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Pus in the urine tube area after prostrate surgery, stoma injury - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2305 Questions
User :   hi
User :   this is DR xxxx
User :   This is regaring dad underwent LRP 5 months back
User :   how can i help yoiu today
User :   ok
User :   we did the operation in xxxxxx
User :   Dr. XXXXXXXX - HOD of Urology did the surgery
User :   it was unfortunate
User :   that
User :   please proceed
User :   after the surgery it was found Rectal injury
User :   they say this is rare case
User :   he was admitted for 39 days in hospital
User :   now my question
User :   becuase of rectal injury
User :   2 things happend
User :   one still the urine bag continues
User :   two, colostomy was done
User :   ok
User :   its almost 4 months we did the surgery for prostrate
User :   the rectal hole is not healing
User :   now doctor is suggesting one more procedure to close the hole
User :   ok
User : immdiate problem
User :   2 things....
User :   one there is pus coming from the are where the rine tube is fixed on the urinary bladder area
User :   ok
User :   two, around the stoma, becuase of the stoma bag place..there are injuries...whic is painful and itching
User :   dad is 72 years
User :   he is daibetic
User :   last sugar check with medicine is 143
User :   so from what i understand, your father had radical prostatectomy, and developed complications like rectal incontinence and local spesis around the wound
User :   are you there with me
User :   hmmm..tough terms to understand
User :   i am just getting the report
User :   i will type in the correct terms
User :   recto vesical fistula
User :   could u please let me know, did he have benign prostrate hyperplasia OR prostrate cancer ?
User :   i understand, the formation of fistula post surgery is a complication
User :   it was carcinoma of prostrate T3 N0 M0 Gleason score (4+5=9)
User :   i am typing reading his report
User :   and since your father has diabetes, and at this age, post surgery regrowth of tissue is affected because of persistant localised infection
User :   yes..
User :   im so sorry to hear about that
User : immediate concern is
User :   the wound around the stoma
User :   and itching around the stoma
User :   also, cancerous growth, and its surgical resection in stage 3 is difficult
User :   OK
User :   i took the risk of doing..i am thankful to him
User : my concern is not getting addressed by him
User :   i am upset the doctor who did colostomy never bothers to meet my dad
User :   PERSISTANT INFECTION around the infected operated site can be causing the persistant itching
User :   i am upset by seeing the wound around the stoma...
User :   yes...
User :   i am sure..there is a solution
User :   currently urologist has only given niftran 100mg
User :   i understand that you are anxious about management of the colostomy stoma
User :   yes...
User :   is there any onimtment which i can apply in the area..for faster healing
User :   is there any tablet which he need to take to stop infection
User :   the fecal matter that comes out of the colon, contains bacteria, and the persistant moisture around the area, causes the area to appear to be red and cause itching
User :   niftran is a antibiotic for treatment of infection in the prostrate
User :   can u please tell me the medicines he takes for diabetes?
User :   how about the pus coming from the area where tube is fixed for urine
User :   i will give you doctor
User :   i am calling home..give me a second
User :   melmet 2 times..
User :   since, the urethra or the tube draining urine, must have been affected, and your father is not able to urinate because of the nerve damage during surgery, he will have to keep the tube in place
User :   gemer - morning before breakfast
User :   melmet - afternoon and night
User :   amgicam for Bp only in the night
User :   mutivitamin from centrum
User :   above the medicine he is taking
User :   .the best management here - is to adequate control of diabetes, proper wound care of the colostomy bag and the colostomy site. AND adequate control of any infection
User :   yes doctor..thats my immdiate concern too
User :   FOR THE diabetes: you will ahve to make sure that his HBA1C should be around the range of 7.0
User :   hmmm..i need to take test again to check it
User :   i will get it done tomorrow
User :   . DO u know the previous HBA1C score , and when was it done earlier ? for the wound care: proper antibiotics have to be taken
User :   please give me a minute, so that i can give u some info, regarding colostomy site management
User : i dont have reports
User :   no , i said, i will give u some info, please give me a few minutes
User :   yes doctor
User :   doctor are u there?
User :   hi
User :   u said u will help me with colostomy site management
User :   yes i did
User :   the condition your father has - is Irritant contact dermatitis - due to allery to some component of the colostomy bag
User :   i guess it because of the of the ring which we place the bag
User :   its belt type..we use..on the belt a plastic ring is there
User :   yes
User :   on the plastic ring we place the bag
User :   the bag is romoved every day
User :   the polyurethane in the bag , causes this contact dermatitis
User :   and the area is getting cleaned atleast twice a day
User :   when you remove the bag daily, clean the place with savlon or dettol
User :   what do we do doctor?
User :   we are cleaning it with dettol
User :   then apply some astringent powder available in the market
User :   yesterday i was thinking of ointment
User :   what is astringent powder?
User :   it is a powder that reduces the moisture
User :   and keeps the skin dry
User :   DERMICOOL & NYCIL are examples
User :   understood..
User :   for the wound management..
User :   also apply neosporin
User :   is it ointment?
User :   neosporin powder
User :   i hope i have solved your issues.
User :   thank you for contacting health care majic
User :   have a good day
Doctor :   hi
User :   hello doctor
User :   This is xxxxx
Doctor :   this is dr xxxx
Doctor :   i guess the connection got cut
User :   Dr.xxxxx...our chat got discountinued
User :   u were helping me with stoma management..
