Johns Hopkins Hospital Patients and Johns
Hopkins Bayview Medical Center Patients please
use the phone numbers listed above.
In the event of an emergency and you need to contact someone
in the evening hours or on the week end, please call the paging
operator at 410-955-6070 (for
Johns Hopkins Hospital Patients) or 410-550-0100 (for
Johns Hopkins Bayview Medical Center Patients) and ask to speak
to the urologist on call.
NOTE: Patients must remember to bring all
pathology reports, PSA values, and glass pathology
slides to their consultation appointment. The pathology
slides will be submitted for review at Johns Hopkins.
For directions to Johns Hopkins Hospital and
Johns Hopkins Bayview Medical Center please click
PRIOR TO THE SURGERY
What to expect during you preoperative
During your preoperative consultation your
surgeon will review your history, medical records, PSA values,
and any available radiology films or reports.
You will then undergo a full
physical examination followed by a discussion of treatment
options for your stage of prostate cancer.
Your glass pathology slides will be submitted for review by
the Johns Hopkins Pathology Department. Results of this review
require 1-2 weeks after which the slides will automatically
be sent back to the original facility from which they came.
If your surgeon decides
that you are a candidate for robotic assisted radical prostatectomy,
you will then meet with a Patient Service Surgery Coordinator,
to schedule a date for your operation.
Any scheduling changes can be made directly through her at
Note: It is the responsibility of the patient
to inform the Patient Service Surgery Coordinator of any scheduling changes/cancellations
at least 4 weeks in advance of the surgery date out of courtesy
to your surgeon, the operative staff, as well as other patients.
What to expect prior to the surgery
Since insurance companies will not permit patients to be admitted
to the hospital the day before surgery to have tests completed,
you must make an appointment to have pre-operative testing
done at your family doctor or primary care physician's office
within 1 month prior to the date of surgery.
For Johns Hopkins Hospital Patients:
These results need to be faxed by your doctor's office to
the Pre-operative Evaluation Center at
443-287-9358 two weeks prior to your
surgery. Please call The Documentation Center at 410-955-9453
two weeks before your surgery date to confirm that this information
For Johns Hopkins Bayview Medical Center Patients
: These results need to be faxed by your doctor's office to
the Pre-operative Evaluation Center at 410-550-1391
one week prior to your surgery. Please call The Documentation
Center at 410-550-2495
before your surgery date to confirm that this information
Once your surgical date is secured, you will receive a form
along with a letter of explanation to take to your primary
care physician or family doctor in order to have the following
preoperative testing done prior to your surgery.
Aspirin, Motrin, Ibuprofen, Advil, Alka
Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex,
Voltaren, Vioxx, Plavix and some other arthritis medications
can cause bleeding and should be avoided 1 week prior to
the date of surgery (Please contact your surgeon’s
office if you are unsure about which medications to stop
prior to surgery. Do not stop any medication without contacting
the prescribing doctor to get their approval).
Bowel Preparation and Clear Liquid
Do not eat or drink anything after midnight the night before
the surgery and drink one bottle of Magnesium Citrate (can
be purchased at your local pharmacy) the evening before
your surgery. Also patients are advised to self administer
one Fleets enema the morning of surgery to evacuate the
Drink only clear fluids for a 24-hour period
prior to the date of your surgery. Clear liquids are liquids
that you are able to see through. Please follow the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after
midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
Clear Broths (no cream soups, meat,
Juices (no orange juice or tomato
Apple juice or apple cider
Tea (you may add sweetener, but no cream
Coffee (you may add sweetener, but no
cream or milk)
Clear Jello (without fruit)
Popsicles (without fruit or cream)
Italian ices or snowball (no marshmallow)
Nerve-sparing robotic assisted radical
prostatectomy is a well established procedure at Johns Hopkins
and is performed with the assistance of an experienced and
dedicated laparoscopic surgical team including nurses, anesthesiologists,
operating room technicians, many of whom you will meet the
day of surgery.
