Robotic ProstatectomyRobotic ProstatectomyCourseCourse

Carrie A. Collin R.N., B.S.N.Carrie A. Collin R.N., B.S.N.CSG - Division of UrologyCSG - Division of Urology

Prior to SurgeryPrior to Surgery Pre op labsPre op labs Necessary MD visits for clearance, i.e., PCP, Necessary MD visits for clearance, i.e., PCP,

Cardiologist, etc.Cardiologist, etc. Stop all aspirin and aspirin containing medicines Stop all aspirin and aspirin containing medicines

(Excederin, Anacin) at least 7 days before surgery(Excederin, Anacin) at least 7 days before surgery Stop all blood thinners 5-7 days before surgery Stop all blood thinners 5-7 days before surgery

UNLESSUNLESS directed otherwise. directed otherwise. Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days

before surgerybefore surgery Please check with prescribing MD!Please check with prescribing MD! May restart 5 days after surgery unless directed May restart 5 days after surgery unless directed

otherwiseotherwise

Prior to SurgeryPrior to Surgery

Start Kegels if not started alreadyStart Kegels if not started already Some will have anesthesia consults at Some will have anesthesia consults at

HHHH Clear liquids diet to start at noon, day Clear liquids diet to start at noon, day

prior to surgey prior to surgey Bowel prep, per paperworkBowel prep, per paperwork NONO food or drink after midnight, night food or drink after midnight, night

before surgery, except a sip of water before surgery, except a sip of water to take pillsto take pills

HBOTHBOT StudyStudy

Certain criteriaCertain criteria Age 65 or lessAge 65 or less Bilateral nerve sparing, pt specificBilateral nerve sparing, pt specific Good erectile function before surgery Good erectile function before surgery

(without need for Viagra, etc)(without need for Viagra, etc) Must meet inclusion criteria (verified by Must meet inclusion criteria (verified by

research coordinator)research coordinator) Must come in for consent and hyperbaric Must come in for consent and hyperbaric

education session prior to surgeryeducation session prior to surgery

HBOT StudyHBOT Study

Viagra starts POD#15 for the studyViagra starts POD#15 for the study Half the patients will be given room Half the patients will be given room

air, half will be given hyperbaric air, half will be given hyperbaric oxygenoxygen

Double blind study – neither patient Double blind study – neither patient or doctor will know what you receiveor doctor will know what you receive

Call the research coordinator at Call the research coordinator at least 7-10 days before surgeryleast 7-10 days before surgery

HBOT StudyHBOT Study

PROSPROS

FREE VIAGRA FOR FREE VIAGRA FOR ONE YEAR!!!ONE YEAR!!!

CONSCONS• Daily trips to HHDaily trips to HH• 5-10 sessions5-10 sessions• 90 min in the room90 min in the room• Not everyone Not everyone

qualifiesqualifies

Day of SurgeryDay of Surgery First case of the day goes First case of the day goes

straight to OR, otherwise straight to OR, otherwise report to where the hospital report to where the hospital tells youtells you

NO NO food or drink, sips of water food or drink, sips of water to take needed medicationsto take needed medications

Shower with Hibiclens soap Shower with Hibiclens soap provided by the hospital, if not provided by the hospital, if not provided Dial works as wellprovided Dial works as well

Approximate length of surgery Approximate length of surgery is anywhere from 2-5 hours is anywhere from 2-5 hours depending on size of prostate, depending on size of prostate, level of difficulty and if there is level of difficulty and if there is lymph node dissectionlymph node dissection

Post OpPost Op

Diet - post op will be clear liquids, Diet - post op will be clear liquids, diet will be advanced when passing diet will be advanced when passing gasgas

Activity - Out of bed as tolerated, Activity - Out of bed as tolerated, minimum of at least onceminimum of at least once

Incentive spirometry -10x every hour Incentive spirometry -10x every hour while awakewhile awake

