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DaVinci Robotic Prostate Removal

DaVinci Robotic Radical Prostatectomy is a Robotic Surgery and Prostate Cancer Treatment. Robot-assisted radical prostatectomy (removal of prostate) is becoming the gold standard for treating organ confined prostate cancer using the DaVinci Surgical System.

When you get home:

Diet

You may return to your normal diet. Alcohol, spicy foods, and drinks with caffeine may cause some irritation or sense of the need to void despite the fact that the catheter is emptying the bladder. If these foods do not bother you, however, there is no reason to avoid them in moderation. More importantly, keep your urine flowing freely. Drink plenty of fluids during the day (8-10 glasses). The type of fluid (except alcohol) is not as important as is the amount. Water is best, but juices, coffee, tea, soda are all acceptable.

Activity

Your physical activity is to be decreased especially during the first two weeks after surgery. During this time, use the following guidelines:
  • No lifting heavy objects (anything greater than 10-15 lbs.) for 4 weeks
  • No strenuous exercise for 4 weeks
  • No driving for about 10-14 days
  • No severe straining during bowel movements - take a laxative if necessary
  • You may walk as much as you want. You may use stairs, but be careful
  • You may shower or take baths unless instructed not to do so
  • No driving or machinery while having pain and taking narcotic pain meds. Usually until foley catheter is out. Limit long car rides

Medication

You should resume your pre-surgery medication(s) unless told not to. You may be discharged with iron tablets to build up your blood count. These may cause constipation, and will cause dark stools. You will also be discharged with narcotic pain pills for post-operative pain control from the incision and catheter. Tylenol (acetaminophen) or Advil (ibuprofen) which have no narcotics may be used if the pain is not too bad and you can tolerate these medications.

Catheter Care

Your catheter is very important to allow healing of the bladder and urethra. You may use either leg bags or external bags. The tip of the penis may get sore from the catheter rubbing it. Use plain soap and water to wash this area daily or more often as needed. You may apply neosporin or bacitracin ointment daily and as needed. Make sure you secure the catheter to your leg with some tape so that the catheter does not pull and put tension on the catheter.

Wound

Your incisions are sealed from outside bacteria within two days of surgery. Nonetheless, you should protect it from dirt and soiling for the first ten days or so. The steri-strips (white tapes) should be left on for at least 10-14 days, if possible. After this period, you may remove the steri-strips. If a new area of redness or swelling occurs, please let us know.

Hygiene

You may shower upon discharge. Avoid baths until the incisions heal.

Side Effects:

Bowels

The rectum and prostate are next to each other and any very large and hard stools that require straining to pass can cause bleeding. You may take stool softeners (Colace, Surfak, etc.) as needed. A bowel movement every other day is reasonable. Use a mild laxative if needed and call if you are having problems (MOM 2-3 tbsp or 2 Dulcolax tabs). Patients sometimes develop diarrhea secondary to antibiotics. You may use Kaopectate as directed (avoid Imodium). If it persists, please call. Do not strain to have a bowel movement as this may break the sutures connecting your bladder and urethra which may require leaving your catheter in longer.
Problems you should report to us:
  • Fevers over 101 degrees Fahrenheit
  • Heavy bleeding or clots. You will notice blood in your catheter and bag which is normal, but if it is excessive or the catheter becomes plugged and not draining, please call your office immediately
  • Drug reactions (hives, rash, nausea, vomiting, diarrhea)
CALL IMMEDIATELY IF THE CATHETER FALLS OUT OR STOPS DRAINING

Follow Up:

You will need a follow-up appointment in approximately 2 weeks. Call your office and schedule an appointment. Most people will not have good urinary control at first. Come to the office with a small supply of adult diapers or pads (Attends or Depends) that can be purchased at many stores (Walmart, Walgreens, Kmart etc.).
Pelvic Muscle Exercises to Improve Bladder Control:
Pelvic muscle exercises strengthen the group of muscles called the pelvic floor muscles. These muscles relax and contract under your command to control the opening and closing of your bladder/sphincter. When these muscles are weak, urine leakage may result. However, you can exercise them and in many cases, regain your bladder control. You need to build the strength and the endurance of your muscles which requires regular exercise.

Kegel Exercises

Begin by locating the sphincter muscle to exercise:
As you begin urinating, try to stop or slow the urine stream WITHOUT tensing the muscles of your legs, buttocks or abdomen. This is very important. Using other muscles will defeat the purpose of the exercise.
When you are able to stop or slow the stream of urine, you know that you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.
Once you figure out the correct muscles, discontinue the practice of stopping your urine stream.
TIPS: You may squeeze the area of the rectum to tighten the anus as if trying not to pass gas. This also helps locate the correct muscles.
Exercising the Kegel Muscle regularly:
After you have located the correct muscles, set aside time each day for 3 exercise sessions (morning, midday and evening).
Squeeze your muscles to the slow count of five. Then, relax the muscle completely to the slow count of five. The five second contraction and the five second relaxation make one "set."
Your goal is to hold each contraction for five seconds, to relax for five seconds, and to complete 3-4 sets in each of the three exercise sessions per day.
Inner Thigh/Abduction Exercise on a Stability Ball
Begin by placing a ball between your thighs.
Squeeze you are thighs inward to the slow count of five. Then, relax the muscles completely to the slow count of five.
Your goal is to hold each contraction for five seconds, to relax for five seconds and to complete 3-4 sets in each of the three exercise sessions per day.
Outer Thighs/Adduction Exercises
Begin by placing a belt or elastic band around your knees which will provide resistance.
Squeeze your thighs outward to the slow count of five. Then, relax the muscles completely to the slow count of five.
Your goal is to hold each contraction for five seconds, to relax for five seconds and to complete 3-4 sets in each of the three exercise sessions per day.
TIPS: When your pelvic floor muscles are very weak, you should begin by contracting the muscles for only 2-3 seconds. Begin doing what you can and continue faithfully. In a few weeks, you should be able to increase the amount of time you are able to hold the contraction and the number of exercise sets you are able to do. Your goal is to hold each contraction for five seconds, to relax for five seconds and to complete 3-4 sets in each of the three exercise sessions per day.
If you are unsure that you are contracting the correct muscles, at your next exam, ask your urologist to help you identify the proper muscle contraction.
Use daily activities such as eating meals, watching the news, waking up, going to bed and stopping at traffic lights as clues to do a few pelvic muscle exercises. Exercise your pelvic muscles regularly.