Robot-assisted Laparoscopic Prostatectomy Postoperative Instructions

The following is postop information to help answer questions you may have, help you prepare for your care after surgery, and hopefully calm any anxiety you are feeling. Do not ever hesitate to call our office with any questions or concerns.

Clothing

After surgery, your abdomen may be bloated, and it can be difficult to fit into your regular pants. Bring a pair of comfortable pants that have a loose waistband to wear home.

After Anesthesia

Do not drive a car or operate machinery for 24 hours after anesthesia. Do not consume alcohol, tranquilizers, sleeping medication, or any non-prescribed medications for 24 hours after anesthesia or if taking prescription pain medication. Do not make important decisions or sign any important papers in the next 24 hours after anesthesia.

Foley Catheter

During surgery, you will have a Foley urinary catheter placed in your bladder. A Foley catheter is a tube that drains urine from the bladder to the outside of your body into a bag. The catheter will stay in place until your body heals. This varies between 7 and 14 days. While the catheter is in, you may notice leakage of urine or blood from the tip of the penis around the catheter. This may be more noticeable with bowel movement. You may also notice some blood, debris or mucous sediment in the drainage tube or in the bag. The color of the urine may vary. Be sure to drink plenty of water, at least 60 ounces (2 liters) per day.

It is very important to make sure the catheter drains well. The bag should always be lower than your bladder. It is very important that there is no pulling or tugging on the catheter. Keep the catheter well secured to the leg at all times. There should never be any tension or pulling on the catheter. You may use over-the-counter medical tape to secure the catheter if needed. During the day, the catheter can be connected to a smaller bag called a leg bag. A leg bag can be worn under your pant leg. At night, the catheter should drain into a large drainage bag. You will receive instructions about the care of your urinary catheter before discharge from the hospital.

Drain

A surgical drain called a Jackson Pratt (JP) drain may be placed after surgery to drain excess fluid and blood from the body. Blood and fluid will leak around the drain. This is expected and is not a cause for alarm. The drain dressing needs to be changed when wet.

It may be removed once the drain output is low, generally less than 60 mL over 8 hour periods. It may be removed before you leave the hospital or in the office a few days later.

If you go home with the drain, secure it by attaching it to your clothes with a safety pin. Place gauze around the drain and secure with medical tape. Gauze and medical tape can be purchased at a drug store without a prescription. Change the gauze daily and as needed once wet.

Keep a record of the amount of drainage every 8 hours. Bring the record to the office for the nurse to review to see if it is safe to remove the drain.

Dressings

Remove dressings the day after surgery. There are skin staples in each incision. You do not need to place a dressings over the staples. If there is oozing or spotting from the incision, you may place over-the-counter gauze over the incisions. Secure with over-the-counter medical tape. If dressings are placed, change daily. Stop placing dressings once there is no more oozing or spotting.

Bathing

You may shower daily starting the day after surgery. Let warm soapy water run over the incision and the catheter. Once out of the shower, pat the incisions dry. Do not take baths or submerge in water until your catheter has been removed and your surgical sites have healed.

Medications

Resume your regular medications or follow instructions given at the hospital.

A pain medication to be taken by mouth may be prescribed for you. Narcotic pain medications are addictive and constipating and therefore should be discontinued as soon as possible.

NSAIDs (Alleve, ibuprofen, Motrin) decrease pain and inflammation. These may be prescribed or can be purchased at a drug store without a prescription.

Acetaminophen (Tylenol) helps decrease discomfort after surgery. This is available at any drug store without a prescription. Some narcotic pain medicines also contain acetaminophen. Do not take more than 3000 mg acetaminophen total per day. Ask your medical provider if you have history of liver problems.

A stool softener should be taken by mouth twice a day to avoid constipation. Constipation can cause you to strain to have a bowel movement, which puts stress on the surgery site and can impair healing. A stool softener or laxative may be prescribed or is available at any drug store without a prescription. These include Senna or Senokot or SennaGen, Dulcolax or Bisacodyl, Milk of Magnesia or magnesium hydroxide. Decrease or stop the stool softener for loose stools or diarrhea. Take stool softeners by mouth only. Avoid suppositories or enemas unless directed by your physician.

An antibiotic may be prescribed for you to take by mouth. Take this one hour before catheter removal.

Sildenafil (Viagra), Tadalafil (Cialis) or Vardenafil (Levitra) may be prescribed to help with blood flow and return of erections. Take as directed.

Ditropan or oxybutynin (an anticholinergic) may be prescribed for you to take by mouth for bladder spasms.

Activity

Get up and walk at least six times daily starting the day after surgery. You may be up and about as much as you like. You may go up and down stairs. You may take walks outside. Gradually increase the amount you walk each day.

Do not drive while the catheter is in place or if you are taking narcotic pain medicine.