Robotic prostatectomy is accomplished
with the assistance of a experience and dedicated laparoscopic
and robotic operating room staff including nurses,anesthesiologist,
and technicians many of whom you will meet the day of surgery
assisted radical prostatectomy is accomplished using the daVinci
Surgical System, a sophisticated robotic device that uses
a high quality three dimensional camera image to provide a
superior view of the prostate gland and surrounding anatomy
Figure 1. daVinci® Surgical System operating room setup
Miniaturized robotic instruments are passed
through 5 - 6 small 1-cm keyhole incisions across the mid
abdomen (Figure 2) to allow the surgeon to dissect the prostate
and sew the bladder to the urethra with great precision.
This is in contrast to the conventional
open radical retropubic prostatectomy where a lower midline
abdominal incision is required for dissection and removal
of the prostate gland.
During robotic assisted
radical prostatectomy, a telescopic lens is inserted into
one of the keyhole incisions, providing a three dimensional
and magnified view of delicate structures surrounding the
prostate gland (e.g. nerves, blood vessels, muscles) thus
allowing optimal preservation of these vital structures. The
cancerous prostate gland is dissected free from the bladder
and urethra, and the bladder and urethra are sewn together
without the surgeon's hands ever entering into the patient's
body. The prostate is eventually removed intact through one
of the keyhole incisions located at the belly button by extending
the incision to accommodate the prostate depending on its
size (usually 3-5 cm). Results from multiple centers specializing
in robotic surgery have indicated that patients undergoing
robotic assisted radical prostatectomy have less blood loss
than traditional open surgery. Early results for cancer cure,
urinary continence, and potency also appear similar to open
The surgeon is seated at
a computer console (Figure 4) and manipulates the robotic
wristed instruments with joystick hand controls (Figure 5).The
surgery is performed adhering to the same anatomic principals
of open surgery, but without the surgeon’s hands entering
into the patient’s body cavity.
Figure 4. daVinci® Surgical System
Figure 5. Joystick hand controls
All surgical steps of nerve-sparing
robotic assisted radical prostatectomy can be viewed in the
Video Resources section
of this site. Once the prostate gland is dissected free from
the bladder, rectum, and urethra, it is placed in a small
plastic bag and eventually removed by extending the incision
at your belly button to accommodate the prostate. The bladder
is sewn back to the urethra to restore continuity of the urinary
tract using laparoscopic suturing techniques inside the body.
A Foley catheter is placed through the penis to drain the
bladder and allow healing of the bladder-urethra connection.
In addition, a small drain is placed around the surgical site,
exiting one of the keyhole incisions.
The length of operative
time for robotic assisted radical prostatectomy can vary greatly
(3-5 hours) from patient to patient depending on the size
of the prostate gland, shape of the pelvis, weight of the
patient, and presence of scarring or inflammation within the
pelvis due to infection or prior abdominal/pelvic surgery.
Blood loss during robotic assisted radical prostatectomy is
routinely less than 300 cc. Transfusions are rarely required.
Donation of blood prior to surgery for autologous blood transfusion
can be arranged if the patient desires.
these video clips include footage from an actual surgery which
some viewers may find difficult to watch.
Potential Risks and Complications
Although this procedure has proven to be
very safe, as in any surgical procedure there are risks and
potential complications. The safety and complication rates
are similar when compared to the open surgery. Potential risks
Bleeding: Although blood
loss during this procedure is relatively low compared to
open surgery, a transfusion may still be required (in <1%
of patients) if deemed necessary by your surgeon either
during the operation or afterwards during the postoperative
period. If you are interested in autologous blood transfusion
(donating your own blood) prior to surgery, you must make
your surgeon aware. An authorization form can be faxed to
the Red Cross in your area.
Infection: All patients
are treated with intravenous antibiotics, prior to the start
of surgery to decrease the chance of infection from occurring
within the urinary tract or at the incision sites.
Adjacent Tissue / Organ Injury:
Although uncommon, possible injury to surrounding tissue
and organs including bowel, vascular structures, pelvic
musculature, and nerves could require further procedures.
