What Are The Risks Of Robotic
As with any major surgery done under general anesthesia, there is a certain amount of risk, including heart attack, stroke and death. Preoperative assessment of a patients overall health is part of the surgical workup at UC Davis. Prostatectomies, including those done with a robotic-assisted surgery system, are also associated with the risks of impotence and incontinence.
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. Itâs 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:
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:
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What To Do After Surgery
After surgery, you will get detailed instructions to follow at home. For example, you will need to keep the surgical wound clean. You will also have to avoid driving for at least a week and engaging in vigorous activities for six weeks.
After surgery, you will need to be careful with stairs you should only climb the stairs when necessary.
Changing sitting positions is important for your recovery. You should not spend more than 45 minutes in one position. While youre healing, you should avoid soaking in bathtubs, hot tubs, and swimming pools.
Since pain and discomfort are common after surgery, you will need to take medications to alleviate these symptoms.
Although it may seem like you can do everything on your own, you should allow someone to help you until your catheter is removed. That way, you wont put too much pressure on your prostate and catheter or injure them accidentally.
Within a day or two, you will need to have bowel movements. To make that happen, if you have constipation, you will have to take a fiber-rich diet, drink fluid, or take laxatives.
Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when itâs half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
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Tips For Better Prostate Surgery Recovery
Regardless of the procedure used, patients will be closely monitored after surgery. For the first few days after surgery, patients will experience quite a bit of soreness with the incision. Follow the doctor’s post-surgery instructions strictly and don’t forget follow-up visit. The time it will take to recover depends on the patient’s overall health, the type of surgery he had, and his compliance with the doctor’s instructions. For better recovery:
1. Avoid Strenuous Activity
Many recover pretty well, if not completely, a week after surgery, meaning they can resume activities such as driving after a week. However, the patient should not perform any strenuous activities such as motorcycling, running, etc. for about six weeks after the surgery.
Never climb stairs simply for the sake of exercising or sit in the same position for too long. If a catheter is used, don’t use bathtubs or swimming pools or anything like that.
2. Mind Your Diet
Many patients, after such a surgery, often adhere to a mostly liquid diet. They find it easier to consume immediately after surgery. Avoid carbonated beverages. As soon as bowel movement resumes, start eating soft foods such as scrambled eggs, oatmeal, soup, etc. Then slowly work your way back to a normal diet. Foods that induce gas should be avoided. For the first few days after surgery, eat little but often, rather than a lot all at once.
3. Wear Loose Clothes
4. Be Careful with the Wound
5. Regain Urinary Control
6. Regain Sexual Function
Advantages And Disadvantages Of Surgery
What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.
Advantages
- If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
- The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
- Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
- If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
- Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.
Disadvantages
- There are risks in having surgery, as with any major operation.
- You might get side effects such as erection problems and urinary problems.
- Youll need to stay in hospital for a few days usually between one and five days depending on the type of surgery you have.
- If the cancer has started to spread outside the prostate, the surgeon may not be able to remove all of the cancer and you might need further treatment.
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The Morning Of Your Surgery
Instructions for Drinking Before Your Surgery
You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take Your Medications As Instructed
A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower With a 4% CHG Solution Antiseptic Skin Cleanser
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Dont wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items at home.
What to bring
Once youre in the hospital
Get dressed for surgery
When its time to change for surgery, youll get a hospital gown, robe, and nonskid socks to wear.
Meet With a Nurse
What Are The Benefits To Patients
Robotics procedures, and minimally invasive surgeries in general, involve smaller incisions than traditional open surgeries, which reduces blood loss and postoperative recovery times. Patients typically experience significantly less pain and blood loss than in conventional open incision procedures. Patients also tend to enjoy quicker recovery times. Traditional open surgery can require several days of hospitalization and recovery time can last several months. While every case is unique, the return to normal, everyday activities following robotic-assisted surgery can occur in as little as two to three weeks.
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Points To Take Into Consideration After A Prostate Surgery
- Do not sit on hard floors.
- Avoid getting constipated.
- Consume at least 3 liters of water per day.
- Regularly use the drugs prescribed by your doctor.
- Do not drive for the first week during the recovery period after surgery. In addition, stay away from activities such as cycling, exercising, and horseback riding for 6 months, which may strain the groin area.
- Do not wear trousers that tighten the groin area.
- Do not consume drinks that contain alcohol and caffeine.
- Do not shower in a sitting position after the surgery, unless your doctor tells you otherwise.
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Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.
