Your inpatient stay for PSMA-radioguided surgery

We have developed a standardised structure for inpatient stays with us for surgical removal of lymph nodes or soft tissue metastases (salvage operation) with or without the use of a gamma probe. This is not a set of rigid targets and instead acts as a guide for the required measures. Of course, we always tailor this structure to each individual patient’s treatment. One main advantage of this structure, however, is that you have a better idea of what to expect, which will help you prepare for your stay. This page therefore provides a guide to a typical inpatient stay with us.

Day of admission for radioguided surgery

You can eat breakfast as normal on the day of your admission; you do not need to fast before arriving at the clinic. On the day you are admitted, we will hold several conversations with you and conduct some tests to allow you and us to prepare fully for your upcoming treatment. You will be welcomed firstly in the Outpatient department, where you will sign all the necessary treatment contracts. You will then be taken to the ward where a nurse will welcome you and explain what will happen during your stay. The following things will happen on the day of admission, potentially in a different order for organisational reasons:

The ward doctor will explain your upcoming procedure in detail and answer any questions you have.
The anaesthetist will discuss the anaesthesia with you. They will also determine which of your usual prescribed medication you should continue to take and may also prescribe a sleeping tablet for the evening before the operation.
If your salvage operation has been planned with radioactive labelling and a gamma probe (PSMA-radioguided surgery), you will also have to visit our colleagues in nuclear medicine early in the afternoon. They will inject you with a mildly radioactive prostate-specific marker (PSMA ligands).

In addition to explanatory and informative conversations, we will also carry out the following examinations:

Blood samples
ECG
Physical examination
Ultrasound scans
Any further tests required due to pre-existing conditions or findings

The nursing staff will show you around the ward and your room, and tell you about nursing procedures during your stay.
If you wish, you can also arrange a consultation with one of our psycho-oncologists.
Over the course of the day, you will also speak with your surgeon about the planned procedure.

In addition, you will be given a heparin injection in your upper arm in the evening to prevent thrombosis. You will be given these injections every day for the duration of your inpatient stay and should continue to take measures to prevent thrombosis after returning home.

Your contact person

Katharina Molles
Ward manager

Your questions are welcome
mk-sl-team(at)uke.de

Day of the surgery

We will wake you early enough for you to shower and get ready.
On the morning of your operation, you will undergo a SPECT-CT scan in the Nuclear Medicine department before the procedure.
Once you return to the ward, we will ask you to put on your gown for surgery. The nursing staff will provide everything you need. After that, you will be taken to the operating room.
You will have to fast for several hours before the operation, so you will not be able to eat, drink or smoke. The anaesthetists and nurses will inform you of the exact times of your fast. Please adhere to this schedule precisely as we cannot perform surgery if you have not fasted for long enough before the scheduled start of anaesthesia.
You will only leave the post-anaesthesia recovery room once you are fully alert again. It might be the evening before you return to the ward.
You can drink fluids after the surgery. Please speak to the team on your ward about when you can and wish to eat. You will be given infusions over the course of the day via an IV line to make sure your body gets the fluids it needs.
We will take a blood sample in the evening.
Due to the anaesthetic, it is likely that you will not sleep particularly well following the procedure. You will also be given pain relief via infusion or injection to treat any wound pain you experience. Please let the nursing staff know immediately if the pain relief you have been given is not sufficient.
It is sometimes necessary to place a surgical drain during the procedure. If a surgical drain has been placed to remove wound secretions, this will usually be removed after two or three days, or in rare cases slightly longer.
You will also have a catheter in place in your bladder to remove urine. The urine will flow into a bag beside your bed. In some cases, the catheter can cause some abnormal sensations, such as the feeling of constantly needing to pass urine.

The first day after the procedure

Another blood sample will be taken in the morning.
You can also do exercises to promote blood flow while lying in bed. Tensing and relaxing your calves from time to time and coughing up any phlegm in your airways will go a long way towards preventing thrombosis (blood clots in leg veins) and pulmonary inflammation (pneumonia).
Pain relief is particularly important on this day, because post-surgical pain must not prevent you from mobilising or cause difficulty breathing. Your pain relief will be administered according to a strict schedule. Nevertheless, if you experience more severe pain, please inform the nurses immediately.
Another tip is to place your hands on your wounds when coughing, sneezing or making other sudden movements to counteract the pressure.
The nursing staff will help you to stand up and go through respiratory and physiotherapy exercises with you. If the doctors and nursing staff think you are ready, you can begin to eat and drink as normal again the following day. Please take your time when eating, or wait a little longer if you feel you are not yet ready. The procedure and anaesthetic may cause constipation, so your body is unlikely to tolerate food and large quantities of fluid.
However, due to your increased need for fluids, you will be given an infusion. If there are no complications, the IV line can usually be removed at this point. The indwelling catheter can also be removed as soon as you are sufficiently mobile again.
Patients are generally given a mild laxative in the evening of the first day after the procedure to stimulate intestinal function.

Ein Patient der Martini Klinik wird von einem Pfleger über den Flur geführt

The first time you mobilise – that is, the first time you get out of bed – will be the morning after your treatment, assisted by our nursing staff.

The second day after the procedure

You should get up and about more often today to stimulate blood flow and take several walks around the ward.
If the surgical drains we mentioned earlier are no longer producing much secretion, they can also be removed today.
Effusions of blood and water can sometimes accumulate in the penis and scrotum and result in swelling and blue-ish colouration. This is a normal reaction to the surgery; you should cool the area and elevate the scrotum.

Day of discharge

You will be discharged on the third day after your procedure, provided that you feel well enough and have made progress.

Another blood sample will be taken before you are discharged.
Before you are scheduled to be discharged, we will hold a final conversation with you to give you another opportunity to ask your doctor any questions and clear up any things you are unsure about.
In this final conversation, you will also be given all the medication and anticoagulant shots you will need for your first few days at home.
As soon as we have the final results of the histological examination (of the tissue removed during surgery), we will inform you of the results and explain it to you.
If the results of your histological examination only arrive after you are discharged, we will inform you of the results by telephone or in writing.

Ein Patient wird aus der Martini Klinik entlassen

After that, you will be ready to return home. You’ll be leaving with our best wishes!