Transient injury to nerves or muscles can also occur related
to patient positioning during the operation.
Hernia: Hernias at incision
sites rarely occur since all keyhole incisions are closed
under direct laparoscopic view.
Conversion to Open Surgery:
The surgical procedure may require conversion to a pure
laparoscopic procedure (performed without the robotic system)
or even to the standard open operation if extreme difficulty
is encountered during the robotic procedure (e.g. excess
scarring or bleeding). This could result in a standard open
incision and possibly a longer recuperation period.
As in open surgery, urinary incontinence can occur following
robotic prostatectomy, but often improves over time with
the use of Kegel exercises, which help strengthen the urinary
Similar to open surgery, a nerve-sparing technique is attempted
during robotic dissection of the prostate gland unless there
is obvious involvement of the nerve tissue by tumor. The
return of erectile function following prostatectomy is a
function of the age of the patient, degree of preoperative
sexual function, technical precision of the nerve-sparing
technique, and time.
Urethrovesical Anastomotic Leakage:
Transient small urinary leakage can occur at the connection
between the bladder and urethra following both open and
robotic prostatectomy and often resolves without further
intervention within a few days to up to a week. The urinary
catheter will remain in place until the leakage has stopped.
WHAT TO EXPECT AFTER
During your hospitalization
Immediately after the surgery you
will be taken to the recovery room, then transferred to your
hospital room once you are fully awake and your vital signs
Hospital Stay: Length
of hospital stay for most patients is 1 - 2 days.
Diet: You can expect
to have an intravenous catheter (IV) in for 1-2 days. (An
IV is a small tube placed into your vein so that you can
receive necessary fluids and stay well hydrated; in addition
it provides a route to receive medication.) Most patients
are able to tolerate clear liquids the first day after surgery,
and a regular diet the following day. Once on a regular
diet, pain medication will be administered by mouth instead
of by IV or shot.
Post Operative Pain:
Pain medication can be controlled and delivered by the patient
via an intravenous patient-controlled analgesia (PCA) pump
or by injection (pain shot) administered by the nursing
staff. You may experience minor transient shoulder pain
(1-2 days) related to the carbon dioxide gas used to inflate
your abdomen during the laparoscopic surgery.
Bladder Spasms: Bladder
Spasms are commonly experienced as a moderate cramping sensation
in the lower abdomen or bladder and are quite common after
prostatectomy. These spasms are usually transient and often
decrease over time. If severe, medications can be prescribed
by your doctor to decrease the episodes of these spasms.
Nausea: You may experience
transient nausea during the first 24 hours following surgery,
which can be related to the anesthesia. Medication is available
to treat persistent nausea.
Urinary Catheter: You
can expect to have a urinary catheter (Foley) draining your
bladder (which is placed in the operating room under anesthesia)
for approximately 1-2 weeks after the surgery. It is not
uncommon to have blood-tinged urine for a few days to a
week after your surgery.
Pelvic Drain: The pelvic
drain is placed in the operating room and drains the pelvic
space around the bladder-urethra anastomosis. This drain
is usually removed in 2-3 days when the drainage is minimal.
Fatigue: Fatigue is common
and should start to subside in a few weeks.
You will be expected to do some very simple breathing exercises
to help prevent respiratory infections by using an incentive
spirometry device (these exercises will be explained to
you during your hospital stay). Coughing and deep breathing
is an important part of your recuperation and helps prevent
pneumonia and other pulmonary complications.
Ambulation: On the day
after surgery it is very important to get out of bed and
begin walking with the supervision of your nurse or family
member to help prevent blood clots from forming in your
legs. You can expect to have SCD's (sequential compression
devices) along with tight white stockings on your legs to
prevent blood clots from forming in your legs while you
are lying in bed.
Constipation/Gas Cramps: You may experience
sluggish bowels for several days following surgery as a
result of the anesthesia. Suppositories and stool softeners
are usually given to help with this problem. Taking a teaspoon
of mineral oil daily at home will also help to prevent constipation.
