we would like you and your family to have as much information as you would like, and we welcome the opportunity to answer all of your questions.  The following are the steps to admission:

1.  The Doctors’ Office

The Doctor will review your history, do a physical exam and explain the procedure answering any questions you may have. We ask that you complete a simple worksheet and bring it with you to the hospital so that we have as much information about you as possible.

At your doctor’s office you will receive:

  • A date for your surgery.
  • A Pre Admission Clinic appointment
  • Blood Bank appointment if a donation is recommended by your doctor.
  • An informational booklet " A Patient Guide to Urology at MGH "
  • A follow up Office appointment.

2.  Pre-admission Clinic

You will have your pre-admission testing.

Your testing will take about 2 to 3 hours.

You may park in the garages in front of the hospital for a fee, depending on the length of your visit. Be sure to have your parking ticket with you when you leave and have it validated at the White Front Desk, at the main entrance.

On the day of pre admission testing, go to the General Admitting office, which is located on Gray 1, Room 108. An interviewer will have you sign some important insurance documents and provide you with information about your admission.

From the General Admitting Office, you will be escorted to the Pre admission clinic. There, you will be seen by an anesthetist, a nurse and several technicians.

The anesthetist will talk to you about your anesthesia and expectations. Also discuss any medications that you are currently taking. The anesthetist will tell you which medications to continue to take on the morning of surgery.

The nurse will ask you some questions that will help the staff plan your care. The nurse will tell you more about what to expect before and after your surgery. If there is anything that you feel the staff should know , please tell the nurse.

Pre Admission testing may be done at an outside hospital. The results would have to be faxed or hand carried to the Urologist’s office. Discuss this option with your Urologist.

More information on pre-admission services and procedures

3.  Insurance Approval for admission

The staff in the Admitting Office will notify your insurance company of your pending surgery and admission to obtain approval. During this process, an admitting Office staff person will call to make sure that the hospital has all of the necessary information to process your admission. Some insurance plans require patients to make a co-payment or pay a deductible. If you have this type of insurance, you may receive a call from the Admitting Office 1 - 3 days before your admission. If you have any questions concerning the process, you may call the Mass General Admitting Office at 617-726-3393.

4.  Case Manager / Social Worker

A case manager / social worker is available to see you in the Pre Admission Clinic while you are having your testing if you have any concerns related to your discharge.

While you are an inpatient a case manager will be available to assist you in identifying any special needs / problems you may anticipate having when you are discharged. She / he will then assist you and your family by arranging for the supports necessary for discharge. They will also assist if there is a need for family lodging while you are in the Hospital.

Questions to ask yourself about your discharge so that we may help you and your family plan for it:

  • Is there a family member/friend available to bring you home on the day of discharge?
  • Will a family member/friend be available to assist you at home for at least the first week?
  • Will you need a Visiting Nurse to follow up with you at home?
  • Will you need a short Rehabilitation stay?

5.  Medication Restrictions

Any medication which increases your potential to bleed must be stopped before surgery.

Aspirin or aspirin like products ( such as Advil or any other medication which contains Ibuprofen ) must be stopped 1 week before surgery. Coumadin must be stopped 3 days before surgery ( discuss with your Urologist). Persantine must be stopped 5 days before surgery. Tylenol may be taken any time. Please review the attached list of medications containing aspirin or ibuprofen, all of which must be avoided.

6.  Inpatient Nursing Unit

The team on our inpatient nursing units are available to both you and your family before your surgery. We encourage you to call or come up to visit the unit, we can then introduce ourselves, review some of the educational information and answer any of your questions.

7.  Activity

Being active before surgery helps to condition you and often makes you feelbetter. If you have an exercise program continue to follow it; if not try to increase you daily walking.

If you have any questions about appropriate exercises for you, ask you doctor. For most patients, walking is an appropriate exercise. Deep breathing and breathing exercises will be important after surgery.

The Day of Surgery

Just a few reminders:

  • Take all your cardiac ( heart ) and blood pressure medications with a sip of water, unless otherwise told by your doctor or the anesthetist.
  • Do not take your insulin unless instructed to do so but bring it with you.
  • DO NOT EAT ANYTHING AFTER MIDNIGHT.
  • After midnight and up to 3 hours before your arrival at MGH you may drink one cup of one of the following, ONLY: black coffee, black tea, or water. You may Not drink milk or citrus juices.
  • Please bring your medications, particularly any inhalers and eye drops.
  • Do bring your own comfortable slippers and personal toilet articles.
  • Please leave all valuables at home.

Reporting to Same Day Surgery Unit

On the day of your surgery we will ask that you report to the Same Day Surgical Unit approximately two hours before your surgery is scheduled. The Same Day Surgical Unit is located in the Wang Ambulatory Care Center, Room 309.

A receptionist will greet you, check your belongings and ask your family member or escort where the doctor can reach them after your surgery is completed. A nursing assistant will then escort you to an area where you will change into hospital pajamas. A nurse will take your temperature and blood pressure, check to see when you last ate and answer any questions that you might have.

