This is a general instruction guide. All of your specific preoperative instructions will be reviewed with you by the surgical scheduler.
2-6 Weeks Preop:
Dr. Kaynan’s surgical schedulers will help you pick a date for surgery (typically Tuesdays and Thursdays). The operative schedule is typically backlogged one month, however patients are required to wait a minimum of six weeks from the time of their prostate biopsy. This allows for the inflammation to settle and facilitates the performance of a safe operation. From the perspective of potential for cancer spread, it is safe to wait up to six months until definitive treatment is rendered in most cases. If you intend to postpone treatment longer than six months, you must discuss this with Dr. Kaynan.
All patients must have medical clearance prior to surgery. This should be done about one month prior to the planned surgical date.
For patients biopsied elsewhere, the pathology slides of your prostate biopsy must be submitted to Dr. Kaynan for review with the pathologists at Morristown Medical Center.
When you are scheduled for prostate surgery you are required to attend the Preop Prostate Teaching Class. (Most patients coordinate this with the preoperative lab tests which are done in the same place.) A nurse from Morristown Medical Center will review with you what to expect, where to go, how to care for your catheter postop, etc.
At some point prior to surgery, preferably a week or two prior, Dr. Kaynan will perform cystoscopy (using local anesthesia) to identify the internal architecture of your prostate and location of ureteral orifices. The surgical schedulers will schedule you for this at the time that you are given a date for your robotic procedure.
1 Week Preop:
Beginning the week prior to surgery, stop all non-steroidal anti-inflammatory agents such as Aspirin, Ibuprofen, Advil, Aleve, Motrin, Celebrex, etc. Also, eliminate all blood-thinning herbals such as garlic, vitamin E, Ginko berries, etc. If you are on Coumadin, a specific de-anticoagulation plan will be coordinated with your primary care physician or cardiovascular specialist. Make sure you speak with Dr. Kaynan about this.
1 Day Preop:
On the day before surgery you may drink liquids but eat no solid food. A bowel prep is administered (1 gallon of Go-Lytely, followed by 2 fleets enemas). We suggest that you begin the bowel prep no later than 2PM. You may not eat or drink anything after midnight except a sip of water with your medications.
On the day of surgery you will register at the surgery desk on the D level of the Carol G. Simon Cancer Center. You will then be brought to the preoperative holding area. After you’ve changed and once the room is ready, you will be brought into the operating room. An intravenous line will have been started, and compression boots will be applied to your legs.
Patients awaken in the recovery room with two intravenous lines in their arms, a urethral catheter in the penis, and a small pelvic drain exiting from the right lower abdomen. Once recovered in the recovery room, patients are delivered to one of the surgical floors (Jefferson 1, Franklin 4, or Franklin A). The nurses on these floors are specially trained to care for Minimally Invasive Surgical patients.
Once on the ward you will be encouraged to use the incentive spirometer to ensure deep breathing, and your legs will be massaged by compression boots to help recirculate your blood.
The following day, patients are typically given clear liquids for breakfast, and then regular food for lunch. The drain is typically removed. Once you demonstrate the ability to walk, eat a regular diet, take care of your catheter, and tolerate pain medications by mouth, you may be discharged from the hospital. Most patients are capable of meeting these requirements after only a one night stay. You may not drive home – someone else must drive you.
Most patients are discharged home with the following additional medications*:
- Percocet (5/325) one or two by mouth every 4 – 6 hours (most patients don’t need the pain killer after two or three days).
- Colace 100 mg by mouth twice a day (this is to keep the stool soft for the first two weeks postop).
- Cipro 500mg by mouth twice a day, #6 – to begin the morning of the cystogram at one week postop.
- Cialis 20mg or Viagra 100mg (this is to assist with penile rehabilitation, to begin after the urethral catheter is removed).
- Penile Vacuum Pump (this is to assist with penile rehabilitation, to begin after the urethral catheter is removed).
Avoid use of aspirin or any other blood thinner until Dr. Kaynan gives his approval.
*These prescriptions are general guidelines and do not account for your particular circumstance. Dr. Kaynan will review with you your specific regimen prior to discharge from the hospital.
For the first week postop while at home:
- It is OK to ride in a car, but driving is prohibited.
- You are encouraged to walk around the house, and you are permitted to climb stairs or take short strolls.
- You may not lift heavy objects or engage in any rigorous manual labor.
- You may not engage in any strenuous exercise and bike riding is strictly prohibited.
- The wounds are sealed with Dermabond which is a sterile plastic coating. You are allowed to shower and pad yourself dry. You should refrain from sitting in a bath for 2 weeks.
- The urethral catheter should be kept below the level of your bladder at all times. The small leg bag may be used during the day and should be strapped to the thigh such that there is some slack in the catheter. You will be given a large drainage bag to use at night so that it does not need to be emptied while you are asleep.
1 Week Postop:
At the time that you schedule your robotic surgery, arrangements will have been made by the surgical schedulers for you to have an x-ray test on your bladder (called a cystogram) at about a week postop. The purpose of this test is to verify that the newly reconstructed urinary tract (urethro-vesical anastomosis) has adequately healed for purposes of removing the urethral catheter. Most patients have no demonstrable leak in which case the catheter is removed on the spot. It is just an x-ray test and no anesthesia is given for this, even if it is scheduled for you in the operating room. The test itself takes less than 2 minutes, and you will be in the cystoscopy suite no more than 15 minutes. There are no dietary restrictions and you may eat whatever you like the morning of the test (despite warnings to the contrary by the ambulatory surgical staff at the hospital or surgery center). You are reminded to take the antibiotic prescribed on the morning of your cystogram, and for the two days following. You are also reminded to bring pads with you to the hospital in order to protect your outer garments.
Following removal of the urethral catheter:
Kegel Exercises: It is normal to leak urine from the penis immediately following removal of the urethral catheter, and you should expect this. Until now, your prostate was responsible for much of your urinary control, and your voluntary sphincter muscle had very little work to do. Now that your prostate is gone, this external sphincter is called to task for much more than it had been accustomed. You must exercise this muscle to get back your urinary control. To train yourself on which muscle group to exercise, try on occasion to restrict or stop the flow of urine. Then commit to performing Kegel exercises: hold the muscle group for 10 seconds, then relax for 10 seconds. Repeat this sequence 10 times to make a set, and perform 10 sets a day.
Once the catheter is removed, and provided that you no longer need narcotics (as most do not at this point), you may drive a car again. You should still refrain from any heavy physical exertion for at least one month. You are encouraged to begin the penile rehabilitation program at this point, though it is advised that you not attempt intercourse for a month.
One month after catheter removal (5 weeks postop):
Dr. Kaynan will see you in the office at which point blood will be drawn for a PSA check.
Prostate Cancer Surveillance After Treatment:
Patients are typically followed after surgery every three months for the first two years, then twice a year. Patients receive a digital rectal examination and a PSA check at these visits.