Robotic radical prostatectomy: pre- and post-operative information

Who is the leaflet for? What is its aim?

This leaflet is for any patient who is going to have his prostate removed by a robotic procedure at Addenbrooke’s hospital.

Your specialist nurse (direct telephone line: 01223 216897)

Your specialist nurse works as an integral part of the urology team. They will:

• provide information and support
• work alongside the consultants
• organise and co-ordinate your treatment and follow up
• be a point of contact for you and your family

Please note; this telephone is not manned and is only covered during office hours Monday to Friday. Please leave a message on the specialist nurses voicemail and your call will be returned as soon as possible (usually within 24 to 48 hours).

If you have any urgent issues, please contact your own GP practice, contact NHS 111 or attend your local accident and emergency department.

The day before the surgery

The pre-assessment clinic will give you advice on any regular medication that you take. They will tell you if changes to your regular medication are needed in the days leading up to your surgery. Please follow their advice carefully.

Instructions for administering specific medication before surgery:

• Omeprazole is given to reduce the acidity in your stomach prior to surgery as you will be in a head down position during the procedure, for around 2.5 hours.
• Take 1x 20mg tablet orally (by mouth) between 18:00 and 22:00 the evening before your surgery and 1x 20mg tablet at 05:00 on the morning of your surgery. You may take these with a sip of water.
• Please note: the rest of the box of tablets can be discarded. You can bring these to the hospital and we can dispose of them safely. If you are already taking medication to reduce stomach acid, for example; lansoprazole, esomeprazole, pantoprazole, rabeprazole, famotidine, nizatidine or cimetidine - you may not need to take omeprazole. Your medical team will discuss this with you prior to surgery.
• Glycerol suppositories will empty your bowels prior to surgery. One suppository should be inserted into the back passage/rectum between 18:00 and 22:00 the evening before surgery. Then insert a further one suppository at approximately 05:00 on the morning of surgery.
• If you have a lengthy drive to hospital, administer the suppository early so that you have your bowels open before you leave the house.
  • To administer the suppository, open the box and take the suppository out of the plastic wrapper. Run the suppository under lukewarm water, lie on your left-hand side, then gently insert it into the back passage. Relax in this position for 15 minutes or until you feel the need to open your bowels.
  • The pre-assessment department will give you advice on when you should stop eating and drinking – it is important that you follow their advice.

On the day of surgery

• Please arrive at the Addenbrooke’s day surgery unit on ward L2 by 07:00am.
• If you are first on the theatre list you will leave the ward, for theatre, at approximately 08:00. If you are second on the theatre list, you will leave the ward at approximately 13:00.
• The operation takes approximately two and a half hours and you will be away from the ward for approximately five hours.
• On your return to the ward you may have intravenous (through your vein) fluids running, a surgical drain, oxygen via nasal cannula and a catheter.
• You can usually eat and drink as you are able.

The day after surgery

• We will take blood samples from you to check all relevant blood parameters.
• You will be taught how to care for your catheter for when you are discharged home.
• You will be required to walk 25 laps of the ward prior to discharge.
• We will remove your drain, if you have one.
• You will normally be ready to go home at around midday.
• We advise you to drink 2 to 2.5 litres of fluid daily while the catheter is in place.

Catheter removal day and trial without catheter (TWOC)

• Your catheter will be removed 7 to 10 days after your surgery; this appointment will be at Addenbrooke’s.
• It will be an early morning appointment and you should expect to be at the hospital most of that morning.
• You will be asked to have a routine blood test (full blood count) while you are here.
• Please bring with you at least three incontinence pads and good fitting briefs.

Post-surgery follow-up appointment (6 to 8 weeks post-surgery)

• We will ask you to organise a PSA (prostate specific antigen) blood test a week prior to the appointment. It would help optimise the appointment if you could ensure you obtain the result of this PSA blood test and inform us/ pass a copy onto us/ our secretaries, prior to your appointment.
• A doctor will report on the results of the prostate tissue taken at the time of surgery.
• Your continence will be assessed
• A doctor will discuss penile rehabilitation and erectile function with you.
• Following this appointment, you will be transferred to nurse-led care for the remainder of your follow up with us at Addenbrooke’s.

Routine nurse-led follow-up appointments (including PSA blood test)

• Three monthly follow up for the first 12 months post-surgery.
• Six to twelve monthly follow up from years 1 to 4 post-surgery (this will be assessed on an individual basis).
• Your nurse may discuss discharge back to your GP with you, from around years 3 to 5 post surgery, to continue PSA monitoring in the community (this will be assessed on an individual basis).
• You will be required to have a PSA blood test prior to every appointment.
• We will request that you actively take part in your follow up by taking responsibility for arranging a PSA blood test at your GP surgery prior to each appointment and to also keep a record of it.
• We will provide you with a PSA follow up booklet and information about a website called ’TrackMyPSA’ where you can register and set up reminders for blood tests. (Information with instruction included – see appendix 1.)
• If you do not have access to a computer, we can provide you a follow up book; please ask your specialist nurse.
• If you think that you are due an appointment but have not received one, please get in touch with your specialist nurse.

