The following information will help patients and their care givers learn about robotic assisted laparoscopic radical prostatectomy or RALP before undergoing surgery. If you have a family member or a caretaker available, please stop this video and have them watch this with you.
Feel free to pause this video to make a list of questions you have or information that is not clear to you. Your surgeon and health care team will spend time with you reviewing this information in greater detail and will answer any questions or concerns you may have. Please tell your doctor if there are recent changes in your health.
Practicing Kegel exercises before surgery will help you with post-operative continence - the ability to control your urine after surgery. Kegel exercises help strengthen the pelvic floor muscle, also known as the urinary sphincter, which allows you to stop and start your urine stream while urinating. When you are urinating, you can identify the muscle by stopping your stream, holding it for two seconds, then resuming the stream. Practice this several times until you can easily isolate the muscle.
You should not strain or contract your abdominal muscles when doing Kegels. Once you have learned to easily contract and relax this muscle, practice doing the exercise anytime of day, except during urination. For example, you can do Kegels when you are watching television, lying in bed, stopped at a red light, or in an elevator. You should do five sets of 20 a day, for a total of 100 per day. Remember, the pelvic muscles are not your stomach muscles. The pelvic muscles are located in the floor of your pelvis. When you clench this muscle you will feel your penis contract a little and your anus clench.
Other things you can do before surgery include:
Combining a healthy diet with appropriate exercise is usually the best way to lose weight. Before beginning a new exercise program, discuss the program and your current health status with your doctor.
The day before your surgery:
It is very important to stop taking all aspirin products; Ibuprofen… for example… Advil and Motrin; naproxen… for example…Aleve and Anaprox; coumadin; clopidogrel, which is Plavix or other types of blood thinners for at least seven days before surgery. Both fish oil and Vitamin E can act as blood thinners. Please do not consume these for at least five days before surgery. Discontinue any herbal supplements also at least 5 days before surgery.
If you feel you need to take pain medication before surgery, please discuss this with your doctor. Acetaminophen…Tylenol… is usually safe for most patients and will not interfere with surgery. Please give a member on your surgery team a list of all the medicines that you are taking, including prescriptions, over-the-counter medications, herbal and nutritional supplements, homeopathic substances and complementary or alternative medicines.
Day of Surgery
The morning of your surgery you will be taken into the pre-operative holding area and an intravenous catheter - called an IV - will be started. An IV is a small tube inserted through a vein in your arm. Through this tube you may receive medication to help you relax before going into the operating room. You will also be asked to wear special stockings that will help prevent blood clots in your legs.
In the operating room, you will receive anesthesia that will completely put you to sleep before other procedures are started. When you are asleep, the staff will prepare you for surgery. This includes placement of more IVs by the anesthesia team, shaving the abdomen, cleaning the area of surgery and positioning your body for surgery. Please do not shave the area of surgery yourself. All of this preparation can take one-half to one full hour. Once you are prepared, the actual operation begins.
After the procedure, your surgeon will discuss your surgery and current status with your family or others you have assigned to receive your medical information.
After surgery you will be moved to the PACU - short for post-anesthesia care unit - also known as the recovery room.
Occasionally, some patients stay in the recovery room overnight, either because no hospital beds are available or because the surgical team wants to monitor the patient more closely. In this case, the recovery room nurse may allow visitors, but overnight guests are not permitted.
After about three hours in the recovery room, you will be moved to a private room where one family member or friend is allowed to stay over night with you. The room has a fold out chair that converts into a bed.
Please do not bring valuable items with you. You only need comfortable clothes to wear when you are discharged and your personal hygiene products.
Most patients stay one night in the hospital and are discharged the next day. Sometimes, a patient will stay two nights.
Your surgical team will determine the amount of time you need to stay in the hospital. This depends on several factors:
When you wake up, you will see two tubes and six surgical punctures - or incisions - and a few IVs. The largest surgical incision will be above or near your belly button. This is where the prostate was removed during surgery. The incision will be one to three inches long, depending on the size of the prostate removed. The other incisions, which are smaller, were used to insert the surgery instruments.
One of the two tubes is a drain, which will be coming out from one of the incisions. This tube will help drain fluid that collects in the surgery area. Usually, this tube is removed before patients leave the hospital, but sometimes patients are discharged with the drain in place. If this is your case, a nurse will give you instructions on how to care for the drain and when and where to report to have it removed.
The second tube will be a Foley, or bladder, catheter. Foley catheters are inserted through the penis and into the bladder while the patient is under anesthesia. It is held in place by a balloon in the bladder and is secured to one leg. Most patients stay one night in the hospital and are discharged the next day. Sometimes, a patient will stay two nights.
You will be asked to walk within a few hours after surgery, as this helps reduce the risk of many different types of complications.
Before you leave, you will receive instructions on how to care for your Foley catheter from the nursing team.
Several types of pain medication are available to help control your pain.
Most patients receive a strong non-narcotic medicine, called ketorolac - also know as Toradol® - through their IV every six hours while in the hospital. If you need additional pain control you may ask for Morphine as often as every 30 minutes. If your stomach is not upset and you are tolerating clears liquids, your doctor may prescribe a pain pill for you, usually Vicodin. You will receive a prescription for this pain medication when you are discharged.
Most patients do not have significant pain after this surgery, but everyone has a different level of pain tolerance. Most patients need only small doses of pain medication after two to three days. After this point, some patients need only Tylenol to control the pain.
If you need a refill of your prescriptions, please call the pharmacy early and do not wait until you have only one or two tablets left. Also, some pain medications can cause or worsen constipation.
