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Robotic Prostatectomy Course

Robotic Prostatectomy Course. Carrie A. Collin R.N., B.S.N. CSG - Division of Urology. Prior to Surgery. Pre op labs Necessary MD visits for clearance, i.e., PCP, Cardiologist, etc. Stop all aspirin and aspirin containing medicines (Excederin, Anacin) at least 7 days before surgery

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Robotic Prostatectomy Course

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  1. Robotic ProstatectomyCourse Carrie A. Collin R.N., B.S.N. CSG - Division of Urology

  2. Prior to Surgery • Pre op labs • Necessary MD visits for clearance, i.e., PCP, Cardiologist, etc. • Stop all aspirin and aspirin containing medicines (Excederin, Anacin) at least 7 days before surgery • Stop all blood thinners 5-7 days before surgery UNLESS directed otherwise. • Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days before surgery • Please check with prescribing MD! • May restart 5 days after surgery unless directed otherwise

  3. Prior to Surgery • Start Kegels if not started already • Some will have anesthesia consults at HH • Clear liquids diet to start at noon, day prior to surgey • Bowel prep, per paperwork • NO food or drink after midnight, night before surgery, except a sip of water to take pills

  4. HBOTStudy • Certain criteria • Age 65 or less • Bilateral nerve sparing, pt specific • Good erectile function before surgery (without need for Viagra, etc) • Must meet inclusion criteria (verified by research coordinator) • Must come in for consent and hyperbaric education session prior to surgery

  5. HBOT Study • Viagra starts POD#15 for the study • Half the patients will be given room air, half will be given hyperbaric oxygen • Double blind study – neither patient or doctor will know what you receive • Call the research coordinator at least 7-10 days before surgery

  6. PROS FREE VIAGRA FOR ONE YEAR!!! CONS Daily trips to HH 5-10 sessions 90 min in the room Not everyone qualifies HBOT Study

  7. Day of Surgery • First case of the day goes straight to OR, otherwise report to where the hospital tells you • NO food or drink, sips of water to take needed medications • Shower with Hibiclens soap provided by the hospital, if not provided Dial works as well • Approximate length of surgery is anywhere from 2-5 hours depending on size of prostate, level of difficulty and if there is lymph node dissection

  8. Post Op • Diet - post op will be clear liquids, diet will be advanced when passing gas • Activity - Out of bed as tolerated, minimum of at least once • Incentive spirometry -10x every hour while awake

  9. Post Op • JP drain – To drain any blood or fluid. Most likely will be removed prior to leaving hospital • 5 bandages and/or Dermabond

  10. Foley Catheter • Tube coming out of the penis to drain urine • Stays in until 1st post op visit • 2 types of drainage bags

  11. 2 Types of Drainage Bags • Large bag or Overnight bag • Can hold more urine • Leg bag • Easily hidden under clothes, smaller capacity

  12. Catheter Care • Clean hands prevent infection! • Gently clean around the catheter • Place small amount of bacitracin ointment around catheter near opening of penis, do not allow it to cake up. This helps the catheter move easily • May shower, disconnect bag first • When switching bags, wipe connection of bag with alcohol swab

  13. Discharge Home • Diet • Slow progression as tolerated • Bowel Regimen • Daily or twice daily stool softener such as Colace • If no bowel movement by 3 days take Milk of Magnesia • NO self placed enemas! • Any increase of abdominal pain, nausea, or vomiting call the office

  14. Discharge Home • May drive when off narcotics and catheter is out • May gradually resume normal activities and exercise as tolerated. Everyone will be at a different pace. • Start Viagra

  15. No Worries • Leaking from around catheter – as long as urine is draining into bag • Leakage from JP sites – if requiring frequent dressing changes, call office for bag • Scrotal and perineal pain and swelling, 3-5 days after surgery • Bladders spasms • Bloody urine – increase fluids • Small blood clots – increase fluids • Bruising

  16. Worries • Incisions that are red, have pus, hot, worsening of pain or severe pain in general • Nausea/vomiting • Temperature >100.5, chills • Shortness of breath, chest pain • Foley came out or not draining • Large blood clots or heavy bleeding • Calf pain and or leg swelling • Both legs likely normal. If one leg is painful, red, hot, more swollen could be a blood clot

  17. 1st Post Op Visit • 7-1o days after surgery • Start antibiotics the day before, morning of, and the day after • Catheter removal ! • Incontinence/Stress Incontinence • Please bring pads or adult diaper to this visit • Leaking will improve, be patient!! • Avoid excessive fluids • Best if able to avoid caffeine and alcohol consumption

  18. 1st Post Op Visit • May resume sexual activity • Kegel exercises • Continue!! • 4x/day, 10 sets each • Muscles need exercise, helps improve strength of pelvic muscles • Pathology report • Pathology report will be discussed with you and the MD. If you are seeing the RN and not the MD for catheter removal, the MD will call to discuss report.

  19. Incontinence • BE PATIENT! • Limit alcohol and caffeine, which can irritate the bladder • Will gradually improve • Lucky patients will regain control in a few weeks • Average patient in 3-6 months • Unlucky patient 6-12 months • By month 12 • 93% no pads • 6% pads • 1% severe leaking that may require another intervention • TIME IS THE GREATEST FACTOR!

  20. Penile Rehabilitation • Oral Medications • Viagra - 50mg daily (1/2 dose) or 100mg (full dose) 1 hr before sex and works better on an empty stomach • Cialis – taken 2 hrs before activity and can be taken with or without food • Levitra – taken 1 hour before activity and can be taken with or without food

  21. Oral Medications • Side effects • Headache • Facial flushing • Lightheadedness • Upset stomach • Muscle aches • Visual disturbances • Auditory distubances • Erection lasting more than 4 hrs, call MD

  22. Penile Rehabilitation • Vacumn Therapy System • User friendly • 98% effective • Some insurances cover • www.stamenmedicalsystems.com

  23. Penile Rehabilitation • Injection Therapy • Needle injected in the penis • Relaxes penile blood flow which allows blood to flow freely into the penis to cause an erection • Muse • Medicated pellet inserted into the urethra via an applicator • Opens bloods vessels to increase blood flow into the penis • Penile implant • Not until all other efforts are exhausted, at least 2 years after

  24. 1st Year Follow up

  25. 2nd Year Post Op • Lab work • PSA and • Office Visit • every 6 months

  26. 3rd, 4th, & 5th Year • Yearly PSA and Office visits • May resume care with usual urologist whenever desired

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