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.
Stop taking any of the new weight loss medications such as Ozempic, Wegovy, semiglutide, trizapatide, Mounjaro as they increase the risk of vomiting with anesthesia.
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.

For post-prostatectomy Kegel exercises, there are several instructional videos available on YouTube that come highly recommended:

Kegel Exercises for Men AFTER Prostate Surgery – This video provides guidance on performing Kegel exercises to help stop bladder leakage fast after prostate removal surgery. It is presented by a Pelvic Floor Physiotherapist named Michelle, offering a step-by-step guide through the exercises. Watch it here.
Kegel Exercises for Men – This is a different video on performing Kegel exercises. Watch it here.
Kegels – Mini Guide – This video is a very quick guide on Kegels. Watch it here.

The Kegel Routine

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 cannot 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).

What to Bring with you to the Hospital

A pair of loose-fitting pants, like sweat pants.
Brief-style underwear that is 1 to 2 sizes larger than you normally wear.
Sneakers that lace up. You may have some swelling in your feet, lace up sneakers can accommodate this swelling.
If you have a history of sleep apnea and use a CPAP, then bring it to the hospital.
Your cell phone with a charger cord/plug
Your Health Care Proxy Form, if you have completed one.
A case for your personal items, such as eyeglasses, hearing aid(s), dentures, toothbrush, shaving kit, and religious articles.
This handout as a reference.
Your Driver’s License for ID and insurance cards.
List of all your current medications.

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 eat very light meals and stay hydrated, in the evening before surgery try to stay on 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

Day of Surgery

Here is what you should expect on the day of surgery.

Arriving to Hospital

You will be asked to arrive at least 2 hours prior to the surgery.
Once parked, please go to the admitting/registration of the hospital, directions will be given by the security at the hospital entrances.
After registration, you will be going to the preoperative area.

Pre-Operative Area

In the preoperative area, you will be in a semiprivate suite with a bed and curtains around you for privacy. Your family members may stay with you in this area.
Here you will meet with your nurse who will get you ready for surgery
You will change to a hospital gown, robe, and nonskid socks to wear.
Tell your nurse the dose of any medications and tell the nurse when you last took those medications
Your nurse will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia medications during your surgery.

Meeting With Your Anesthesia Team

After meeting your nurse, the anesthesia team will start talking with you to review your medical history, your surgical history and your experience with any previous anesthesia.
They will talk to you about your comfort and safety during your surgery.
You will have a chance to talk about the kind of anesthesia you will receive.
For most major surgeries, general anesthesia is given with you completely asleep and a machine breathing for you.
The anesthesia team includes a nurse anesthetist who is a very experienced nurse trained to administer anesthesia, they work under direct supervision of the anesthesia doctor. After initial questions by the nurse anesthetist, you WILL meet the doctor and will have a chance to ask any questions you may have about your anesthesia.

Seeing Dr. Gorbatiy

Once the nurse and the anesthesia are done getting you ready, Dr. Gorbatiy will meet with you and your family and answer any last questions you may have.
The surgery (including anesthesia, preparation, operation, waking up in recovery) takes about 4 hours in total on average.
PLEASE tell Dr. Gorbatiy of any changes in your health since the last time you saw him in the office. If these changes are things like a fever, severe cold or flu, respiratory or heart problems, please call our office prior to surgery as these problems may pose risk to your surgery and the procedure may need to be delayed for safety reasons.

Time To Rock & Roll!

Once all your questions have been answered and you are ready for surgery, the anesthesia team will give you an IV medication for relaxation and make you sleepy and forgetful. At this point you may kiss your loved ones, who will be escorted to the family waiting area.
You will be taken in on a stretcher. to the operating room by a member of the operating room team will help you onto the operating bed. Compression devices that look like large blood pressure cuffs will be placed on your legs and will be squeezing your leg muscles to move blood out of your legs and prevent blood clots both during and after surgery.
Once you’re fully asleep under anesthesia, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You will also have a urinary catheter placed to drain urine from your bladder.
Surgery then begins and you will then be gently woken up and safe, the anesthesia team will remove the breathing tube. You will not remember any of this. You will be moved from the operating room bed to a stretcher and transported to the PACU (post anesthesia care unit), which is the recovery area.

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