The following blog is for those people who are awaiting or have interest in information regarding a robotic simple prostatectomy. The aim really is to prepare you for this surgery and to let you know what you can expect if you have this operation.
As you may be aware from previous discussions with your urologist there are several treatment choices available to treat urinary symptoms related to a big prostate but if you have a truly enormous prostate or massive BPH (benign prostatic hyperplasia) one of the most efficient ways to remove the bulk of the obstructing prostate tissue is with an enucleation procedure which can be done via a robotic approach.
Before we get to surgery most people will attend the pre-admission clinic. They may have some blood work done, a tracing of their heart and a urine test to make sure that there is no sign of urinary infection. At the pre-admission clinic they will make an assessment of your background and current health issues including different medications that you may or may not use. It’s really important at this stage for you to highlight to us if you’re taking any blood thinners which can include anything from aspirin, Plavix, xarelto or eliquis so please let us know and then we can give you a tailored approach as to whether or not you need to stop this medication before we proceed on with your surgery.
Surgery is performed under a general anaesthetic so you are asleep during your operation and an additional spinal anaesthetic is used as well which is a small injection into the lower part of the back. This has the added benefit to keep you very comfortable when you wake up from your procedure.
The procedure itself is done at Pindara Private Hospital here in Benowa. When you arrive in the hospital you will present to the admissions desk. Before you come to hospital you’ll have some advice from your anaesthetist about the last time that you can eat or drink prior to your surgery. This is usually around six hours before your surgery.
When you wake up from the operation you will have a catheter in place which is a plastic tube that comes through the penis and into the bladder. It allows your bladder to drain after the surgery. Sometimes we will wash out the catheter. If there is any debris or small amounts of bleeding from the surgical site this can just be gently washed away. If that is the case we usually leave the washings going through the night and take everything down the next day.
There are dissolvable stitches in the wound and you’ll notice a slight purple covering over each of the small incisions in your tummy. This is skin glue, it keeps the wounds waterproof afterwards and just means that you can’t have a shower the next day after your surgery.
For the majority of people they are discharged on the day after their operation. it’s important to note that you are discharged with your catheter in place, a bag is applied onto the end of the catheter and you’re provided with some education about how to manage that bag over the following week.
You will also be given a night bag which is a larger bag with connecting tubing. At night time you plug the larger bag into the day bag. YOU DON’T ROMOVE THE LEG BAG FORM THE CATHETER. If you do remove the day bag from the catheter we’re increasing the potential for infection to travel through the catheter and into the blood stream. Obviously that’s something that we don’t want to happen.
So to recap you’ll have a catheter that comes out through the penis. It will be connected through to a leg bag and at night time before you go to sleep you will attach it through to a larger bag. What this does is is to allow urine to flow from the bladder through into the first bag and then to collect into the second bag thus allowing you to have a better night’s sleep as things will passively drain and fill up the larger bag through the evening rather than needing to change the smaller capacity bag through the night.
Many men report to me that they’re quite surprised at actually how much urine they produce particularly in the first few days following surgery so be reassured this is entirely normal. The reason for that is that you’re given quite a bit of fluid through the drip during your hospital stay and when your body starts to recover that fluid is then mobilized back into the vascular tree. Your kidneys then start to produce more urine.
The key to a quick recovery after this surgery is to make sure that you do stay really well hydrated in that first week so drink plenty of fluid. I like patients to walk gently on the flat really as much as they can tolerate in that first week so I encourage everyone on the first day after your operation to walk a minimum of half a kilometre.
From day two until we remove the catheter a minimum of one kilometre. At seven days following your operation you come back to hospital at which stage we send off a urine test. It is very common at that time to find that there can be bugs that grow on the catheter. It does not mean that you have a urinary tract infection. It just means that the catheter itself is colonized with a bug and the process of removing the catheter, giving you a single dose of antibiotic is usually sufficient to make sure that you don’t develop an infection.
After removal of the catheter we go through a process which is called a trial of void. We get you to perform three sequential pees into a bottle after which the team will measure how much urine you maybe retaining. As long as you are not retaining excessive amounts of urine we are happy for you to be discharged from hospital that day. Be prepared for that process to take half a day.
I will usually have the pathology available and will either call you with the results of the pathology discuss with you at the time that we remove the catheter.
I see everyone back in the office again 12 weeks after your surgery and the aim of that visit is to make sure that your urinary function has improved. We ask you to fill out another questionnaire which you will have filled out prior to your surgery. This allows us to compare the two so that we can see where things have improved. In addition we will require you to do a flow test so PLEASE ENSURE THAT YOU ARRIVE WITH A FULL BLADDER.
Usually moving forward the plan is for you to have a PSA test (the blood test for the health of the prostate) which we’ll do on an annual basis. This can be done either with your GP, locally or it can be done through The Prostate Clinic. I hope this helps but if there are any additional questions please let us know.