Urology

Robotic Prostatectomy Preoperative Instructions

Prostate needle biopsies must be reviewed by BWH pathologists to confirm the diagnosis of prostate cancer prior to surgery. Leading up to surgery, diet and exercise to approximate ideal body weight. In addition, blood thinners such as aspirin, ibuprofen, Coumadin, Plavix, Motrin, etc. should be stopped at least 7 days prior to surgery. Please check with your primary doctor to assure that it is safe to cease these medications. If there is a history of heart disease, please check with your cardiologist to ensure that general anesthesia is safe. Also, the day prior to surgery, remain on a clear liquid diet (chicken broth, jello, apple juice, cranberry juice, etc.). 

You will also take a bowel prep the day before surgery called Magnesium Citrate. You should drink (1) 10-ounce bottle the day before your surgical procedure. Magnesium Citrate should begin working within 30 minutes to 3 hours. The bowel prep with magnesium citrate does not apply if you suffer from kidney disease or renal insufficiency."

Robotic Prostatectomy Postoperative Instructions

At home, take Aspirin or Tylenol in the morning, mid-day, and at bedtime. If there is break through pain, then take Vicodin. Follow the instructions given with the prescription, and stay on a stool softener until bowel habits return to normal.

Do not lift more than 10 pounds for up to 4 weeks after surgery. Walking is encouraged, and walking up stairs do not pose a problem. While the catheter is in, drink more than 8 glasses of fluids a day. If the urine becomes dark and thick (like tomato juice) notify the doctor on call. There may be a clot in the bladder that needs to be irrigated out through the catheter. If the catheter does not drain, or falls out (rare), then call the doctor on call and return to the emergency room. The urine may be blood tinged with activity such as walking, due to the catheter rubbing the lining of the bladder. Also, you may notice some drops of blood come around the catheter, particularly when having a bowel movement.

Wounds should be kept dry for at least 48 hours following surgery. Take the wound dressing off from your drain site two days after discharge from the hospital, at which time you may also shower.

Expectations Following Robotic Prostatectomy

Actual operative time for Dr. Hu varies between 2-3 hours.  Over 95% of men are discharged home the following day, and most men do not require narcotic pain medications once they get home.  The risk of blood transfusion is <1%.  Most men achieve continence between 3-6 months following surgery.  Return of potency is achieved over a period ranging from a few weeks up to two years following surgery.  Both return of continence and potency is dependent on age and preoperative functional status.

Instructions After Catheter Removal

Perform Kegel [J1] exercises. Return of continence plateaus at 2 years postoperatively; however, most men are continent by 2-6 months. Discuss the use of potency rehabilitation with Dr. Hu. Similar to urine function, sexual function also plateaus at 24 months.  

Cancer Surveillance

A PSA now serves as a cancer marker. It should be drawn between 4-6 weeks postoperatively. This can be done with your primary doctor or urologist. Please have them fax the results to Dr. Hu at 617-566-3475. PSA’s should then be monitored every 3 months until the 1 year anniversary of surgery, every 6 months until the 5 year anniversary of surgery, and the annually thereafter. These can be drawn with your primary doctor, a lab closer to your residence, or at BWH prior to your return visit with Dr. Hu. The PSA should be less than 0.4.