Surgical procedures are performed at one of two facilities depending on the case.

• Procedures that require more than an overnight stay are performed at Duke University's main operating facility located within Duke Unversity Hospital.
• For cases that are likely to allow discharge on the same day of surgery or that require only a single night stay, the ambulatory surgery center is used. This facility is new and offers state-of-the-art operating rooms combined with modern overnight patient rooms. Being in a university environment, the facility gives us access to an outstanding anesthesia department as well as specialists from a wide range of other fields of medicine.

Pre-Op Instructions

Once you and the physicians have decided on surgery and have discussed the surgical procedure, our physician assistant, Mr. Cary Z., will be in contact with you to schedule your operation as well as a pre-operative appointment.

At this appointment you will have a physical examination, blood tests, and any other studies deemed necessary. During this time, any specific preoperative preparation instructions will be given. You will also meet with the anesthesia representative. Information concerning your arrival time the day of surgery will be given to you at this time.

Post-Op Instructions

Following your procedure you will be given post operative instructions. If you have undergone a procedure that requires a catheter in your bladder, instructions will be given to you regarding its management and how to perform the voiding trials necessary prior to its removal. You will be in contact with our physician assistant, Mr. Z, by phone and removal of the catheter will be arranged at the appropriate time.

Follow up visits with Dr. Webster and Dr. Amundsen are usually scheduled at the time of your discharge. They will usually be four weeks after your surgery depending on the procedure you have undergone.

Medications

• Prescription pain medication may be used for the next five to seven days.
• Tylenol may then be used for pain.
• After a rectocele repair, colace or ducolax will be prescribed. If you do not have a bowel movement within three days of being discharged, please call the office.
• You may continue all medications you were previously on unless told to do otherwise.

Wounds

• You may have vaginal spotting for several weeks. Call if the bleeding is like a moderate-heavy period.
• You may take a shower. Refrain from taking a bath for four weeks. No douching, intercourse, or tampons for four weeks.
• Sutures in the abdominal incision as well as in your vagina will dissolve in several weeks.
• If you have steri strips on your abdominal incision, you may take them off after one week or sooner if they fall off.

Catheter

• If your catheter accidentally falls out, cover the hole with a towel and call the doctor.

Voiding trial

• Clamp the suprapubic catheter.
• Void when you feel the urge and measure the amount.
• Release the suprapubic tube and measure the amount of urine left in the bladder.
• Record information on voiding trial record.
• If you cannot void, release the suprapubic tube and measure the amount of residual urine.
• Keep a diary of how often you void and the volumes you void.
• Change suprapubic tube dressing as needed.

Activity

• No heavy lifting for four weeks (i.e. Manually opening the garage, lifting the vacuum cleaner or small child).
• Climb stairs slowly the first two weeks.
• Increase your activity gradually after the first week.

If you need medical help after 4 p.m. daily, on weekends, or holidays, call the Urology resident on second call at 919-684-8111.

Weekdays between 8:30 a.m. - 4 p.m. call Dr. Webster's and Dr. Amundsen's office at 919-684-2516 or their physician assistant, Cary Z, at 919-684- 4308.