Operating Room

You will be escorted from the Same Day Surgery Unit to a holding area where the final preparations for your surgery will be completed. There is always a lot of activity in this area. The nurses, anesthetist and surgeons will be talking with you so feel free to ask any questions. The anesthetist will start an intravenous and may give you some medications to help you relax.

After this you will be moved into the operating room. The anesthetist will then attach various monitors and administer oxygen to you. Soon after this you will drift off to sleep.

When the surgery is complete you will be escorted to the recovery room by the anesthetist.

Post-Anesthesia Care Unit

Your next stop is the Post Anesthesia Care Unit (PACU) also known as the recovery room. At this time you will be sleepy but arousable.

Once again the environment will be cool, noisy and busy but the nurse will be close by to make you feel as comfortable as possible. Your stay in the recovery room will range from 2 - 4 hours.

Family Waiting Area

For your family this will be a long day. We recommend that if they are planning to wait at Mass General during your surgery, they do so in the Yawkey Family Waiting Area: Yawkey Building, Floor 2, Room 2E-2700 (above the Riverside Café). It will be open 8 am to 5 pm, Monday through Friday. After 5 pm (Monday through Friday), families will wait in the Blum Center, White Building, first floor, Room 110. The phone number for the Family Waiting Area is 617-726-2078. Volunteers there can provide the most accurate information regarding your status. In most cases your family will be notified when the surgery is beginning and the doctor will contact them when your surgery is finished.

After the surgery is finished and your family has talked to the doctor we suggest that they go for lunch, coffee or for a short walk because you will spend at least 2 - 4 hours in the PACU. The staff on your inpatient unit has very little information about you until the PACU is ready to send you to the floor.

If your family will be waiting at home for the doctor’s call, tell the reception desk in the Same Day Surgery Unit. The receptionist can leave a note for the doctor, if you have not already made arrangements for the phone call at the end of your surgery.

Common Issues After Surgery

Pain

You can expect that you will have some pain at the site of your incision. Your nurses and doctors will work with you to find the best way to ensure your comfort. Here are some of the common ways:

  • Patient-Controlled Analgesia: You will have a button to push when you are feeling pain and the pain medication will be delivered through your IV (most commonly used by urologists).
  • Epidural Catheter: Right before your operation a catheter is placed into your back. Medication continuously flows into the nerves so that your incision is not painful. (Not frequently used in Urology).
  • Oral Medications: When you are able to drink and/or eat, you will be switched to medications you can take by mouth, such as Percocet.

It is important for you to let us know if your pain is interfering with your ability to cough, breathe deeply, or move. We will ask your to rate your pain on a scale of 0 to 10; 0 = no pain, 10 = the worst pain.

Take the prescribed pain medication as you need it so that you can heal and perform activities that promote recovery.

Activity / Physical Therapy

One of the best things you can do for yourself is to be physically active after your surgery. Participating in physical therapy ( not all patients require) and normal activities of daily living helps prevent complications associated with your operation. The most common complications are pneumonia, thrombosis ( blood clot in the leg ) and general weakness, which may delay your recovery.

We will assist you with your bath and with getting out of bed the day after surgery. If needed the physical therapist will show you general exercises to help prevent problems associated with immobility ( for Nephrectomy & Cystectomy patients ).

Coughing, Deep Breathing

To prevent pneumonia and help your lungs to expand, you will need to cough and deep breath at least every two hours. You will be shown how to use an incentive spirometer and will need to use it at least once every hour ( 10 - 15 repetitions ), while you are awake. You will be shown how to support your incision using a pillow or your hands.

Eating and Drinking

Anesthesia, surgery and pain medicines often slow down your bowel activity. How soon you are able to eat and drink depends on what type of surgery you have had; whether or not you have had nausea and how your bowels are working after surgery.

Rectal passing of gas is an indication to us that you are ready to begin eating.

Recovery

Once you have recovered from anesthesia and are ready, you will be transferred to an inpatient room. The staff on these units specialize in caring for patients who have had surgery.

We will be expecting you! Upon your arrival we will get you settled and make you comfortable in your room. Your family is welcome to visit shortly thereafter. While you are getting settled in your room, your family may wait in the visitor’s lounge.

We will do the best to honor your request for a private room, but ask for your understanding if there are none available.

The hospital visiting hours are 1PM - 8PM. However we are very flexible. Children under the age of 12 should not visit patients. This is for their own protection as well as a courtesy to the other patients on the unit. Please realize that we will need some time in the morning to provide care and do patient teaching. We also ask visitors to leave by 8 PM in the evening for the same reasons. Your family is welcome to call the nursing staff after 10AM for information at (617) 726-3348. This time frame gives the nurses a chance to see and assess all of their patients.

What to Expect Each Day

The plan for your care each day will generally follow the Patient Clinical Pathway (a plan of care designed by your doctors and nurses). However, you and your nurse will design your day together. The following will explain in greater detail some specific areas of the pathway.

