What To Expect After Robotic Prostate Surgery

When To Call Your Doctor Or Nurse

What to Expect After Prostate Cancer Surgery

Its important to tell your doctor or nurse if:

your bladder feels full or your catheter isnt draining urine
your catheter leaks or falls out
your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
you have a fever
you feel sick or vomit
you get cramps in your stomach area that will not go away
you get pain or swelling in the muscles in your lower legs.

Your doctor or nurse will let you know if you should go to the hospital.

Incontinence After Robotic Prostatectomy: What To Expect

Robotic Prostatectomy is becoming the most prominent choice for the surgical removal of prostate cancer. The popularity of the procedure has increased rapidly since its introduction in 2000.

This rise in popularity is due to Robotic Surgery being accurate and precise. During robotic surgery, there is less trauma to the pelvic muscles. Surgeons aim to minimize injury to the sphincter muscle when removing the prostate gland. Experts also agree that the Urologist is able to visualize the pelvic organs better than in Open Radical Prostatectomy. As Alliance Urology Specialist surgeon Lester Borden explains, robotic prostatectomy patients receive the benefit of smaller incisions, which results in less postoperative pain, shorter hospitalization and quicker recovery. Patients who undergo robotic prostatectomy have significant advantages such as less blood loss, less pain, shorter hospital stays and faster recovery times. This procedure is also designed to be minimally invasive. Recent results have shown the procedure to achieve similar outcomes to an open surgery method for removing cancerous tissue. A large proportion of men choose this procedure in that it is more effective in preserving long term urinary and sexual function.

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What Happens Immediately After Surgery

Once your surgery has finished, you are taken to the recovery room where you will wake up.

There will be a catheter in your bladder and sometimes a small wound drain.

You will often feel a sense of needing to empty your bladder. This is normal and is due to the irritation and spasm of the bladder caused by the catheter. This sensation slowly resolves and medication can be given to help relax the bladder. The catheter is held in place with a 3cm inflatable balloon on the catheter tip so cannot fall out with normal activity. Your catheter will remain in for approximately ten days to allow the new join between your bladder and urethra to heal.

Typically, after one hour in the recovery room, you are taken back to the ward. You will be able to sit up in bed and eat dinner on the evening of surgery and walk about the ward that day or the following morning. Blood thinners and calf compressors are used to reduce the risk of blood clots forming within the veins. Post-operative pain is well controlled through the use of regular pain medication. Once you are comfortable and confident in caring for the catheter you can head home. Hospital stay is typically 1-2 nights for robotic surgery and 2-3 nights for open surgery.

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What Happens Before Radical Prostatectomy

Before radical prostatectomy, your provider will ask you about your health history. Youll also need to tell your provider what drugs and vitamins you take. You may need to stop taking some of your medications a few days before your surgery, especially drugs that cause blood thinning.

Your hospital will give you specific instructions, including how long before your surgery to stop eating and drinking.

To check your health before your procedure, you also may need:

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What Are The Patient Criteria For Robotic

The decision to surgically treat prostate cancer involves many considerations. UC Davis urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.

Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction:

What Should I Expect When I Get Home

When you are discharged from the ward you will need some baggy trousers or track pants as you may find that your abdomen is uncomfortable and the catheter is easier to manage if your clothing is loose.

There will be some blood, urine, and mucus which passes alongside or through the catheter and is particularly noticeable after passing a bowel motion this is normal. You should wash the area with soap and water to remove this discharge to reduce any irritation. Keeping a high oral fluid intake reduces the risk of catheter blockage.

Following surgery, you will be given a prescription for regular pain medication as well as some laxative medication to keep your bowels regular and thus avoid any straining.

Light walking is encouraged straight after the surgery. After four to six weeks you may resume heavy lifting.

Showering, bathing, and getting the wounds wet is fine the skin has been sealed with glue.

Driving is safe once you are comfortable to do so and feel able to make an emergency stop. This would normally be around 3 weeks following surgery.

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Prostate Surgery Recovery Timeline

Prostate surgery recovery varies from person to person depending on how their body heals naturally and how severe the condition was prior to surgery. Here are some tips to help you through your recovery.

Prostatectomy typically requires general anesthesia and a hospital stay of 1 to 4 days. Your physician will have you walk around the day of or the day after your procedure. You may also be instructed to do little exercises while you are in the bed. All prostate cancer patients will be discharged from the hospital with a urinary catheter in place. A catheter is a thin flexible tube that is usually left in your bladder for 1 to 2 weeks to help drain your urine. Your doctor will give you specific guidelines about how to care for your catheter at home. Bladder control may be difficult for a few months after the catheter is removed. Some males will need a urinary catheter for 5 to 10 days after surgery.

Refrain from driving for 1 week after your prostate surgery. Do not drive until your catheter is removed. Also, be aware that you should not drive on prescribed pain medications unless a doctor says its ok. After one week, it should be safe to resume driving and begin most daily activities.

Getting Ready For Surgery

Tom Had a Quick Recovery after Robotic Prostate Surgery at NWH

You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if youre not sure.

I take a blood thinner, such as:

I smoke or use an electronic smoking device, such as a vape pen, e-cigarette, or Juul®.

I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these problems, we can prescribe medications to help keep them from happening.
If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

Be honest with your healthcare providers about how much alcohol you drink.
Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
Get a headache.

For information about being a health care agent, read How to Be a Health Care Agent.
If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

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Why Is Radical Prostatectomy Done

Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.

For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:

Managing Incontinence After Robotic Prostatectomy

After the procedure, kegel exercises are recommended by experts as a safe option for improving symptoms. You can learn how to do kegel exercises here.After surgery and after removal of the catheter, you should do this exercise in sets of ten, four times a day. Dr Samadi encourages patients to even do these before surgery to work as pre-conditioning.

