Transcript Robotic Prostatectomy Course - Hartford HealthCare Medical Group

Robotic Prostatectomy
Course
Carrie A. Collin R.N., B.S.N.
CSG - Division of Urology
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

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
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
HBOT Study
 Viagra starts
POD#15 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
HBOT Study
PROS
FREE VIAGRA FOR
ONE YEAR!!!
•
•
•
•
CONS
Daily trips to HH
5-10 sessions
90 min in the room
Not everyone qualifies
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
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
Post Op

JP drain – To drain
any blood or fluid.
Most likely will be
removed prior to
leaving hospital

5 bandages and/or
Dermabond
Foley Catheter
Tube coming out of the penis to drain urine
 Stays in until 1st post op visit
 2 types of drainage bags

2 Types of Drainage Bags

Large bag or Overnight bag


Can hold more urine
Leg bag

Easily hidden under clothes, smaller capacity
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
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
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
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
Worries







Incisions that are red, have
pus, hot, worsening of pain
or severe pain in general
Nausea/vomiting
Temperature >100.5, 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
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
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.
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!
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
Oral Medications

Side effects








Headache
Facial flushing
Lightheadedness
Upset stomach
Muscle aches
Visual disturbances
Auditory distubances
Erection lasting more
than 4 hrs, call MD
Penile Rehabilitation

Vacumn Therapy System

User friendly
98% effective
Some insurances cover

www.stamenmedicalsystems.com


Penile Rehabilitation

Injection Therapy



Muse



Needle injected in the penis
Relaxes penile blood flow which allows blood to flow
freely into the penis to cause an erection
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
1st Year Follow up
12
9
PSA
Office Visit
6
3
0
1 Month
3 Month
6 Month
9 Month 12 Month
nd
2

Lab work
 PSA and
 Office Visit
 every 6 months
Year Post Op
12
11
10
9
8
7
6
5
4
PSA
Office Visit
3
2
1
0
6
Month
12th
Month
3rd, 4th, & 5th Year
Yearly PSA and Office visits
 May resume care with usual urologist whenever
desired