Frequency volume chart

Penile rehabilitation and erectile dysfunction

Your ability to have an erection will be affected after the surgery. Whether erections return is dependent on many factors and this will be discussed before the operation. You will also no longer produce fluid when you ejaculate. This is called dry ejaculation which will be permanent. However, there are various options to help you with achieving an erection after surgery.

Medication

To improve recovery of erections, you can start a medication to help improve the penile blood supply, Cialis (tadalafil) 5mg once per day. These tablets can cause some side effects, such as facial flushing, dizziness, low blood pressure, stomach discomfort or muscle ache. They should not be taken if you have a known allergy to it, or are taking other medicines containing nitrates (eg GTN spray used for angina). However, they will not work if you have had non-nerve sparing procedure performed (if you are unsure, please speak with your specialist nurse).

Vacuum device

In addition to medication, we recommend the use of a vacuum erection device (penile pump) on a regular basis: once daily as an exercise from around 6-8 weeks post-surgery. This can also be used for sexual activity. Using a penile pump maintains penile length, helps to prevent negative changes in the penile tissues until natural erections return, and can improve the quality of erections.

The vacuum device can be used with an elastic constriction band around the base of the penis in order to maintain an erection. Using the vacuum device, when urinary continence has not properly returned, can lead to leakage of urine. It is advisable to use it with an empty bladder. The vacuum device can be uncomfortable, so trial and error are needed to get it working properly. However, it should not be painful. It can be used for men who have not had nerve sparing surgery, and for men who have had nerve sparing. It can also be used in conjunction with medication (see above). Discuss with the surgical team whether it is appropriate for you.

Self-management advice

• Ensure that you are regularly performing pelvic floor exercises.
• Ensure that you understand your follow up plan and the expected interval of PSA blood tests.
• Ensure that you ask GP to give you a printout of the PSA result if you are having it taken at your GP practice and if you live outside the Cambridgeshire area.
• Ensure that you contact your specialist nurse if you have not received an appointment but you think that you are due one.
• If you have an active email address that you use regularly, please join our patient portal ‘MyChart’. Please ask the reception team or your specialist nurse regarding this.

Useful telephone numbers

• Lisa Geoghegan (Specialist nurse)
• Megan Dumphreys (Specialist nurse)
• Charmaine Odal (Specialist support nurse)

Direct telephone line: 01223 216897

• Penny Nixon (Physiotherapist): 01223 216633
• Clinic 4A: 01223 216575
• Ward M5: 01223 348525
• Ward L5: 01223 348908
• Maggie’s Wallace centre: 01223 249222
• REACT: 01223 349294

Useful information

Pemberton House – Somewhere to stay on site

Pemberton House is an affordable on-site accommodation. It is available for patients who are being admitted to Addenbrooke’s hospital and their relatives.

• Each room is en-suite with TV, tea and coffee making facilities and towels.
• Please visit the Pemberton house website (opens in a new tab) for prices and further information.
• For bookings call the Frank Lee Leisure Centre on 01223 868300.
• Parking is charged on a daily rate; ensure you get your parking ticket stamped by the ward or outpatient clinic.

Robotic prostatectomy support group

• Location: Maggie’s Wallace centre, 01223 249220
• Time: 17:00 - 18:30
• Date: First Monday of every month

General advice

• NHS choices (opens in a new tab)
• Prostate Cancer UK (opens in a new tab)

Services available

• Urology nurses at Addenbrooke’s – 01223 257049
• Self-referral link to physiotherapy for Cambridgeshire patients – outpatient-physiotherapy musculoskeletal-conditions accessing-service
• REACT – Rehabilitation and Exercise during Addenbrooke’s cancer treatment - Email REACT, 01223 349294
• Maggie’s cancer services Cambridge – 01223 249220 (drop in or join a group session to gain knowledge and support after prostate surgery)
• Robotic prostatectomy support group, held 17:00 - 18:30 on the first Monday of the month – 01223 249220. Please contact Maggie’s for further information
• Pro-active Peterborough Oncology CNS Team – 01733 677476
• Ipswich – Fiona Lennard, physiotherapist, Ipswich Hospital -01473 703522
• Bedford – Milena Testori, physiotherapist, North wing Bedford Hospital – 01234 409232
• See video class link on CUH- Urology (opens in a new tab)

Books and booklets

• Prostate Recovery Map 2 by Craig Allingham
• The Prostate Playbook by Craig Allingham
• CSP male pelvic floor exercise booklet (opens in a new tab)
• Urgency and urge incontinence
• Fluid volume chart – Bladder matters (opens in a new tab)

Products

• The Squeezy App (opens in a new tab)
• Pads – all supermarkets or Tena
• Wearever pants (opens in a new tab)
• Dribble stop clamp (opens in a new tab)
• Pacey cuff (opens in a new tab)
• Afex (opens in a new tab)

References

• Milios et al. BMC Urology (2019) 19:116 pelvic floor muscle training in radical prostatectomy

Further advice

Please be aware that this leaflet is to be used as a guide. If you find these exercises aggravate your symptoms or are painful, seek advice from your specialist nurse, physiotherapist or GP.

This information has been compiled by the specialist nurse and physiotherapy team at Addenbrooke’s Hospital.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one to one care is required.