Post OpPost Op JP drain – To drain JP drain – To drain

any blood or fluid. any blood or fluid. Most likely will be Most likely will be removed prior to removed prior to leaving hospitalleaving hospital

5 bandages and/or 5 bandages and/or DermabondDermabond

Foley CatheterFoley Catheter

Tube coming out of the penis to drain Tube coming out of the penis to drain urineurine

Stays in until 1Stays in until 1stst post op visit post op visit 2 types of drainage bags2 types of drainage bags

2 Types of Drainage Bags2 Types of Drainage Bags

Large bag or Overnight bagLarge bag or Overnight bag Can hold more urineCan hold more urine

Leg bagLeg bag Easily hidden under clothes, smaller capacityEasily hidden under clothes, smaller capacity

Catheter CareCatheter Care

Clean hands prevent infection!Clean hands prevent infection! Gently clean around the catheter Gently clean around the catheter Place small amount of bacitracin Place small amount of bacitracin

ointment around catheter near ointment around catheter near opening of penis, do not allow it to opening of penis, do not allow it to cake up. This helps the catheter move cake up. This helps the catheter move easilyeasily

May shower, disconnect bag firstMay shower, disconnect bag first When switching bags, wipe When switching bags, wipe

connection of bag with alcohol swabconnection of bag with alcohol swab

Discharge HomeDischarge Home DietDiet

Slow progression as Slow progression as toleratedtolerated

Bowel RegimenBowel Regimen Daily or twice daily stool Daily or twice daily stool

softener such as Colacesoftener such as Colace If no bowel movement If no bowel movement

by 3 days take Milk of by 3 days take Milk of MagnesiaMagnesia

NO NO self placed enemas!self placed enemas! Any increase of Any increase of

abdominal pain, nausea, abdominal pain, nausea, or vomiting call the or vomiting call the officeoffice

Discharge HomeDischarge Home

May drive when off narcotics and May drive when off narcotics and catheter is outcatheter is out

May gradually resume normal May gradually resume normal activities and exercise as tolerated. activities and exercise as tolerated. Everyone will be at a different pace.Everyone will be at a different pace.

Start Viagra Start Viagra

No WorriesNo Worries

Leaking from around catheter – as long as Leaking from around catheter – as long as urine is draining into bagurine is draining into bag

Leakage from JP sites – if requiring frequent Leakage from JP sites – if requiring frequent dressing changes, call office for bagdressing changes, call office for bag

Scrotal and perineal pain and swelling, 3-5 Scrotal and perineal pain and swelling, 3-5 days after surgerydays after surgery

Bladders spasmsBladders spasms Bloody urine – increase fluidsBloody urine – increase fluids Small blood clots – increase fluidsSmall blood clots – increase fluids BruisingBruising

WorriesWorries Incisions that are red, Incisions that are red,

have pus, hot, worsening have pus, hot, worsening of pain or severe pain in of pain or severe pain in generalgeneral

Nausea/vomitingNausea/vomiting Temperature >100.5, Temperature >100.5,

chillschills Shortness of breath, chest Shortness of breath, chest

painpain Foley came out or not Foley came out or not

drainingdraining Large blood clots or Large blood clots or

heavy bleedingheavy bleeding Calf pain and or leg Calf pain and or leg

swellingswelling Both legs likely normal. Both legs likely normal.

If one leg is painful, If one leg is painful, red, hot, more swollen red, hot, more swollen could be a blood clotcould be a blood clot

11stst Post Op Visit Post Op Visit 7-1o days after surgery7-1o days after surgery Start antibiotics the day Start antibiotics the day

before, morning of, and before, morning of, and the day afterthe day after

Catheter removal !Catheter removal ! Incontinence/Stress Incontinence/Stress

IncontinenceIncontinence Please bring pads or Please bring pads or

adult diaper to this visitadult diaper to this visit Leaking will improve, Leaking will improve,

be patientbe patient!!!! Avoid excessive fluids Avoid excessive fluids Best if able to avoid Best if able to avoid

caffeine and alcohol caffeine and alcohol consumptionconsumption

11stst Post Op Visit Post Op Visit

May resume sexual activityMay resume sexual activity Kegel exercisesKegel exercises