Constipation is very common after surgery and it may take a few days before you have a bowel movement. In this case it is important for you take some additional over the counter medication to prevent this from getting worse.
Sometimes an oral laxative is needed in addition to the stool softener to produce a bowel movement. Any over-the-counter oral laxatives can be used, including Milk Of Magnesia.
You may be having bladder spasms if you are suffering from abdominal cramps that your pain medicine has not relieved. Other symptoms include a feeling like you have to urinate even though the catheter is draining well or you feel like you have bladder urgency. Taking medication for bladder spasms will help relieve the crampy feeling and the urgency.
Do not put anything in the anus, such as enemas or suppositories, for at least two weeks after surgery
Instructions for After You Are Discharged
It is normal for blood and small blood clots to drain into your Foley catheter. There is no cause for concern if the urine is clear enough that you can see through the tube. Contact your nurse immediately if the blood clots are larger than pea-size or if you can not see though the drainage.
You may notice that walking may cause your urine to be blood-tinged. This is normal and should not prevent you from walking. After surgery, while the catheter is in, you will need to walk but only for short periods of time. Once the catheter is removed, you can walk for much longer distances at a time. Stay well hydrated to help prevent blood clots in the catheter. Drink at least four, 8-ounce glasses of water daily. When you have a bowel movement, urine may leak around your catheter. This is expected and normal. Do not be alarmed.
Ask your doctor when your catheter can be removed. This will range anywhere from five-14 days, and on occasion, longer. After the catheter is removed, please remain near the hospital until you are either urinating comfortably or not leaking urine. Please return to the clinic if you cannot urinate, if you think your bladder is full but you are unable to empty it, or if you are having abdominal pain. The catheter may need to be put back in. In this case, you should be recatheterized with a curved, or coudé, catheter. This is very important. If a doctor or nurse tries to catheterize you with a straight catheter you should politely refuse and ask them to page a urologist. You may want to tell the staff that you were instructed to be recatheterized with a curved catheter.
Side Effects of Surgery
When the catheter is removed you will leak urine. Some men leak a lot while others only leak a little, but everyone leaks in the beginning. When you come for your catheter removal you will need to bring a urinary pad with you. You can find these pads in the adult continence section of your local grocery store or pharmacy. Typically, men leak when they stand, sneeze, cough and laugh. Performing the Kegel exercises before certain activities such as standing can help prevent or reduce leaking.
The amount of leakage that you experience soon after surgery will not indicate how much you will leak permanently. Patients may have continued improvement in their urinary control for up to one year after surgery.
All men have erectile dysfunction after surgery. This may improve depending on several factors, including the patient's age, the status of erections before surgery and whether nerve-sparing was done during surgery. Your health care team will address this issue during your first follow-up visit after surgery.
Erectile rehabilitation will involve using a vacuum pump and erectile dysfunction medications to help increase the blood flow to your penis. This may help prevent penile shrinkage and may speed your recovery of erections. You may experience improvement in your erectile function for up to two years after surgery. It is best to refrain from sexual activity for at least the first two weeks after surgery.
Although it is possible to experience an orgasm without an erection you will not produce ejaculate fluid after your prostate is removed. This will cause you to be sterile following your prostatectomy, meaning you will not be able to father children. If this concerns you, ask your surgeon about sperm banking before surgery. There are additional glands in the urethra that will produce a small amount of lubrication during sexual stimulation. On rare occasions, patients may discharge a small amount of urine during orgasm.
There are no dietary restrictions after surgery. Most patients eat simple, easily digestible foods for at least the first week or two after surgery. Try to eat five to six small meals a day rather than three large meals.
You may return to work within two weeks after surgery depending on how much physical labor your job requires. It is very important that you do not lift objects heavier than 10 pounds for the first two weeks after surgery. Beginning two weeks after surgery, you may start to gradually lift objects weighing more than 10 pounds. For example, do not mow your lawn, vacuum, pick up your children/grandchildren or pets. Slowly ease back into your regular routine.
When you feel you are ready, try to lift a fraction of what you did before surgery, wait until the next day and see how you feel. If you feel fine, you may progress. If you are sore in the area of surgery, this is your body's way of telling you that you are not ready for more work. Let your pain be your guide.
You can ride as a passenger in a car anytime. In the first week or two after surgery it may help to sit on a foam donut (available at most pharmacies). Avoid long car drives as this will increase your chance of developing a blood clot, also called deep vein thrombosis, a potentially life-threatening condition.
You can drive two weeks after surgery if:
You will have to use common sense and your best judgment when deciding when it is safe for you to drive. If you have any concerns, do not drive.
If you have problems or questions after your surgery, please call your nurse or physician assistant. If you cannot reach the person you wish to speak with, and you do not need an immediate response, you may leave a voicemail message. If your issue cannot wait and needs either immediate attention or within the next few hours, please call the main clinic line and follow the prompts for a patient with an immediate medical concern. Your call will then by transferred to a receptionist. You should tell the receptionist that you have an urgent medical question and you need to speak with the triage nurse. Although we try to return phone calls within 24 hours on weekdays, please do not leave a voicemail message expecting an immediate response. On nights and weekends, if you are having an emergency related to surgery please call the hospital operator and ask them to page the Urology Fellow On Call. Your team will provide you with all these numbers.
We hope this information has increased your knowledge of what to expect, eased some of your fears and answered many of your questions. Your healthcare team will now be happy to discuss any questions or concerns you may have regarding this procedure.
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