Narcotic pain medication can also cause constipation and
therefore patients are encouraged to discontinue any narcotic
pain medication as soon after surgery as tolerated.
What to expect after discharge from
Pain Control: You can expect to have some
incisional discomfort that may require pain medication for
a few days after discharge, and thereafter Tylenol should
be sufficient upon returning home to control your pain.
Showering: You may shower at home. Your
wound sites can get wet, but must be padded dry. Tub baths
can soak your incisions and therefore are not recommended
in the first 2 weeks after surgery. You will have adhesive
strips across your incisions. They will either fall off
on their own or can be removed in approximately 5-7 days.
Incisions and suture: Your incisions will
be closed with sutures beneath the skin, which will dissolve
within 4 – 6 weeks. (Figure 6).
Figure 6. Postoperative Incisions
Activity: Taking daily
walks is strongly advised. Prolonged sitting or lying in
bed should be avoided and can increase your risk for forming
blood clots in the legs as well as developing pneumonia.
Climbing stairs is possible but should be limited. Driving
should be avoided for at least 2 weeks after surgery. Absolutely
no heavy lifting (greater than 20 pounds) or exercising
(jogging, swimming, treadmill, biking) for six weeks or
until instructed by your doctor. Most patients return to
full activity an average of 3-4 weeks after surgery.
Medications: You can resume your usual
medications after surgery with the exception of aspirin
or other blood thinners, which can increase the risk of
Follow up cystogram appointment: The first
postoperative appointment will be to remove the catheter,
usually done at 1-2 weeks after surgery. Your surgeon will
decide on the timing of this and this appointment will be
arranged through the urology clinic (410-955-6707).
At this appointment you may undergo a cystogram (if determined
necessary by your surgeon) in the radiology department.
The cystogram is an X-ray study of the bladder that determines
whether the bladder has healed completely to the urethra.
At that same visit, your urologist will decide on whether
the catheter can be safely removed after reviewing your
cystogram X-ray films or whether it will need to remain
for a longer period of time to allow for healing. Most people
will have some difficulty initially with urinary control
at the time the catheter is removed. Therefore, come to
the office with a small supply of adult diapers or insert
pads (ATTENDS or DEPENDS) that can be purchased at any drug
Pathology Results: Pathology results are
usually available approximately 7 days following surgery.
These results will be reviewed with you in the office. Alternatively,
you can contact your surgeon by phone or email at one week.
Long-term Follow-up: A prostate-specific
antigen (PSA) test is drawn at 3 months following surgery.
Patients are evaluated every 3-6 months. This can be easily
accomplished over the telephone for patients who do not
live close to the Baltimore area.
Your catheter is very important to allow
healing of the bladder to the urethra. The catheter should
drain your bladder continuously. It should not be put on tension
at any time. If you feel pulling or tugging, this means that
your catheter needs to be fastened higher up on your leg to
allow for some slack on the catheter as you move and walk.
Your surgeon should be notified immediately if the catheter
stops draining completely or if it falls out.
The urine collection bag must be positioned
at all times below the bladder for proper draining by gravity.
Drain the bag before it gets too full as this will result
in a back up of urine in the bladder. Although use of the
larger collection bag is advised, a smaller leg bag is available
and can be worn under clothing. The larger bag is required
at night as the smaller bags are likely to fill up too quickly.
The tip of the penis may get sore from catheter
irritation. Use plain soap and warm water to wash this area
daily. You may use Vasaline to prevent dryness and discomfort
at the tip of the penis. A small amount of blood-tinged urethral
secretions or even urine may leak around the catheter at the
tip of the penis especially during bowel movements. This occurs
due to mild straining and is completely normal.
It is common for your urine to turn pink
or red-tinged as you become more active simply from the catheter
rubbing against your bladder lining. If this occurs, reduce
your walking and increase your fluid intake. It is permissible
to bring the urine collection bag in the shower.