The Urology Team

  • YOU and Your family
  • Your Urologist
  • Urology Residents
  • Nurse Manager
  • Nursing Staff
  • Operations Coordinator
  • Unit Support Staff
  • Case Manager
  • Social Worker
  • Physical Therapists
  • Environmental Staff
  • Dietary Staff

Communication

  • If you have any questions, please ask!
  • If you have specific questions for your doctor, write them down so you won’t forget to ask when your doctor makes rounds.
  • Most of the Urologists and the Urology Residents make patient care rounds twice a day usually 7 AM and 5 PM and more often if needed.

Pain

Sometimes patients are worried about taking pain medication for fear of addiction. Addiction does not develop in the relatively short time that pain medication is needed. Please remember to be kind to yourself and to let us know if your pain is interfering with your ability to move and cough. It is important for you to be as comfortable as possible so you can participate in the activities that will help you get better.

The patients who under go Perineal Prostatectomies may experience some lower back strain due to positioning on the operating table.

Activities

  • After surgery the nursing staff and/or the physical therapist will assess your lungs. You will be encouraged to take deep breaths and cough in addition to using an incentive spirometer, hourly while you are awake. This will not harm your incision and it is very important in preventing pneumonia.
  • While you are in bed, changing your position from side to side every few hours is also good for you.
  • With your nurses’ help you will usually get out of bed and start walking the day after surgery. This may vary slightly depending on the doctor. Each day your activity will increase. It is very important to walk as much as possible since this helps in preventing blood clots from forming as well as helping your bowels return to normal.
  • You will wear elastic stockings and air ( pneumo ) boots while in bed until you are able to get up and walk around on your own. However, you will wear the air boots at night until discharge. The boots are made of soft plastic material and wrap around your legs. They help the circulation and assist in the prevention of blood clots by rhythmically inflating and deflating.
  • For Prostatectomies Only - No sitting for the first 48 hours and then only for short periods of time. The recumbent position will be the most comfortable when you start sitting.

Medications

Initially you will receive antibiotics and pain medication intravenously. When you begin to take liquids these will be changed to pill form. You will receive your daily medications each day from the nurse. Please do not take your own, however if you have a specific routine when taking your medications let the us know and we will maintain that schedule.

Diet

Surgery, pain medication and anesthesia commonly slow down your bowel function.

You will start out with sips of liquids and progress to a regular diet once you have passed gas. To us passing gas is a milestone. We are cautious about feeding patients because if we feed you too fast you may become sick to your stomach.

Initially we expect that you will not move your bowels for a few days. Our cardinal rule is NO STRAINING! It will come. Activity helps move things along and relieve gas pains.

Urinary Catheter

  • A catheter is a tube that goes into your bladder to drain urine. The catheter is usually placed while you are asleep in the operating room. Some patients experience a feeling that they have to urinate even though the catheter is draining urine. This is normal, but we encourage you to discuss it with your nurse.
  • Don’t worry, the catheter is held firmly in place. It won’t fall out while you are moving.

Teaching

Your nurses and doctors will explain the procedures and the plan to you. There is patient teaching done daily. We focus on post operative routines, preparation for discharge and individual concerns. The teaching is very specific to the procedure that you had done. We also try to include your families as much as possible.

Feel free to ask any questions.

Remember

  • Every day things will get easier.
  • Don’t be afraid to take pain medication when you are uncomfortable.
  • Walk, Walk and Walk some more....it will help speed your recovery.
  • Ask us anything that concerns you.
  • Your care will be delivered and reviewed by a collaborative team of whom you are the most important person.
Discharge

Prior to discharge you will:

  • Have received and reviewed the discharge information specific to your procedure.
  • Demonstrate the ability to care for any tubes that you may have upon discharge.
  • Have a plan for any home care you will need such as the Visiting Nurse if needed.

Prior to discharge you will receive:

  • Written discharge instructions.
  • Supplies to care for any tubes that you have upon discharge.
  • Written information with your follow up appointment and the visiting nurses phone number (if needed ).
  • Prescriptions for pain medication and antibiotics ( if needed ). If your home is out of state, be aware that prescriptions for pain medication must be filled in Massachusetts. There is a CVS across the street, on the corner of Charles and Cambridge Streets
  • If requested any information related to community resources or support groups.

To help you be more comfortable on the ride home, we recommend you take pain medication about a half hour or so before you leave. If your nurse does not offer pain medicine at this time, don’t hesitate to ask.

Discharge time is flexible, but usually it will be before noon.

The information in this site is intended solely for educational purposes. It is not an attempt to practice medicine and should not be used for individual treatment purposes. You should consult a qualified physician for medical advice and answers to personal questions. You assume full responsibility for using this site and understand that MGH and Partners-affiliated entities are not responsible for damage or injury to any individuals or property arising from the use of the site. While we try to maintain the accuracy of the information we present, health care information changes quickly. We disclaim any representation or warranty about the site’s accuracy, completeness or appropriateness for a particular purpose.