Doctor :   as i remember, i was informing you the management of irritant contact dermatitis
Doctor :   yeah
User :   the last message was apply neosporin powder
Doctor :   yes i do remeber
User :   can i use..neosporin with Nycil or dermicool
User :   doctor...
Doctor :   you can use neosporin powder for the infection control
Doctor :   it will also help in itching control
User :   okay
Doctor :   but since there is history of prostate cancer, some amount of itching may not be controlled at all
User :   will citrizen help during heavy itching...
Doctor :   if the would of the stoma is not healing, then it will need further re-debridement as advised by your treating doctor
User :   okay...
Doctor :   antihistamines do help in controlling the itching, but its use along with the other medications prescribed should be discussed with your treating doctor.
Doctor :   since it may react /interact with them and reduce their eficacy
Doctor :   hence do not self medicated yourself
User :   doctor regarding pus that coming from the urine do we manage it
Doctor :   you need to first see if that is pus or protien casts
User :   there is one hole just above the tube also come from there
Doctor :   if it is pus, then a culture sensitivity test will be needed to identify the organism causing it and treat it with antibiotics
Doctor :   if it is identified as protien casts, then it will need to be managed with other medications to help dissolve it
Doctor :   protein casts are seen in urine when protien breakdown is more
User :   last time i did the said no pus found
Doctor :   like in case of the cancer, fever, chronic illness, or bed ridden ststus
Doctor :   *status
Doctor :   ok
Doctor :   so in all probabilities they would be protien casts
User :   is there any medication..
Doctor :   you should dicuss with your urologist about their managment. if they are less, no need to worry. with time they will go
Doctor :   if they are more and with danger of causing obstruction to tube
User :   can this becuase of continues bedridden...
Doctor :   then it needs attention of your doctor
Doctor :   yes it is possible
User :   yes..its obstructing the tube...
User :   i keep telling my dad to keep walking..he does not listen
User :   he always love to lie down
Doctor :   then you will need to re-consult his urologist along with re-examination
Doctor :   and frequent change of teh tube
Doctor :   else with the obstruction there would be more complications
User : it matter of worry
Doctor :   he needs ambulation
User :   waht is ambulation
Doctor :   consult with physiotherapy people about coming home and giving physiotherapy and aiding in his mobilization
Doctor :   ambulation is mobilization like walking, changing positions
User :   okay...understood...
User :   morning mom and dad go for 30 minutes walk
Doctor :   ok. that is good
User :   later in the day..he just keep lieing on the bed...which we are asking him not to do...
Doctor :   even during the entire day, he needs to keep moving, instead of just lying in bed
User :   doctor...other than the powder do u suggest any ointment for the wound
Doctor :   no, not yet, as I am not examining him or teh wound personally, I would not be able to suggest you any ointment
Doctor :   take him for an re-examination
User :   okay...
Doctor :   and possible debridement of the wound
Doctor :   to assist in faster healing
Doctor :   generally in diabetic patients, would healing is slow
Doctor :   so you need lots of patience
User :   which department doctor will be the best for stoma wound care...
User :   is it general surgery
User :   or diabetician
User :   oncologist
Doctor :   gastroenterology or even general surgery would be fie. but since he is a diabetic too, an opinion from an diabetologist is better
Doctor :   he will also suggest best remedies for would healing
User :   somehow my experience with doctor showing stoma is not good...
Doctor :   in a diabetic patient
Doctor :   ok
User :   for protien cast is there any medicine..
User :   meaning which we can do at home
User :   currently we keep cleaning the area
Doctor :   yes there is, but the decision to give that along with his present medication lies with the treating doctor/urologist
User :   but..Urologist is not taking any steps...
Doctor :   you need to keep on cleaning the area. give him more water to drink to be able to flush out as much of casts as possible.
User :   Tuesday i met him and told him
User :   he did not react
Doctor :   ok did you discuss about giving medications for it?
User :   hence...i am disturbed
User :   yes..i told him
User :   i am showing this for last 3 months now...
User :   no separate medication is given
Doctor :   ok. then you should just try and see if increasing water intake solves the problem.
User :   okay..i will try..that...Barley water will be good
User :   for this conditions
Doctor :   if the current treating urologist is not showing interest, try and take a second opinion from a different urologist to see what best can be done
Doctor :   yes it is considered good to give, but plain water is better option
User :   i was actualling doing today..then in the morning i was doing search i found this website
Doctor :   ok
User :   i have taken an appointment with xxxxx
Doctor :   ok. He is good. you can consult with him
User :   thanks doctor for your valuable time
User :   immediate worry is solved...
User :   i have some ideas...
Doctor :   try consulting Dr. XXXXXXXX xxxx, he has good experience
User :   thanks..
User :   which hospital
User :   or online
Doctor :   He was also there in
User :   okay..i will try checking today
Doctor :   or he should be availabl ein xxxx group of hospitals
User :   okay...thanks for suggestion
Doctor :   you can ask our CRM team to help you in this
User :   hmmm..i will..
Doctor :   they will help in fixing appointment with him
Doctor :   is there anything else I can help you with?
User :   nothing much doctor..thanks for your time
Doctor :   thanks for consulting me. bye for now.
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