You may return to your normal diet immediately upon discharge
from surgery. However, adhering to foods such as rice, soups,
noodles and avoiding high fiber meals (e.g. vegetables such
as celery) is advised as your intestines may take up to a
week to recover from the surgery an anesthesia. Because of
the raw surface in your bladder and urethra, alcohol, spicy
foods and drinks with caffeine may cause some irritation or
sense of the need to void despite the fact that the catheter
is emptying the bladder. If these foods don't bother you however
there is no reason to avoid them in moderation. More importantly
is to keep your urine flowing freely, drink plenty of fluids
during the day (8 10 glasses). The type of fluids (except
alcohol) is not as important as the amount. Water is best
but juices, coffee, tea, soda are all acceptable.
Your physical activity is to be restricted, especially during
the first two weeks home. During this time use the following
a. Walking 6-8 separate short walks a day is advised to
prevent blood clots from forming in the legs or pneumonia
in the lungs.
b. Climbing stairs is permitted if necessary but should
be taken slowly. Climbing stairs is otherwise not a necessary
activity in terms of exercise.
c. No lifting heavy objects (anything greater than 10 lbs)
d. No driving a car and limit long car rides.
e. No strenuous exercise for 4-6 weeks. Following this,
patients can return to their normal activities of daily
Your bowels should return to normal after the surgery (over
the course of 2-4 weeks) though pain medications can cause
constipation and therefore should be discontinued as soon
as tolerated. The rectum and the prostate are next to each
other and any very large and hard stools that require straining
to pass can cause bleeding in the urine. Use a mild laxative
(e.g. milk of magnesium) or stool softener (e.g. colace) if
needed and call if you are having problems.
You should resume your pre surgery medication unless told
not to. We recommend staying off aspirin or aspirin-containing
products until after the catheter comes out and for at least
4 weeks following surgery. You will be given a prescription
for pain pills (e.g. Tylox) for incisional discomfort. Most
men following robotic prostatectomy rely only on extra strength
Tylenol at home and do not require narcotic pain medication.
You will also be given a prescription for an antibiotic (e.g.
Ciprofloxacin) to take around the time the catheter comes
out. Typically it will be a three-day course of antibiotics,
which we ask you to start the day prior to your scheduled
You may shower or bathe as soon as you get home. Dab your
incision sites dry following a shower and avoid heavy creams
or ointments on your incisions. Keeping them dry and open
to air is adequate.
PROBLEMS YOU SHOULD REPORT TO US:
If this is an emergency the Urologist On-Call
can be contacted at 410-955-6070.
a. Fevers over 101 degrees Fahrenheit as this may be a sign
b. Heavy bleeding or clots in the urine.
c. Calf or thigh pain or swelling as this may be a sign
of a blood clot.
d. Difficulty breathing or chest pain as this may be a sign
of a pulmonary embolus or heart attack.
e. Skin rash or hives as these may be signs of potential
f. Nausea, vomiting, diarrhea which may be a sign of infectious
diarrhea (e.g. Clostridium difficile)
g. Call immediately if your catheter stops draining completely
or falls out.
The first postoperative appointment will be to remove the
catheter, usually done at 1-2 weeks after surgery. Your surgeon
will decide on the timing of this and this appointment will
be arranged through the urology clinic (410-955-6707).
At this appointment you may undergo a cystogram (if determined
necessary by your surgeon) in the radiology department. The
cystogram is an X-ray study of the bladder that determines
whether the bladder has healed completely to the urethra.
At that same visit, your urologist will decide on whether
the catheter can be safely removed after reviewing your cystogram
X-ray films or whether it will need to remain for a longer
period of time to allow for healing. Most people will have
some difficulty initially with urinary control at the time
the catheter is removed. Therefore, come to the office with
a small supply of adult diapers or insert pads (ATTENDS or
DEPENDS) that can be purchased at any drug store.
Once your catheter is removed it
is recommended that you avoid caffeine, alcohol, and excessive
fluid intake for 1-2 months as this can aggravate incontinence.