Do not lift more than 10 pounds (4.5 kilograms) for 6 weeks. Do not bicycle or ride a motorcycle, tractor or horse for six weeks.

You may tire easily with minimal activity and find that you require an occasional nap. Your energy will return over the course of weeks to months.

Diet

Anesthesia and pain medicine can cause nausea and decrease your appetite. Start with clear fluids and bland diet. You may resume your regular diet as your appetite returns. Be sure to drink plenty of water, at least 60 ounces (2 liters) each day. Be sure to eat plenty of vegetables and fruits to promote healing and avoid constipation.

Postop plan

Call the office to make an appointment in 7 to 10 days if you do not already have a postop appointment. Call the office for fever over 101°F or inability to urinate.

Things You May Encounter After Surgery

• Bruises around the incision sites: These are common and should not alarm you. They will resolve over time.
• Abdominal distention, constipation or bloating: Make sure you are taking your stool softener as directed. If you don’t have a bowel movement or pass gas or are feeling uncomfortable 24 hours after surgery, try taking Milk of Magnesia as directed on the bottle. If, after two doses of Milk of Magnesia, you still have not had a bowel movement, call our office. Do not use an enema.
• Weight gain: This can occur from shifting of fluid during and after surgery. Your weight typically returns to normal in five to fourteen days.
• Scrotal/penile swelling and bruises: This is common and should not alarm you. It may appear immediately after surgery or it may start four to five days after surgery. Your scrotum may become as big as an orange or a grapefruit. It should resolve in about seven to 14 days. You may elevate your scrotum on a small towel or washcloth that you have rolled up when you are sitting or lying down to decrease the swelling. It also helps to wear Jockey or snug-fitting underwear for support, even with the catheter in place.
• Bloody drainage around the Foley catheter or in the urine: Especially after increased activity or after bowel movement is common. Resting for a short period of time will improve the situation.
• Leaking urine around the catheter: Urine, mucus or blood may leak around the tube, which is OK. If this happens, wear your underwear with a pad inside for protection/absorption. Most of the urine should drainage into the collection bag.
• Bladder spasms: These are common. You may feel mild to severe bladder pain or cramps, the sudden, urgent need to urinate, or a burning sensation when you urinate. These typically resolve once the catheter is removed.
• Perineal pain (pain between your rectum and scrotum)/testicular discomfort: This may last for several weeks after surgery, but it will resolve. You can also try elevating your feet on a small stool when you have a bowel movement. When you are able to take baths again, try warm tub soaks as this may be helpful as well.
• Lower legs/ankle swelling: This is not abnormal when it occurs in both legs and should not alarm you. Elevating your legs while sitting will help. Call us if the swelling is in only one calf or becomes painful.

Contact Us Immediately If You Are Experiencing Any Of The Following Symptoms:

• Temperature over 101°F (38.3°C)
• Urine stops draining into the drainage bag
• Any pain unrelieved by the pain medication
• Blood clots in urine that block the catheter
• Bladder spasms that are not relieved with medication
• Nausea/vomiting
• Pain or swelling in one calf

Pathology Results

The pathologist will look at the prostate, glands behind the prostate and lymph nodes under the microscope and write a report. This report is available on the patient portal as soon as it is released by the pathologist.

Patients typically have a postoperative appointment with their surgeon two weeks after surgery to review the pathology report and discuss next steps.

Staple and Catheter Removal

Skin staples and catheter are typically removed one week after surgery at a nurse visit. After catheter removal you well know to leakage of urine. It is common to lack control of passing urine. Typically men where a pad or shield inside the underwear for urinary leakage.

Urinary Control

Start Kegel exercises after catheter removal. Instructions will be given at catheter removal and are available on our website. These exercises will help you to regain your urinary control. Many men have improved urinary control in four to six weeks. Return of urinary function may take longer. You can see improvements in urinary control for up to two years. Continue Kegel exercises during this time. Do Kegel exercises 3 times per day, 10 repetitions each. You can improve return of urinary function with healthy diet, achieving and maintaining a healthy weight and exercising at least 30 minutes per day 5 times per week. Get plenty of sleep. Avoid smoking and excess alcohol.

Erectile Function

Your recovery of erections after a prostatectomy can be slow. Even though the nerves to the penis can be spared, there is still some injury from trauma or stretching during the operation. These damaged nerves need time to heal. Most men need help with erections after surgery. Most men start with pills to help with erections. If this is not enough, we discuss vacuum pump or injections of medicine into the penis. Erection recovery can continue for 18 months after surgery. There is evidence that erections themselves help healing and decrease scar tissue. At each follow-up visit, your physician will discuss sexual function and treatment options to help with erections.

Long Term Follow Up

PSA blood test will need to be followed long-term after surgery. This is often checked after surgery then every several months. PSA will be undetectable if there is no cancer. Eventually PSA is checked yearly if it remains undetectable. PSA will need to be monitored indefinitely.