Robotic Prostatectomy Course

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Robotic ProstatectomyCourse

• Carrie A. Collin R.N., B.S.N.
• CSG - Division of Urology

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Prior to Surgery

• Pre op labs
• Necessary MD visits for clearance, i.e., PCP,
  Cardiologist, etc.
• Stop all aspirin and aspirin containing medicines
  (Excederin, Anacin) at least 7 days before
  surgery
• Stop all blood thinners 5-7 days before surgery
  UNLESS directed otherwise.
• Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days
  before surgery
• Please check with prescribing MD!
• May restart 5 days after surgery unless directed
  otherwise

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Prior to Surgery

• Start Kegels if not started already
• Some will have anesthesia consults at HH
• Clear liquids diet to start at noon, day prior to
  surgey
• Bowel prep, per paperwork
• NO food or drink after midnight, night before
  surgery, except a sip of water to take pills

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HBOT Study

• Certain criteria
• Age 65 or less
• Bilateral nerve sparing, pt specific
• Good erectile function before surgery (without
  need for Viagra, etc)
• Must meet inclusion criteria (verified by
  research coordinator)
• Must come in for consent and hyperbaric education
  session prior to surgery

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HBOT Study

• Viagra starts POD15 for the study
• Half the patients will be given room air, half
  will be given hyperbaric oxygen
• Double blind study neither patient or doctor
  will know what you receive
• Call the research coordinator at least 7-10 days
  before surgery

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HBOT Study

• PROS
• FREE VIAGRA FOR ONE YEAR!!!

• CONS
• Daily trips to HH
• 5-10 sessions
• 90 min in the room
• Not everyone qualifies

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Day of Surgery

• First case of the day goes straight to OR,
  otherwise report to where the hospital tells you
• NO food or drink, sips of water to take needed
  medications
• Shower with Hibiclens soap provided by the
  hospital, if not provided Dial works as well
• Approximate length of surgery is anywhere from
  2-5 hours depending on size of prostate, level of
  difficulty and if there is lymph node dissection

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Post Op

• Diet - post op will be clear liquids, diet will
  be advanced when passing gas
• Activity - Out of bed as tolerated, minimum of at
  least once
• Incentive spirometry -10x every hour while awake

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Post Op

• JP drain To drain any blood or fluid. Most
  likely will be removed prior to leaving hospital
• 5 bandages and/or Dermabond

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Foley Catheter

• Tube coming out of the penis to drain urine
• Stays in until 1st post op visit
• 2 types of drainage bags

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2 Types of Drainage Bags

• Large bag or Overnight bag
• Can hold more urine
• Leg bag
• Easily hidden under clothes, smaller capacity

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Catheter Care

• Clean hands prevent infection!
• Gently clean around the catheter
• Place small amount of bacitracin ointment around
  catheter near opening of penis, do not allow it
  to cake up. This helps the catheter move easily
• May shower, disconnect bag first
• When switching bags, wipe connection of bag with
  alcohol swab

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Discharge Home

• Diet
• Slow progression as tolerated
• Bowel Regimen
• Daily or twice daily stool softener such as
  Colace
• If no bowel movement by 3 days take Milk of
  Magnesia
• NO self placed enemas!
• Any increase of abdominal pain, nausea, or
  vomiting call the office

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Discharge Home

• May drive when off narcotics and catheter is out
• May gradually resume normal activities and
  exercise as tolerated. Everyone will be at a
  different pace.
• Start Viagra

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No Worries

• Leaking from around catheter as long as urine
  is draining into bag
• Leakage from JP sites if requiring frequent
  dressing changes, call office for bag
• Scrotal and perineal pain and swelling, 3-5 days
  after surgery
• Bladders spasms
• Bloody urine increase fluids
• Small blood clots increase fluids
• Bruising

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Worries

• Incisions that are red, have pus, hot, worsening
  of pain or severe pain in general
• Nausea/vomiting
• Temperature gt100.5, chills
• Shortness of breath, chest pain
• Foley came out or not draining
• Large blood clots or heavy bleeding
• Calf pain and or leg swelling
• Both legs likely normal. If one leg is painful,
  red, hot, more swollen could be a blood clot

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1st Post Op Visit

• 7-1o days after surgery
• Start antibiotics the day before, morning of, and
  the day after
• Catheter removal !
• Incontinence/Stress Incontinence
• Please bring pads or adult diaper to this visit
• Leaking will improve, be patient!!
• Avoid excessive fluids
• Best if able to avoid caffeine and alcohol
  consumption

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1st Post Op Visit

• May resume sexual activity
• Kegel exercises
• Continue!!
• 4x/day, 10 sets each
• Muscles need exercise, helps improve strength of
  pelvic muscles
• Pathology report
• Pathology report will be discussed with you and
  the MD. If you are seeing the RN and not the MD
  for catheter removal, the MD will call to discuss
  report.

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Incontinence

• BE PATIENT!
• Limit alcohol and caffeine, which can irritate
  the bladder
• Will gradually improve
• Lucky patients will regain control in a few weeks
• Average patient in 3-6 months
• Unlucky patient 6-12 months
• By month 12
• 93 no pads
• 6 pads
• 1 severe leaking that may require another
  intervention
• TIME IS THE GREATEST FACTOR!

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Penile Rehabilitation

• Oral Medications
• Viagra - 50mg daily (1/2 dose) or 100mg (full
  dose) 1 hr before sex and works better on an
  empty stomach
• Cialis taken 2 hrs before activity and can be
  taken with or without food
• Levitra taken 1 hour before activity and can be
  taken with or without food

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Oral Medications

• Side effects
• Headache
• Facial flushing
• Lightheadedness
• Upset stomach
• Muscle aches
• Visual disturbances
• Auditory distubances
• Erection lasting more than 4 hrs, call MD

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Penile Rehabilitation

• Vacumn Therapy System
• User friendly
• 98 effective
• Some insurances cover
• www.stamenmedicalsystems.com

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Penile Rehabilitation

• Injection Therapy
• Needle injected in the penis
• Relaxes penile blood flow which allows blood to
  flow freely into the penis to cause an erection
• Muse
• Medicated pellet inserted into the urethra via an
  applicator
• Opens bloods vessels to increase blood flow into
  the penis
• Penile implant
• Not until all other efforts are exhausted, at
  least 2 years after

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1st Year Follow up
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2nd Year Post Op

• Lab work
• PSA and
• Office Visit
• every 6 months

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3rd, 4th, 5th Year

• Yearly PSA and Office visits
• May resume care with usual urologist whenever
  desired

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