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PRE-OPERATIVE PREPARATION FOR ROBOTIC RADICAL PROSTATECTOMY
One month before surgery:
- Every patient needs to have a medical clearance before the surgery.
- This includes a full set of labs, chest X ray, EKG, urine test, and Consent form. Additionally, a Medical Clearance letter from the medical doctor who is closely familiar with your care is required.
- A review of the slides and pathology by the surgeon performing the procedure
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One week before surgery:
- Stop taking Aspirin or similar products such as Motrin one week before the surgery
- Stop taking any blood thinning medications(such as Coumadin) one week before the surgery. Consult your primary care medical doctor beforehand
- Perform Kegal Exercises
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One day before surgery:
- Take half a bottle of Magnesium Citrate the day before surgery
- Fleet Enema the night before and morning of surgery
- Eat light foods a day before, try mostly liquids the evening of surgery
- Nothing to eat or drink after MIDNIGHT before surgery
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Day of surgery:
Most require you to be at the hospital two hours before the surgery. The exact location and time will be given to you by your surgery staff.
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POST OPERATIVE CARE FOR ROBOTIC RADICAL PROSTATECTOMY
Majority of patients are discharged within 24 hours after the surgery. Every patient is discharged home with a Foley catheter that is connected to a leg bag. Your surgeon and/or nurse should train you how to empty the bag as needed. Someone will need to drive you home after the surgery. Try not to drive for at least one-week after the surgery.
Medication:
Patients usually receive three prescriptions after the surgery:
- Cipro or similar antibiotics. You should start taking it 24 hours before your return for removal of Foley catheter.
- Pain medication typically Tylenol with Codein
- Stool softner medications such as Colace
Resume your usual daily medications after discharged from the hospital except some medications such as Coumadin and Aspirin. If it is absolutely necessary for you to be on these medications, please get in touch with my office and your medical doctor.
Avoid taking any Aspirin or similar medications for one-week after surgery
Take enough stool softner to avoid constipation. This will prevent any stress on the anastomosis and the rectum.
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Catheter:
Catheter is usually removed within 4-5 days after Robotic Radical Prostatectomy. Cystogram which is a simple X-Ray study is performed before removing the catheter. You should call my office right after your discharge to schedule for this test. Start taking your antibiotics one day before this test.
I will personally review your final pathology on the day that your catheter is removed. Our pathologists use whole mount examination in order to detect the location, volume of the cancer. Review of Gleason Scores, margin of the specimen will be discussed as well during this meeting.
You should bring urinary pads on the day that Catheter is being removed.
Occasionally one notices some discharge around the catheter within few days of the surgery. This is due mostly to bladder spasm and there is no need to be concerned. The Foley catheter will not fall out and is secured with a balloon inside the bladder. Ensure that there is no tension on the Foley catheter. Occasionally Urine could be blood tinged, it is recommended to drink more fluid to clear the color. If the Foley Catheter is not draining and you feel an unusual abdominal pain, call your doctor immediately.
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Activities:
It is essential for the patients to continue with Kegel Exercises after the Foley Catheter is removed. By performing this exercise, one can gain a faster control of continence and potency.
You can walk after surgery, however, activities such as running, biking are not recommended. Try not to lift weights heavier than 5lbs. Avoid sexual activity or vigorous activities for 6-8 weeks after surgery
Typically patients are allowed to shave and shower after the surgery. Trocar sites are all covered with dressings which can be removed in 48 hours after the surgery. Avoid scrubbing over the Trocar sites. All of the Trocar sites are hand sewn and no clips are used to approximate the skin.
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Precautions:
Avoid sitting in one position for a long time, place a soft pillow under buttock in order to prevent any pressure on the perineum. Try to drink a lot of fluid after the surgery. You can try soft diet food, juices, soup and jello until you have bowel movement. Once you have had a bowel movement, you can move to a regular diet. In case you notice any fever of 101 or higher, chills or if the color of urine doesn’t clear up despite drinking adequate fluid, call your doctor.
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FOLLOW UP VISITS
The first PSA blood test is performed one month after the surgery.
Follow up visits are as follows:
- Blood test(PSA) and Digital Rectal Exam every three months during the first year after surgery
- Blood test (PSA) and Digital Rectal Exam every six months during the second year after surgery
- Blood Test (PSA) and Digital Rectal Exam every year after the third year
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KEGEL EXERCISES
The purpose of these exercises are to strengthen your pelvic floor muscles. Pelvis muscles play an important role in controlling your urinary flow. It is important to learn the accurate way to perform Kegel Exercises. You can practice as often as you can, the more you do the stronger the pelvic muscles will get. This translate to a much better control of your urination.
These exercises should be performed starting one-week before surgery and to be continued after the Robotic Radical Prostatectomy.
Best way to perform KEGAL exercises
As a beginner the best time to do this is during urination. Try to stop and start your urine flow. Contract the pelvic muscles for five seconds and stop urinating. Continue to urinate again and keep repeating this exercise. Try to tighten up your rectal muscles. Once learned you can perform this exercise even when you are not urinating. While sitting or driving you can try doing this exercise. It is important to remember not to tense the muscles of your legs, buttocks and abdomen. You do not need to hold your breath when you are exercising. Try to perform 10 sets three times a day. The more you perform these exercise the faster you gain the control of your urination. You should see a difference within two to four weeks.
Remember to breath normally and only use the pelvic muscles. You will notice great results soon after.
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If you are still not sure or your symptoms are not improving, feel free to contact my office. |
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