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Robotic radical prostatectomy: pre- and post-operative information

Patient information A-Z

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.
Common problems after surgery

Incontinence

Following surgery you will need to wear incontinence pads for a period of time. You can purchase these from most pharmacies. They can be found amongst the female sanitary wear; however the stock and choice of male pads can be quite limited. They can also be purchased online.

We recommend buying a few boxes of a mid-range pad, level 2, prior to surgery. Following catheter removal you will be more able to gauge your continence and purchase the correct product for your needs.

Free samples are available from:

Fitted briefs work best with the incontinence pads.

Other problems include:

  • Pain in the abdomen or perineum (the space between the anus and the scrotum). You can take a painkiller such as paracetamol or ibuprofen to address this.
  • Bloating due to excess air in the abdominal cavity during surgery: walking is the best way to improve this.
  • Urine bypassing the catheter (urinary leakage) and leaking of urine around the outside of the catheter. This is frustrating but so long as most of the urine is draining into the catheter bag then your catheter is draining , if not, then your catheter may be blocked, so please seek help by either contacting your GP practice, your specialist nurse or your local accident and emergency department.
  • Your bowels may take three to four days to open. Please take the laxatives prescribed upon discharge. Make sure you drink plenty of fluid.
  • Swelling of the penis or scrotum.
  • Erectile dysfunction and dry ejaculation.
Pelvic floor exercises

These exercises are essential to regain your continence post-operatively. Online guidance is available; see the link to the CSP male pelvic floor exercise booklet at the end of the leaflet.

Technique

  • Stand with a good posture.
  • Imagine you are trying to shorten your penis, lift behind the scrotum and gently tighten around the back passage. This gives the feeling of stopping a urine leak.
  • Ensure you are not tightening the big bottom muscles, lifting your shoulders or pulling a funny face.

Power contractions

  • Do these six times a day in a standing position.
  • Do ten full lifts of the pelvic floor muscle, relax fully in between contractions.

By varying the position of your feet the pelvic floor muscle activation will feel different so try:

  • Standing with your toes turned out, do five pelvic floor exercises - emphasis on the back passage.
  • Then with your toes turned in, do five pelvic floor exercises - emphasis on the front part of the pelvic floor.
  • Finally with your toes pointed straight ahead, do five pelvic floor exercises - works the whole pelvic floor.

Endurance contractions

  • Do these six times a day before and after the operation. Do ten repetitions of lifting the pelvic floor muscle, holding each contraction for ten seconds.

These are long, slow holds of your pelvic floor muscle at about a half lift position.

Pelvic floor timings diagram: A vertical line labelled '100% hold' at the top and '0% hold' at the bottom. A horizontal line is attached to the right labelled '10 seconds holds x 10 repetitions' in the middle and '10 seconds' at the end of the line.
Pelvic floor timings

Ensure that you hold the pelvic floor lift and continue to breathe for about 10 seconds or count in breathing cycles to improve the endurance of these postural muscles.

These exercises are best done in a standing position, but you can also practise in sitting and lying positions. You can even try and do a few extra contractions, for example when waiting in a queue or sitting in the car at red traffic lights.

Make sure you fully let go of the contraction between exercises.

The exercises we suggest are in line with current research.

If your pelvic floor muscles feel achy or sore after exercising then have a rest and reduce the numbers you do. Contact your specialist nurse if you are unsure.

The knack

It is important to use the pelvic floor muscles at the correct time. When you increase the intra-abdominal pressure the pelvic floor muscles need to be switched on. When doing activities that involve effort, for instance coughing, sneezing, lifting, squatting, pushing, pulling, sit to stand and yawning, you need to engage the pelvic floor muscle first, then do the activity and do not switch the muscle off until afterwards.

After the operation, when you accidentally leak, notice the activity that you are doing and ensure you practise that same activity engaging the pelvic floor muscle throughout.

