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Robotic Surgery

Robotic Prostatectomy - Preoperative and Postoperative Information

The surgeons at WakeMed Physician Practices - Urology were among the first in the Raleigh area to perform robotic surgery.  They all have extensive robotic training and, together, have performed hundreds of robotic surgeries.  
   
BEFORE SURGERY:

The primary purpose of a prostatectomy is to cure the cancer by removing it completely.  You will have an appointment at the hospital for a pre-operative evaluation.  This consists of a physical exam, blood testes, urine sample, chest x-ray, electrocardiogram, and other tests as needed.  You will meet with an anesthesiologist who will review your medications and answer your questions about the anesthesia you will receive.

IT IS RECOMMENDED YOU START DOING KEGEL EXERCISES BEFORE SURGERY, THEN RESUME THEM AFTER THE CATHETER IS REMOVED POST-OPERATIVELY.

To learn more about Kegel Exercises and how to perform them.

No special changes in diet or activity are required until the day immediately preceding surgery.  If you smoke, you should make every effort to stop as soon as possible.  Also, make sure that you stop taking aspirin or medications that contain aspirin or aspirin-like substances at least 7-10 days before your surgery.  These can cause increased bleeding during surgery.

 THE DAY BEFORE SURGERY:

  • CLEAR LIQUID DIET the entire day before surgery, i.e: broth, apple juice, water, plain Jell-O, etc.
  • Please purchase MAGNESIUM CITRATE ORAL LAXATIVE (8 Oz). Drink the entire bottle at 2:00pm the day BEFORE surgery, followed by 8 Oz (one cup) of water.
  • NOTHING TO EAT OR DRINK AFTER MIDNIGHT THE NIGHT BEFORE SURGERY.

AFTER YOUR SURGERY:

  • After your surgery you will spend 1 to 2 days in the hospital.  Most patients leave the hospital the next day.
  • You will have 5 or 6 small incisions on your abdomen. It is not uncommon to have bruising around these sites. This will resolve over time. Remove all bandages when you get home.
  • You may have scrotal/penile swelling and bruising. This is NOT abnormal.  It should resolve itself in about 7 to 10 days. You can also elevate your scrotum with a small towel or washcloth when you are sitting or lying down.
  • A URINARY CATHETER WILL BE PLACED IN YOUR BLADDER DURING SURGERY.  This allows the bladder and urethra to heal.  A large bag (for night use) and a small bag (for day use) with instructions for changing them will be provided for you.
  • Gently wash the area around the catheter daily.  If it becomes irritated because of the catheter, you may apply Vaseline or an antibiotic ointment to the area after washing.  NEVER pull on the catheter.  Keep the drainage bag tubing free of kinks and loops.  Always keep the collection bag below the level of the bladder.
  • You may shower when you get home (even with the catheter). Use a mild soap and let warm soapy water run over the incision sites.  Do not scrub the incision sites. Pat them dry. Avoid soaking in a tub or pool for at least 2 weeks.
  • Many patients have bladder spasms after surgery. This is due to the catheter irritating the lining of the bladder. Bladder spasms can result in crampy abdominal pain, leakage around the catheter, and pain at the TIP of the penis.  You will be given a prescription for anti-bladder spasm medication (examples: Ditropan (Oxybutynin), Detrol, Vesicare, Enablex, Toviaz).  You will continue this medication for 3-4 weeks after the catheter has been removed.
  • THE CATHETER WILL REMAIN IN FOR 7-10 DAYS AFTER SURGERY. You will be given an appointment for catheter removal. Frequently, an X-ray is taken on the day of catheter removal. Please bring DEPENDS underwear with you to the catheter removal visit. At your follow-up visit, your doctor will discuss the results of the surgical pathology. This is the final analysis of the tissues removed during surgery, which shows the location and extent of the cancer.
  • KEGEL EXERCISES SHOULD BE RESUMED AFTER THE CATHETER IS REMOVED.  These exercises help to regain your continence and should be done on a regular basis.  Most men have difficulty with urinary control after surgery and require some form of protection (Depends or Attends pads).  Jockey underwear usually work well to hold pads in place.  Most men are able to regain reasonable control within 6 months.
  • Recovery of potency (erections) after your surgery can be slow and time dependent. If you were a candidate for a nerve sparing procedure, this will help, but the nerves can be injured or stretched during surgery. These nerves need time to heal. At your follow up visits options for erectile rehabilitation will be discussed with you. You will receive information on medications that can help speed the recovery of erections.
  • Removal of the prostate means no sperm, prostatic, or seminal fluid is ejaculated, but the ability to reach an orgasm (climax) generally remains. Impotence does not have to mean the end of your sex life. There are many options available, even beyond medications.

DIET:

  • You will be started on a clear liquid diet in the hospital.  If this is tolerated, then you will be advanced to regular foods.  A small percentage of patients experience slow return of bowel activity.  If this is the case, then diet advancement will be slower, and you may need to stay in the hospital an extra day or two until bowel activity returns.  At home, eating foods high in protein and vitamin C promotes wound healing.  A well balanced diet promotes good health and aides in your recovery.  Avoid a diet high in fat, salt, fast foods, and convenience foods.
  • Drink 8-10 glasses of fluid every day while you have the catheter and after it is removed.  If you notice blood in your urine, increase your fluid intake.

BOWEL HEALTH:

  • Many pain medications cause constipation.  Upon discharge you will be given instructions to take a stool softener.  One of the commonly used stool softeners is Colace. Take this as directed.  Eating a well balanced diet including foods high in fiber, fruits, vegetables, and whole grains will help avoid problems.  If you are unable to have a bowel movement, you may take Milk of Magnesia (30ml once or twice per day).  Do not use suppositories, enemas, or rectal thermometers.  It is not uncommon to have some blood in your urine after having bowel movements.

 ACTIVITY:

  • You may walk and climb stairs as tolerated. ABSOLUTELY NO BIKING, MOTORCYCLING, HORSEBACK RIDING, OR OTHER SIMILAR ACTIVITIES FOR 4 WEEKS. Avoid heavy lifting (no more than 5 pounds), pushing, pulling, or vigorous exercise (calisthenics, tennis, running, golf) for 4 weeks. 
  • DO NOT DRIVE WHILE TAKING PAIN MEDICATION OR WITH THE CATHETER IN.

PAIN:

  • You will be given a prescription for pain medication. Perineal discomfort (the area between the scrotum and rectum) is common. In the hospital you will be given a foam horseshoe cushion to sit on to decrease pressure.

PROBLEMS TO REPORT:

  • Fever >101.5 degrees Fahrenheit
  • Chills
  • Severe pain not relieved by you medication
  • Heavy bleeding or large clots in your urine
  • Little or no urine output
  • Redness or any separation of any incision sites
  • Severe swelling of the legs or ankles
  • Shortness of breath.