Doctors also recommend behaviour modification as a natural, healthy treatment method. This involves making a number of lifestyle changes that will reduce your leakages. These include limiting fluid intake at night time and avoiding bladder irritants such as caffeine and alcohol. Quitting smoking to reduce coughing and bladder irritation can also reduce the pressure placed on the bladder. Spicy foods, carbonated drinks and citrus fruits can also worsen your symptoms and should be avoided.

Doing gentle exercise is also helpful to ensure your weight does not put additional pressure on the bladder. However, you should avoid over-exercising after your surgery. This has been proven to slow down the healing and stretching. Straining and heavy lifting are also discouraged for the first four weeks after surgery.

Experiencing incontinence can be difficult, however you should remember that there are treatment methods available.

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Surgery For Prostate Cancer

Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.

The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

How Is Urinary Incontinence After Prostate Surgery Treated

If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.

These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.

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Wound Care And Activity

After a robotic prostatectomy there will be 6 small incisions where the robotic instruments were placed, the small incisions will be covered by waterproof dressings. Bruising around these incisions and the abdomen is not uncommon and should not alarm you. This will resolve over time.

The sutures that hold the incision together are under the skin and do not need to be removed as they will dissolve. Occasionally the wound sites may ooze blood stained fluid. If this occurs the dressings can be removed and the wounds washed in the shower. The wounds can then be dried with a clean pad or towel and a clean dressing reapplied.

You may also shower with these waterproof dressings and they can eventually be removed 3 days after the procedure. Once the dressings are removed, the wounds need to be kept clean by showering. Do not take a bath for 1 week after the procedure.

It takes 4-6 weeks for the incisions to heal completely, so you should avoid heavy lifting or straining during that time. Daily exercises such as walking, climbing stairs, or swimming will help you recover faster, but wait 4-6 weeks before beginning heavy exercise such as jogging, weight lifting, or golf with a full swing.

Your perineum may be tender for several weeks or months, so avoid sitting on anything hard or pointed like a bicycle seat, and do not ride a motorcycle or a horse until the tenderness is gone.

Complications And Recovery After Prostate Surgery

Conditions that will Occur as a Result of the Surgical Removal of the Prostate

The healing process and possible complications should be well monitored after prostate cancer. As with any surgery, postoperative care and the recovery process is important after prostate surgery. Some complications such as bleeding and pain are quite common in the postoperative period of prostate surgery. In addition, it is recommended to check the patient for the signs of infection in the surgical site.

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What Changes Do I Need To Make To My Diet

Discuss your post-surgery diet with your doctor as you will probably want to avoid or at least minimize issues such as constipation. The lack of exercise, the medication, even the stress, might affect your bowel functions. Your diet will be focused on eating more vegetables, fruits, grains and avoiding meat, especially the red one, pasta, alcohol, fast-food, sugar and processed desserts.

The First Few Days After Surgery

Robot-Assisted Radical Prostatectomy (RARP): What to Expect for Your Surgery?

After the successful completion a robotic prostatectomy you will stay in hospital for one to two nights. You will be mobilised early. Most patients wake up with a catheter tube and a small drain. You will be prescribed painkillers as well.

You can expect to have this catheter in place for a week, however, some patients will require it for longer, depending on the specifics of the surgery. Your urology specialist will detail how to care for your catheter and will assist in its removal when ready.

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Development Of The Extraperitoneal Space

This step is performed using a 30° upward-looking lens. A transverse peritoneal incision is made extending from the left to the right medial umbilical ligament and extended in an inverted U-shaped manner to the level of the vasa on either side. The vasa can also be divided at this point to aid in bladder mobility. The extraperitoneal space is developed after the medial and median umbilical ligaments are transected, allowing the bladder, prostate, and bowel to drop posterior and the remainder of the operation to be performed extraperitoneally . Some authors fill the bladder to help identify the planes of dissection and to aid in dropping the bladder posteriorly.

A 0° lens is used for optimum visualization, and 1:3 scaling is used for lymphadenectomy. Lymphadenectomy is performed at the surgeons discretion if the preoperative serum prostate-specific antigen value exceeds 10 ng/mL, the biopsy Gleason score is greater than 6, or more than 50% of the biopsy cores are positive for cancer. The anatomic boundaries of the limited bilateral pelvic nodes dissection include the iliac artery superiorly, the obturator nerve inferiorly, the iliac bifurcation cranially, and the obturator fossa caudally. The nodal package is sent for frozen-section analysis only if the nodes appear grossly enlarged.

Facts Every Man Should Know Before Prostate Cancer Surgery

Many men want to know what prostate cancer surgery is like, including what to expect before surgery and what to expect afterwards.

Here are my findings based upon more than 1,000 phone calls to men the day before surgery, almost 700 visits to men the day after surgery and hundreds of calls from men in the weeks following surgery.

Most men experience very little surgical pain – probably 80 percent are like me…I had my surgery on a Monday by Friday I was at a graduation party . I got by with only Advil for pain relief. It’s been described as feeling like they did too many sit-ups.

Men really fear the catheter. I let them know that they will be asleep when it is put in. They may be like me and sleep very well with it in. Changing bags from a large capacity night bag to a smaller capacity day bag is simple and doesn’t involve removing the catheter. Walking with the day bag catheter is not a problem. Removal of the catheter is usually done in the doctor’s office after the prescribed timeframe and is relatively pain-free.

If all goes as planned, you will be walking the night of surgery and then the next day. Most men go home the following afternoon, unless they are otherwise directed by the doctor.

Your biggest discomfort may be from gas pains, hence the walking. For a robotic surgery, they have to fill the body cavity with gas to manipulate the equipment. Until we get rid of the gas in the normal way we do, there can be discomfort.