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What Can I Expect Before And After Robotic Prostatectomy
If after consulting with Dr. Engel, becoming educated on the topic of prostate cancer, potentially seeking other opinions, and being presented all options, a patient opts for robotic prostatectomy, he will then be taken extensively through what to expect. Dr. Engel currently performs robotic surgery exclusively at George Washington University Hospital, and a date and time will be scheduled for surgery there. The patient will generally be urged to see his internist for a pre-operative physical, although this can also be accomplished at the hospital itself. Tests to rule out spread of cancer such as a bone scan and CT scan, looking for spread to bones and lymph nodes, may be performed in higher risk cases. The patient will be given detailed instructions regarding a bowel preparation regimen and the patient must follow this strictly. The purpose of the bowel prep is not only to create more space in the abdomen, but also for safety in the very unlikely event that there is an inadvertent injury to the intestine or rectum during the surgery. If this occurs, a bowel prep will likely keep this from being a life threatening problem.
Our Primary Goal Is Cancer Cure
Overcoming cancer is our goal. Secondary goals, which also critically important, include speedy physical recovery, continence recovery, and erection recovery. Statistically, 10% of men can have an erection that supports intercourse within six weeks following surgery. About 50% of men reach this level of function at six months and about 85% will achieve normal function at one year. Recovery of erections is affected by the level of function before the surgery, age of the patient, the presence of other medical problems like diabetes and high blood pressure, while smoking, alcohol intake, stress, your partner, and a few other things are also a factor. In short, it is complicated.
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What To Expect During And After Prostate Cancer Surgery
At the time of surgery, patients will have a urinary foley catheter placed in the urethra. Upon hospital discharge, patients will keep the urinary catheter with them for one week. Urine drains into a small bag that is strapped to the upper leg. There is a valve at the bottom of the bag to empty it from time to time. It will be necessary to drain the bag as it fills.
After the surgery and while still in the hospital, patients will begin digesting clear liquids. This will be followed by solid food based on the surgeons recommendations. The first bowel movement occurs three to four days later, which is normal. In order to make the first bowel movement as easy as possible, we recommend drinking prune juice daily, while taking a stool softener and laxative. These are highly important to consider because patients should minimize straining and pushing during a bowel movement after treatment.
How Does The Robotic
It is similar to the conventional, minimally invasive laparoscopic prostatectomy. However, working from a special console in the operating room, the surgeon operates four precision-guided robotic arms to cut and remove the prostate. The procedure uses a small video camera, inserted through a keyhole-sized incision to provide surgeons with magnified, 3-D images of the prostate site. This expansive view allows doctors to see the nerve bundles and muscles surrounding the prostate. The robotic arms, with full 360-degree rotation capabilities, are placed through several other keyhole incisions allowing surgical instruments to move with greater precision, flexibility and range of motion than in a standard laparoscopy.
The procedure usually takes 2 to 3 hours under general anesthesia. Most patients experience only a small blood loss and blood transfusions are needed in less than one percent of patients. Prostatectomy patients typically spend one night in the hospital and are usually discharged as soon as their laboratory tests are acceptable, pain is controlled and they are able to retain liquids. Patients are discharged with special catheter, which is removed during an outpatient visit 5-7 days after the operation.
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When To Call Your Doctor Or Nurse
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.
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Prostate Surgery Recovery Time
Your incisions may be sore one to two weeks after the procedure. You will also have a catheter inserted during this time. Within four weeks, you will be able to return to normal activity with minor restrictions. For most men, it may take about six weeks to return to normal.
The exact recovery time depends on the type of condition, the severity of symptoms, and the surgical approach. Some men may take longer than six weeks to recover and heal.
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Dealing With Urinary Issues After Surgery
Inform your doctor about the side effects youre experiencing, especially if urine is blocked. You should also call your doctor if the blood in the urine is thick.
Other, more specific, and serious side effects may also occur. This is particularly the case with radical prostatectomy. The most common adverse reactions here are urinary incontinence and erectile dysfunction.
A man with urinary incontinence may not be able to control urine. Or he may experience leakage or dribbling. Not all cases of urinary incontinence are the same. They may include stress incontinence, overflow incontinence, urge incontinence, and continuous incontinence.
Its useful to remember bladder control may return within several weeks or months post-op. The recovery in urinary control develops gradually. A doctor cant really predict how long this is going to last.
Generally speaking, older patients experience more incontinence problems than younger men. Healthcare professionals will explain how to manage incontinence. Management strategy may include pelvic floor exercises. They strengthen pelvic floor muscle and may improve bladder control.