Pre-Operative Instructions: Robotic Radical Prostatectomy

Pre-Operative Instructions: Robotic Radical Prostatectomy

If you are currently awaiting a robotic prostatectomy, it is essential for your own safety and for the success of your surgery that you carefully read and observe these instructions.

Medications

  • Ten (10) days before surgery please STOP taking any Aspirin, Motrin (Ibuprofen), Aleve, Vitamin E, Fish Oil and any other blood thinners, including Herbal medications and multi-Vitamins.
  • If you are on Plavix (clopidogrel), Coumadin (warfarin) or any other prescribed blood thinner, make sure you mention this to Dr. Gorbatiy so we could have a clear permission from your primary doctor or cardiologist to stop those medications safely prior to surgery.
  • Take usual doses of heart, thyroid, asthma medication on the morning of surgery with a tiny sip of water. If you are diabetic and take medication, do not take them on the morning of surgery. If you take insulin, only use half the normal dose the morning of surgery.

Preparing the Sphincter Prior to Surgery to Hasten Urinary Control

Removal of the prostate will cause a period of incontinence (urinary leakage) for most patients. Every patient is different, so do not compare notes. On average, most patients by 2-3 months are dry but there are patients that will never leak and some that will take much longer. The leaking can be some squirts with position change (stress incontinence) to soaking pads. There can be urge incontinence (when you have to go, you really have to go) so it will be advantageous to urinate before you have a strong urge. Most patients will not leak at night but might have to wake up every hour or two to urinate. The Kegel exercise builds up the muscles around the bladder opening. For most patients, doing the Kegels is the first and only thing needed to regain control. They should be started before surgery so you get a head start and hopefully will spend less time after surgery dealing with incontinence.

Kegel Exercises

Kegels can be done standing, sitting, or lying down. The correct way is to tighten the muscle that helps you stop urine flow during urination. It should be a contraction that you ease into and sustain. It is not a vigorous clamping down and you legs, buttocks, and abdomen should not tighten. You should not strain or hold your breath. You may notice your penis move up when done but do not concentrate on making your penis go up and down. If done correctly, while urinating, Kegeling should stop the urine flow. This can be used to check the technique but you should not be routinely Kegeling while urinating.

The Regime

The Kegels should be 10 repetitions in a row holding each contraction for a count of 10 with a few seconds of relaxing the muscle in between each contraction. Before surgery, doing 4-8 sets of 10 reps every day in the weeks preceding surgery would be helpful. The first few days after the catheter is removed three sets a day can be done. Then for the remainder of that first week you should increase to doing 10 reps every other hour. After that, you can increase to doing them every waking hour. When done correctly you should not squirt urine while tightening or relaxing, become sore, or have your control worsening.

The Occasional Kegel

After the catheter is removed, with position change, cough, sneeze, or strain, you can notice a spritz/squirt. It is ok to Kegel through these movements that make you leak. For example, at night you probably will not leak but you might have to wake up every hour or two. You can tighten up (Kegel) and hold the urine until you get to the bathroom. On the other hand, if you are out walking and you are getting a consistent drip, you can not sustain a Kegel for extended periods of time. It is detrimental and you are wearing a pad. Of note, the best pads are the small ones like Depends Guards for Men that fit into fitted briefs (Jockey’s, tightly whiteys).

Bowel Prep

  • Take a Fleet's enema the morning before surgery to empty the rectum. An enema may be purchased at any pharmacy like Walgreen’s, CVS, Target, Publix and you may use their brand.

Diet Day Before Surgery

The day before your surgery, please follow a clear liquid diet. This includes the following: tea, broth, popsicles, water, Gatorade, apple juice, cranberry juice, grape juice, black coffee, Jell-O, cola/7-Up.

***DO NOT DRINK ORANGE JUICE, TOMATO JUICE OR MILK!*** NOTHING TO EAT OR DRINK AFTER MIDNIGHT

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