Continue!! Continue!! 4x/day, 10 sets each4x/day, 10 sets each Muscles need exercise, helps improve strength Muscles need exercise, helps improve strength

of pelvic musclesof pelvic muscles Pathology reportPathology report

Pathology report will be discussed with you Pathology report will be discussed with you and the MD. If you are seeing the RN and not and the MD. If you are seeing the RN and not the MD for catheter removal, the MD will call the MD for catheter removal, the MD will call to discuss report.to discuss report.

IncontinenceIncontinence BE PATIENT!BE PATIENT! Limit alcohol and caffeine, which can irritate the Limit alcohol and caffeine, which can irritate the

bladderbladder Will gradually improveWill gradually improve Lucky patients will regain control in a few weeksLucky patients will regain control in a few weeks Average patient in 3-6 monthsAverage patient in 3-6 months Unlucky patient 6-12 monthsUnlucky patient 6-12 months By month 12By month 12

93% no pads93% no pads 6% pads6% pads 1% severe leaking that may require another 1% severe leaking that may require another

interventionintervention TIME IS THE GREATEST FACTOR!TIME IS THE GREATEST FACTOR!

Penile RehabilitationPenile Rehabilitation

Oral Medications Oral Medications Viagra - 50mg daily Viagra - 50mg daily

(1/2 dose) or 100mg (1/2 dose) or 100mg (full dose) 1 hr before (full dose) 1 hr before sex and works better sex and works better on an empty stomachon an empty stomach

Cialis – taken 2 hrs Cialis – taken 2 hrs before activity and can before activity and can be taken with or be taken with or without foodwithout food

Levitra – taken 1 hour Levitra – taken 1 hour before activity and can before activity and can be taken with or be taken with or without foodwithout food

Oral MedicationsOral Medications

Side effectsSide effects HeadacheHeadache Facial flushingFacial flushing LightheadednessLightheadedness Upset stomachUpset stomach Muscle achesMuscle aches Visual disturbancesVisual disturbances Auditory distubancesAuditory distubances Erection lasting more Erection lasting more

than 4 hrs, call MDthan 4 hrs, call MD

Penile RehabilitationPenile Rehabilitation Vacumn Therapy Vacumn Therapy

SystemSystem User friendlyUser friendly 98% effective98% effective Some insurances coverSome insurances cover www.stamenmedicalsystems.www.stamenmedicalsystems.

comcom

Penile RehabilitationPenile Rehabilitation Injection TherapyInjection Therapy

Needle injected in the penisNeedle injected in the penis Relaxes penile blood flow which allows blood Relaxes penile blood flow which allows blood

to flow freely into the penis to cause an to flow freely into the penis to cause an erectionerection

MuseMuse Medicated pellet inserted into the urethra via Medicated pellet inserted into the urethra via

an applicatoran applicator Opens bloods vessels to increase blood flow Opens bloods vessels to increase blood flow

into the penisinto the penis Penile implantPenile implant

Not until all other efforts are exhausted, at Not until all other efforts are exhausted, at least 2 years afterleast 2 years after

11stst Year Follow up Year Follow up

0

3

6

9

12

1 Month 3 Month 6 Month 9 Month 12 Month

PSA

Office Visit

22ndnd Year Post Op Year Post Op

Lab work Lab work PSA and PSA and Office Visit Office Visit every 6 monthsevery 6 months

0

1

2

3

4

5

6

7

8

9

10

11

12

6Month

12thMonth

PSA

Office Visit

33rdrd, 4, 4thth, & 5, & 5thth Year Year

Yearly PSA and Office visitsYearly PSA and Office visits May resume care with usual urologist May resume care with usual urologist

whenever desiredwhenever desired