Procedure
Before Surgery
Routine pre-operative testing is performed prior to surgery. A clear liquid diet is started the day prior to surgery. To help evacuate any contents in the bowel, patients are instructed to drink one bottle of magnesium citrate on the evening before surgery and administer a Fleet enema the morning of surgery. Patients should receive nothing by mouth for at least eight hours prior to surgery.
During Surgery
During the surgery, you will be given general anesthesia. The procedure is performed through 5 to 6 small incisions across the mid abdomen. Through these small incisions, fine laparoscopic instruments are inserted to dissect the prostate gland, seminal vesicles, and vasa deferentia from the urethra and bladder. Excellent visualization of the prostate gland and the surrounding neurovascular structures is achieved with the use of a high-powered telescopic lens attached to a camera device. 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 one of the small incisions to accommodate the prostate. The bladder is sewn back to the urethra to restore continuity of the urinary tract. A catheter is placed through the penis to drain the bladder and allow healing of the bladder-urethra connection. In addition, a small drain is sometimes placed near the surgical site.
After Surgery
Hospital Stay: Hospital stay for most patients is 1-2 days.
Post-Operative Pain: Because dVP is performed through very small incisions, it is associated with minimal surgical pain. Most patients recover without
narcotics. The reduction of pain also permits most patients to get back
on their feet within hours of surgery and leave the hospital the next day. A small amount of
drainage from the incisions may be seen. Swelling in the penis and scrotum may occur. Placing a wash cloth under the scrotum when sitting or lying down will help alleviate the swelling.
Bladder Spasms: Bladder Spasms are commonly experienced following prostatectomy
as a moderate cramping sensation in the lower abdomen or bladder. You may have an urgent
need to void. These spasms often decrease over time.
Urinary Catheter: A urinary catheter is used to drain the bladder for
approximately 5-7 days following the surgery. It is not uncommon to have
blood-tinged urine for a few days to a week. Blood or urine may leak around the catheter
and is usually seen with increased activity or bowel movements.
Pelvic Drain: If a pelvic drain is placed in the operating
room to drain the pelvic space around the bladder-urethra, it
is usually removed in 24 hours.
Diet: Most patients are able to tolerate clear liquids a few hours after
surgery. A regular diet may be started after a bowel movement. Liberal fluid intake is encouraged.
Fatigue: Generalized fatigue is common and should start to subside in
a few weeks.
Constipation: Sluggish bowels for several days to a week following surgery can occur. Stool softeners have been ordered for one month. Milk of magnesia as directed on the bottle may be used.
Showering: Wound sites can get wet, but must be patted dry. Showers are
permissable yet tub baths are not recommended in the first 2 weeks following
surgery.
Activity: Walking is strongly advised. Prolonged sitting or lying in
bed should be avoided. Climbing stairs is encouraged. Driving should
be avoided for at least 1 week. Most patients return to full activity
an average of 2 weeks after surgery. No biking or horseback riding for four weeks.
Medications: With the exception of aspirin or other blood thinners, usual
medications can be resumed following surgery. Three new medications will be added; an antibiotic
for one week, a stool softener for one month, and a pain medication taken as needed.
Additional Resources
