Patient handout

Post-Prostatectomy Complications (post-RP + TURP) — bleeding / stricture / incontinence / ED / lymphocele / DVT-PE / rectal injury / TURP syndrome

PRODUCTION

1. Your condition

This handout is for post-prostatectomy complications (post-rp + turp) — bleeding / stricture / incontinence / ed / lymphocele / dvt-pe / rectal injury / turp syndrome. Your care team identified this based on: post-radical prostatectomy follow-up visit (1 wk, 6 wk, 3 mo, 6 mo, annual) (aua bph 2021; nccn prostate 2023).

Other reasons your team may use this plan: post-turp follow-up visit; post-operative bleeding (24-48h or delayed) — hematuria / clot retention (aua bph 2021); weak urinary stream / urinary retention post-op → anastomotic stricture or bladder neck contracture.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
sildenafil	50 mg PO PRN; titrate to 100 mg	PO	PRN before intercourse	PDE5i for post-RP ED rehab; daily low-dose tadalafil alternative; counsel re α-blocker BP interaction (PMID 25140208)
tadalafil	5 mg PO daily	PO	daily	Daily low-dose tadalafil for penile rehab post-RP; counsel re α-blocker BP interaction

Plan: Post-RP ED ladder — PDE5i → VED → intracavernosal injection → penile implant

3. When to call your provider

Contact your care team if any of the following happen:

Severe bleeding / hemodynamic instability → ED + STAT OR/IR (AUA BPH 2021)
Sudden chest pain / dyspnea → ED + STAT CT-PE (route pulm.pe.core.v1)
Severe hyponatremia + AMS → ED + ICU (route syndrome.hyponatremia.core.v1)
Rapid PSA rise → onc consult (NCCN 2023)
Refractory UI → uro + sling/AUS evaluation (PMID 31059663)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Early (<48h) hemorrhage requires resuscitation, transfusion, anticoag reversal, possible OR exploration or IR embolization; delayed (1-3 wk) anastomotic bleed (AUA BPH 2021)
DVT / PE post-pelvic cancer surgery — Wells score gate; route to real cardio.dvt.core.v1 or pulm.pe.core.v1 (ASCO/ACCP)
Rectal injury — intra-operative recognition + repair; delayed rectourethral fistula → surgical repair, often diverting colostomy
TURP syndrome — historic with glycine/sorbitol irrigant → dilutional hyponatremia + AMS + nausea + HTN; ROUTE syndrome.hyponatremia.core.v1; 3% saline if severe symptomatic (AUA BPH 2021)(life-threatening)

5. Follow-up

Coordinate with oncology for biochemical surveillance per NCCN; psych support for functional outcomes; salvage radiation discussion if biochemical recurrence (NCCN 2023)

6. Sources

Guideline: AUA BPH 2021 + NCCN Prostate Cancer 2023 + AUA/SUFU Incontinence + Post-RP ED rehabilitation + ASCO/ACCP VTE prophylaxis