Robotic "Simple" Prostatectomy for BPH

Understanding Simple Prostatectomy

You have just completed an operation to remove the inside "obstructing" part of your prostate. This procedure is usually done by a camera-assisted instrument through the penis (the so-called transurethral resection of the prostate or TURP). However, your prostate was very large, so the incision technique was deemed more effective and safer. Postoperatively, several tubes and drains were used to control any untoward bleeding or urinary leakage.

How you may feel
In general, you will feel fatigued and tired for the first three weeks. You may nap frequently, and simple tasks may exhaust you. Your sleep-wake cycle may be disrupted in the sense that you may be awake part of the night and sleep part of the day. This is normal. It will persist until your activity schedule returns to normal. Your appetite may be reduced and some foods may seen unappealing. These problems will correct themselves over time. Narcotics for pain should, in general, be used only before bedtime to help you sleep. Pain during the daytime can be managed with Motrin and decreased activity.

Your incision
Your incision may have minor irritation around the skin staples (if that is what is used to close the skin). Otherwise, it is normal to feel a firm ridge underneath the incision, and this will go away over time. Do not use topical ointments unless instructed. Your incision will fade and mature over 6-18 months. It is not unusual for a small amount of clear, reddish fluid to leak and stain your dressing. If this staining is greater than the size of a silver dollar, call your surgeon. If you have Steri-strips, they may be removed one week after application. You may take a shower.

Activity
Your postoperative recovery will be divided into two parts: the first 3 weeks and the second 3-5 weeks. The first three weeks will be devoted to the healing of your wound. During this time, you must be a "man of leisure". Passive activity such as walking, going out to dinner, sitting at a desk to answer phone and mail messages is allowable. You may be driven in an automobile, but you should not drive. This is especially true if you are requiring pain medication. The principal reason for not driving is not that you are not capable, but rather your performance during an emergency and any situation requiring sudden movement may be compromised. Urination during this time is best characterized as unpredictable. That is, you may have a sudden urge to urinate and without much warning, urine will appear! For this reason, until you feel confident with your ability to control urination, you should have a plastic urinal nearby (take one home from the hospital). If you are in a situation that will not allow you use of a urinal, then wearing a disposable pad or adult diaper will offer satisfactory protection. Showering is okay. You may feel a great deal of fatigue and require a nap in the afternoon. You will be discharged with enough antibiotics for one week to help prevent infection. Finally, it is not uncommon to experience a small amount of bleeding during the first phase of recovery. Often, patients notice intermittent bouts of blood-tinged urine which is normal. There is no need for concern unless clots form which impair your ability to urinate. If that happens, call your surgeon's office immediately, even if it is in the middle of the night! Finally, aspirin or Motrin should be avoided during the first 3 weeks of recovery because of the potential for bleeding.

The second phase of your recovery, beginning 3 weeks after the date of your surgery, will last about one month. During this time, you should begin to progressively escalate your activities, such that by the end of 4 weeks you are back to a regular schedule. During the entire recovery, it is important not to become constipated. Remember, any pain medicine with narcotics may cause constipation, so adjust your diet accordingly and take stool softeners if necessary.

Catheter Care
Most patients will go home with a catheter. Whether or not your do depends on several factors, including type of operation, size of prostate removed, preoperative status of your bladder, etc. Some patients find that placing antibiotic ointment around the catheter at the tip of the penis will reduce irritation. Most people find that catheter drainage into the "overnight bag" is most convenient, because it simply holds more urine and does not require frequent emptying as does the "leg bag". Also, it may be more convenient to wear loose fitting pants, like sweat pants or exercise pants with side snaps. The leg bag may be clipped to the pants and conveniently carried. When wearing the leg bag, be careful that it does not overfill. In addition, a leg bad should be worn only during walking times, because when sitting, the urine may back up into the catheter.

It is normal to pass small clots through the catheter, although, in general, the urine should be clear. It may become blood-tinged periodically. Please call your surgeon if the catheter stops draining or if you see multiple large clots or persistent blood. Finally, you may experience leakage around the catheter at the tip of the penis. This may be managed by placing gauze around the tip of the penis or by wearing an incontinence pad.

Within one week of discharge, call your surgeon's office for your return office visit appointment which should be already be scheduled.