Pathology results are usually available approximately 7 days
following surgery. These results will be reviewed with you
in the office. Alternatively, you can contact your surgeon
by phone or email at one week.
IMPORTANT CONTACT INFORMATION:
(Myrna Sroka, RN) (410) 955-6070
(Emergency number for urologist on call)
PELVIC MUSCLE EXERCISES TO IMPROVE
BLADDER CONTROL (MALE)
Pelvic muscle exercises strengthen the group
of muscles called the pelvic floor muscles. These muscles
relax and contract under your command to control the opening
and closing of your bladder. When these muscles are weak,
urine leakage may result. However, you can exercise them and
in many cases, regain your bladder control.
To achieve the best results when performing
these exercises, imagine yourself an athlete in training.
You need to build the strength and the endurance of your muscles.
THIS REQUIRES REGULAR EXERCISE.
It is recommended that you start doing Kegel
exercises six-eight weeks prior to surgery.
Begin by locating the muscles to be exercised:
As you begin urinating, try to stop
or slow the urine WITHOUT tensing the muscles of your legs,
buttocks, or abdomen. This is very important. Using other
muscles will defeat the purpose of the exercise.
When you are able to stop or slow the
stream of urine, you know that you
have located the correct muscles. Feel the sensation of
the muscles pulling inward and upward.
You may squeeze the area of the rectum
to tighten the anus as if trying not to pass gas and that
will be using the correct muscles.
Remember NOT to tense the abdominal,
buttock, or thigh muscles.
Now you are ready to exercise regularly:
After you have located the correct muscles,
set aside time each day for three to four exercise sessions
(morning, midday, and evening)
Squeeze your muscles to the slow count
of five. Then, relax the muscle completely to the slow count
of five. The five second contraction and the five second
relaxation make one “set.”
When your pelvic floor muscles are very
weak, you should begin by contracting the muscles for only
three to five seconds. Begin doing what you can and continue
faithfully. In a few weeks, you should be able to increase
the amount of time you are able to hold the contraction
and the number of exercise sets you are able to do. Your
goal is to hold each contraction for ten seconds, to relax
for ten seconds, and to complete 25 to 30 sets each of the
three to four exercise sessions per day.
In the beginning, check yourself frequently
by looking in the mirror or placing a hand on your abdomen
and buttocks to ensure that you do not feel your belly,
thigh, or buttock muscles move. If there’s movement,
continue to experiment until you have isolated just the
muscles of the pelvic floor.
If you are unsure that you are contracting
the correct muscles, at your next exam, ask your urologist
to help you identify the proper muscle contraction.
It is important to know that full control
of urination may take even up to one year to return completely
following surgery. Most men experience improvement within
3-6 months. By 6 months, 70% of patients are pad-free and
90% at one year.
Exercise your pelvic muscles regularly
for a lifetime to improve and maintain bladder control.
Pelvic muscle exercises also improve
orgasmic function. Whether you are doing pelvic muscle exercise
to improve or maintain bladder control or improve orgasmic
function, or both, they must be done faithfully. Make them
part of your routine.
Use daily activities such as eating
meals, watching the news, stopping at traffic lights, and
waiting in lines as clues to do a few pelvic muscle exercises.
Avoid caffeine, alcohol or excessive
fluid intake for first 1-2 months after surgery
as this will exacerbate urinary leakage
FROM ONE PATIENT TO ANOTHER
TIPS FOR EASIER RECOVERY FOLLOWING RADICAL PROSTATE SURGERY
(This paper was written by a patient, describing
his views about recovery from radical prostatectomy. If you
have something to add or suggest, please don't hesitate to
let us know your 'Picks to Click' as they say. Some of the
products may take some searching or calling)
Upon arriving home from the hospital, the
patient will find it much more comfortable (if not absolutely
necessary) to spend most of the time in a Lazy Boy type recliner
chair since it is almost impossible to lie on the flat surface
of a bed because of the catheter. The adjustability of the
reclining chair permits comfortable sleeping as well as sitting.