Labelled pelvic flow chart - two arrows; one pointing down and one pointing up. Smaller arrows around the larger arrows directing clockwise and a grey right-angled triangle on the right hand side.
Pelvic flow chart labelled: Cough, sneeze, laugh, lift, push, pull all put a big pressure down on the pelvic floor muscle. Engage the pelvic floor muscle prior to activity. Make sure that you keep the pelvic floor muscle 'switched on' until the activity is over. Potential leaking zone.

Expectations

Tissue healing takes 12 weeks.

  • You will most probably have urine leakage after the operation, once the catheter has been removed.
  • You should notice a big reduction in leaking at night in the first six weeks.
  • After three months you should notice a marked reduction in leaking.
  • After a year 90% of men are dry.

Maintain ‘good’ bladder habits

You may have problems with urgency (the need to visit the toilet quickly) or frequency (visiting the toilet more than two hourly).

It is quite tempting after the operation to visit the toilet too often. This means that your bladder does not have the chance to fill up properly and it may cause further problems.

To ensure you avoid these problems:

  • Drink enough fluid: one and a half to two litres of fluid per day.
  • If you have bladder sensitivity or are visiting the toilet more often than three hourly avoid caffeine, fizzy drinks, fresh fruit juice and alcohol.
  • Visit the toilet three to four hourly.
  • Avoid ‘just in case’ visits to the toilet.
  • After the operation if you are rushing to the toilet you will need to call or visit your GP to check that you do not have a urine infection.
  • Try deferment techniques to spread out the visits; when you get the message to urinate:
  • try stopping and breathing.
  • sit down, cross your legs and tap your feet.
  • do a pelvic floor contraction.
  • think about something else.
  • complete a fluid volume chart to chart input and output.

Frequency volume chart

Day one
Time Drink Urine Leak
Time for example Drink Tea 250ml Urine 200ml Leak No
Time 6-7am Drink Urine Leak
Time 7-8 Drink Urine Leak
Time 8-9 Drink Urine Leak
Time 9-10 Drink Urine Leak
Time 10-11 Drink Urine Leak
Time 11-12 Drink Urine Leak
Time 12-1pm Drink Urine Leak
Time 1-2 Drink Urine Leak
Time 2-3 Drink Urine Leak
Time 3-4 Drink Urine Leak
Time 4-5 Drink Urine Leak
Time 5-6 Drink Urine Leak
Time 6-7 Drink Urine Leak
Time 7-8 Drink Urine Leak
Time 8-9 Drink Urine Leak
Time 9-10 Drink Urine Leak
Time 10-11 Drink Urine Leak
Time 11-12 Drink Urine Leak
Time 12-1am Drink Urine Leak
Time 1-2 Drink Urine Leak
Time 2-3 Drink Urine Leak
Time 3-4 Drink Urine Leak
Time 4-5 Drink Urine Leak
Time 5-6 Drink Urine Leak
Time Total Drink Urine Leak
Day two
Time Drink Urine Leak
Time for example Drink Water 200ml Urine 50ml Leak Yes
Time 6-7am Drink Urine Leak
Time 7-8 Drink Urine Leak
Time 8-9 Drink Urine Leak
Time 9-10 Drink Urine Leak
Time 10-11 Drink Urine Leak
Time 11-12 Drink Urine Leak
Time 12-1pm Drink Urine Leak
Time 1-2 Drink Urine Leak
Time 2-3 Drink Urine Leak
Time 3-4 Drink Urine Leak
Time 4-5 Drink Urine Leak
Time 5-6 Drink Urine Leak
Time 6-7 Drink Urine Leak
Time 7-8 Drink Urine Leak
Time 8-9 Drink Urine Leak
Time 9-10 Drink Urine Leak
Time 10-11 Drink Urine Leak
Time 11-12 Drink Urine Leak
Time 12-1am Drink Urine Leak
Time 1-2 Drink Urine Leak
Time 2-3 Drink Urine Leak
Time 3-4 Drink Urine Leak
Time 4-5 Drink Urine Leak
Time 5-6 Drink Urine Leak
Time Total Drink Urine Leak

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

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

Services available

Books and booklets

Products

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.

We are smoke-free

Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

Other formats

Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/

Contact us

Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ

Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/