hi dr charles schubert urologist and director of the prostate clinic the following video
is for those people who are awaiting or have interest in the information regarding a robotic
simple prostatectomy so the aim really is to prepare you for this surgery and to let you know
what you can expect if you've had this operation so beforehand to summarize really a robotic simple
prostatectomy is a type of keyhole surgery that we use to treat men who have significant urinary
symptoms that are related to a significantly enlarged prostate as you may be aware from
previous discussions with your urologist there are several treatment choices available to treat
urinary symptoms related to a big prostate but if you have a truly enormous prostate or massive
bph bph is the benign prostatic hyperplasia if you have a truly enormous prostate one of the most
efficient ways to remove the bulk of the obstructing prostate tissue
is with a nucleation and this can be done via a robotic approach so before we get to surgery most
people will attend the pre-admission clinic they may have some blood work done a tracing of their
heart and a urine test to make sure that there is no sign of urinary infection before we proceed on
the surgery is performed under a general general anesthetic so you are asleep during that time and
an additional spinal anaesthetic is used as well which is a small injection into the lower part of
the back and what that does is to keep you very comfortable when you wake up from your procedure
the procedure itself is done at pindara private hospital here in benoa when you arrive in the
hospital you will present to the admissions desk and before you come to hospital you'll have some
advice from your anesthesis about the last time that you can eat or drink prior to your surgery
but usually this is around six hours before your surgery at the pre-admission clinic they will
make an assessment of your background and current health issues including different medications that
you may or may not use it's really important at this stage for you to highlight to us
if you're taking any blood thinners which can include anything from aspirin or plavix all the
way through to xarelto or eliquis so please let us know and then we can give you a tailored approach
as to whether or not you need to stop this medication before we proceed on with your surgery
as indicated a combination of a general anaesthetic and a spinal
anaesthetic is used and we have found over the years that a combination of these two
facilitates the surgery but keeps you really comfortable in the post-operative period
when you wake up from the operation you will have a catheter in place which is a plastic tube that
comes through the penis and into the bladder and it allows your bladder to drain after the surgery
sometimes we will wash out the caster if there is any debris or small amounts of
bleeding from the surgical site this can just be gently washed away if that is the case we
usually leave the washings going through the night and take everything down the next day
there are dissolvable stitches in the wound and you'll notice a slight purple covering over each
of the small incisions in your tummy this is skin glue and it keeps the wounds waterproof afterwards
and just means that you can't have a shower the next day after your surgery and you just pat the
wounds dry for the majority of people after this surgery they are discharged on the day
after their operation it's important to note that you are discharged with your catheter in place
a bag is applied onto the end of the caster and you're provided with some education about how to
manage that bag over the following week so people are discharged with a bag you keep the bag for
a week there is a leg bag that attaches onto the thigh and you will be given a night bag which is a
larger bag with connecting tubing which at night time you plug into the day bag
you do not remove the day bag from the caster that's an important point to note if you do remove
the day bag from the caster we're increasing the potential for infection to travel through the
catheter and into the blood and obviously that's something that we don't want to happen so to recap
you'll have a catheter that comes out through the penis it will be connected through to a leg bag
and at night time before you go to sleep you will attach it through to a larger bag a nighttime bag
and really what this does is it allows urine to flow from the bladder through into the first bag
and then to collect into the second bag it means really that you can have a better night's sleep
as things will passively drain and fill up the larger bag through the evening rather than needing
to change the smaller capacity bag through the night many men report to me that they're quite
surprised at actually how much urine they produce particularly in the first few days and the reason
for that is that you're given quite a bit of fluid through the drip during your hospital stay
and when your body starts to recover that fluid is then mobilized back into the vascular tree
and your kidneys start to produce more urine the keys to a quick recovery after this surgery are to
make sure that you do stay really well hydrated in that first week so drink plenty of fluid
i like patients to walk gently on the flat really as much as they can tolerate in that first week
so i encourage everyone in the first day after your operation i'd like you to walk a minimum
of half a kilometer and then from day two until we remove the caster a minimum of one kilometer
at seven days following your operation you come back to hospital at that stage we send off a
urine test it is very common at that time to find that there can be bugs that grow on the catheter
it does not mean that you have a urinary tract infection it just means that the catheter itself
is colonized with a bug and the process of removing the catheter and giving you a single
dose of antibiotic usually as a tablet at that time is sufficient to make sure that you don't
develop an infection after removal of the catheter so the catheter is removed and at that point we go
through a process which is called a trial avoid which in essence basically means that we assess
your ability to pee and empty your bladder we get you to perform three sequential peas you
pee in the bottle the team will measure how much you actually pee and then we do a small bedside
ultrasound to make sure that you're not retaining excessive amounts of urine as long as you give us
three ticks in the box we are happy for you to be discharged from hospital that day be prepared that
process can take sometimes if it's quick three or four hours but be prepared to spend half a
day through to maybe six hours in the hospital just whilst we make sure that everything is okay
i will have the pathology available and will either call you with the results of the pathology
or that pathology will be made available to you at the time that we remove the catheter i
see everyone back in the office again 12 weeks after your surgery and the aim of that visit
is to make sure that your urinary function number one has improved so we get you to fill out another
questionnaire that you will have filled out prior to your surgery and so we can compare the two and
see where things have improved in addition to that we will require you to do a flow test so on that
occasion please arrive with a full bladder arrival the full bladder we'll check your flow and we'll
make sure that there is a significant improvement which for just about every man there is at that
at that time if there are any questions at that point we'll address them and then usually moving
forward the plan is for you to have a psa the blood test for the health of the prostate which
we'll do on an annual basis and that can be done either with your gp locally or it can be done
through the prostate clinic and we'll make that call at that time i hope this answers
your questions if if however you do have additional questions please leave them in
the comment box below or alternatively if you're awaiting prostate surgery with me
and you'd like to ask a question more immediately please call through to our office leave the
question with the staff and i'll ensure i get an answer back to you hope this helps