Another item needed for comfort because
of the catheter is a nightshirt. An inexpensive substitute
is an XXL "one size fits all" ladies T shirt, which
can be found at Wal Mart stores. Because of the catheter,
replacing the conventional toilet seat with one having a split
front will make use of the toilet much more comfortable and
Once the catheter is removed, a new phase
begins "the return to the diaper" stage. The Depend
Company makes two basic styles of diaper: (a) the "bikini"
style, shaped like a "V" and supported by elastic
straps which button to the diaper, and (b) the typical diaper
similar to that used on babies which covers a much larger
area than the bikini style and attaches by three sticky tabs
on each side. When in place, this diaper resembles a boxer
For at least the first few weeks following
de catheterization, the "boxer style" diaper is
needed to absorb urine that at times may be difficult to control
or unpredictable. The diaper will probably require changing
two or three times a day. During this time, an absorbent pad
should be used to cover the chair seat. Once some control
of bladder function returns, fewer diaper changes will be
required daily. It's a good idea to change to a fresh diaper
before retiring for the night as well as to keep the drinking
of liquids to a minimum after 5:00 or 6:00 pm.
As far as water drinking is concerned, two
liters or more should be taken during the course of the day.
(A two liter soft drink bottle used as a water jug is a good
measure of the amount of water intake.) Also, keeping the
color of the urine in the catheter bag clear is also an indicator
of proper fluid intake. Increase water consumption if the
urine becomes amber or darker.
The scrotum and groin area will become irritated
from being continually wet with urine. An excellent cleansing
material which will increase your comfort is Carrington Perineal
Cleansing Foam for Incontinent Care. It is an aerosol preparation
that is easily applied and then wiped away, leaving the sticky,
messy, irritated area clean and comfortable and will make
life much more pleasant during this trying period. Nothing
beats a good bath and soaking upon awakening in the morning,
but Carrington's Perineal Cleansing Foam applied when necessary
during the day is the next best thing. Another alternative
for skin protection from moisture is Baza® Clear Skin
Protectant Ointment which may be available at certain pharmacies
or can be obtained on-line.
About three weeks following removal of the catheter and after
reacquiring major bladder control, you may find it possible
to sleep without the diaper at night and really enjoy comfortable
sleep. Once you become active during the day, however, the
diaper will be necessary again.
By this time, you can switch to the bikini
style diaper which allows for more freedom and more comfortable
movement. Buy the "extra absorbency" form of the
diaper to reduce changes because, by this time, you will have
become much more mobile. Once you become more mobile, more
socially active, and even feel that you can return to a limited
work schedule, you will find that discarding the diaper for
an "Incontinent Brief' will make your life feel like
ifs almost back to normal. At very nice incontinent brief
is the "Prefer" Incontinent Brief which has a zippered
front into which can be inserted an absorbent pad. What an
improvement over wearing the diaper, even the bikini type!
(The Prefer Incontinent Brief can be purchased at many health
When you finally get to the stage that you
are almost "dry" and experience only occasional
dribbles during the day, another Depend product is great.
It is the "Poise Pad," which has an adhesive tape
on the outer surface that sticks to the inner surface of your
ordinary jockey type shorts. Get the extra absorbent long
You've gotten this far in your recuperation,
so you're in the home stretch. Just don’t get too frisky
and overdo anything: work, exercise, or anything else. Take
it easy, eat properly, drink lots of fluids, get a lot of
rest, follow your doctor's instructions and get well completely.
FREQUENTLY ASKED QUESTION
What is the difference between LRP and
Both of these techniques are minimally
invasive laparoscopic procedures that require 4-5 keyhole
incisions. Both require a general anesthesia and have similar
early outcomes with regards to cancer control, urinary continence,
and sexual function. The only difference is that in the
robotic assisted technique, a sophisticated robotic system
called the daVinciTM robot is used to accomplish dissection
of the prostate gland and suturing of the bladder to the
urethra. In the robotic assisted technique the surgeon has
complete control over movement of a high definition 3-D
camera as well as wristed robotic instruments that move
and rotate with the facility of a human wrist.
How do I know if I am a candidate for
LRP or RALP?
Most men who are considered candidates
for open surgery are also good candidates for a minimally
invasive approach. Patients with a history of multiple prior
abdominal or pelvic surgeries, large prostate glands (e.g.
over 100 grams), or morbid obesity are often more challenging,
however, these conditions are not absolute contraindications
for LRP or RALP.
How long is the operation?
The length of these operations may vary
based on a patient’s weight, size of the prostate,
and the presence of scarring around the prostate gland.
In general these cases can last anywhere between 3-5 hours.
Will I need a transfusion and do I need to
Transfusions are rare with these minimally invasive techniques.
This is one of the most significant advantages over open
surgery as bleeding is drastically reduced as compared to
open surgery with routinely only 100-200 cc of blood loss.
Donation of blood is optional but not generally required
How much pain will I have after surgery?
Patients often require a small amount of
intravenous and/or oral narcotic pain medication during
their hospital stay but often use only extra strength TylenolTM
once discharged from the hospital.
How long is the hospitalization?
Hospitalization is usually 1-2 days with
these minimally invasive laparoscopic techniques. Patients
are able to walk the following day under their own power.
How long will I have to have the bladder catheter?
Removal of the catheter will be dependent
on the surgeon’s particular preference. In general,
however, because of the excellent visualization offered
by these minimally invasive laparoscopic techniques a water
tight connection between the bladder and urethra can be
easily achieved allowing for safe removal of the bladder
catheter within 1-2 weeks following surgery. The surgeon
may perform a cystogram (bladder Xray test) to confirm that
the connection between the bladder and urethra are healed
When can I return to normal activities?
In general most patients can return to
full activities by 3-4 weeks after surgery. However, urinary
control and sexual function may take months and even up
to a year or so to improve significantly, just as in open
What is my chance of urinary incontinence?
Most men experience at least some degree
of stress urinary incontinence for example when sneezing
or coughing. This generally improves with time and with
vigilance in performing Kegel exercises. We have found that
approximately 70% of men were dry at 6 months and 90% at
12 months following LRP.
What is my chance of erectile dysfunction?
The return of erectile function is perhaps the most
difficult outcome measure to predict. Many factors are
involved in the return to sexual function following
surgery including age of the patient, having an active
sexual partner, whether one or both nerve bundles were
spared, and time since surgery. When we evaluated preoperatively
potent men who underwent nerve-sparing LRP, we found
that 48% of men who had both nerve bundles spared reported
successful intercourse at 6 months and 72% at one year
following surgery with or without the use of oral medications
(e.g. Viagra or Cialis) (see Figure 1).
Younger men (< 58 years) appear to have a higher
potency rate as compared to older patients (>58 years)
at one year (i.e. 74% vs. 41%) (see Figure 2).
Lastly, in younger men (<58 years old) who had
both nerves spared, 82% reported intercourse at one
year. These results are very similar to results reported
with open nerve sparing prostatectomy performed at our
Will I need to follow up at Hopkins after my
Your first follow up appointment will be
for the cystogram or bladder Xray study in 1-2 weeks following
surgery. Following this, a PSA test and office visit either
to your local urologist or with your Hopkins urologist is
recommended at 3, 6, 12 months and then typically annually
When will the pathology results be available?
Once the cancerous prostate gland is removed
it is thoroughly evaluated by the Johns Hopkins pathologists.
They are able to identify the Gleason grade, location, and
extent of the cancer. In general these results are made
available to the surgeon in 5-7 days.
Will I need further treatment following surgery
for my prostate cancer?
Much of the decision on whether further
treatment such as radiation or hormonal therapy is required
will be based upon the pathologic stage of the cancer as
well as the trend in PSA values following surgery. Most
patients nowadays have early cancers detected by PSA screening
and therefore are by and large curable with surgery. Therefore
most patients do not require additional therapy following
surgery. But obviously each case is individualized.