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Robotic Prostatectomy Course Carrie A. Collin R.N., B.S.N. Carrie A. Collin R.N., B.S.N. CSG -...
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Transcript of Robotic Prostatectomy Course Carrie A. Collin R.N., B.S.N. Carrie A. Collin R.N., B.S.N. CSG -...
Robotic ProstatectomyRobotic ProstatectomyCourseCourse
Carrie A. Collin R.N., B.S.N.Carrie A. Collin R.N., B.S.N.CSG - Division of UrologyCSG - Division of Urology
Prior to SurgeryPrior to Surgery Pre op labsPre op labs Necessary MD visits for clearance, i.e., PCP, Necessary MD visits for clearance, i.e., PCP,
Cardiologist, etc.Cardiologist, etc. Stop all aspirin and aspirin containing medicines Stop all aspirin and aspirin containing medicines
(Excederin, Anacin) at least 7 days before surgery(Excederin, Anacin) at least 7 days before surgery Stop all blood thinners 5-7 days before surgery Stop all blood thinners 5-7 days before surgery
UNLESSUNLESS directed otherwise. directed otherwise. Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days Stop all NSAIDS (Motrin, Aleve, Naprosyn) 7 days
before surgerybefore surgery Please check with prescribing MD!Please check with prescribing MD! May restart 5 days after surgery unless directed May restart 5 days after surgery unless directed
otherwiseotherwise
Prior to SurgeryPrior to Surgery
Start Kegels if not started alreadyStart Kegels if not started already Some will have anesthesia consults at Some will have anesthesia consults at
HHHH Clear liquids diet to start at noon, day Clear liquids diet to start at noon, day
prior to surgey prior to surgey Bowel prep, per paperworkBowel prep, per paperwork NONO food or drink after midnight, night food or drink after midnight, night
before surgery, except a sip of water before surgery, except a sip of water to take pillsto take pills
HBOTHBOT StudyStudy
Certain criteriaCertain criteria Age 65 or lessAge 65 or less Bilateral nerve sparing, pt specificBilateral nerve sparing, pt specific Good erectile function before surgery Good erectile function before surgery
(without need for Viagra, etc)(without need for Viagra, etc) Must meet inclusion criteria (verified by Must meet inclusion criteria (verified by
research coordinator)research coordinator) Must come in for consent and hyperbaric Must come in for consent and hyperbaric
education session prior to surgeryeducation session prior to surgery
HBOT StudyHBOT Study
Viagra starts POD#15 for the studyViagra starts POD#15 for the study Half the patients will be given room Half the patients will be given room
air, half will be given hyperbaric air, half will be given hyperbaric oxygenoxygen
Double blind study – neither patient Double blind study – neither patient or doctor will know what you receiveor doctor will know what you receive
Call the research coordinator at Call the research coordinator at least 7-10 days before surgeryleast 7-10 days before surgery
HBOT StudyHBOT Study
PROSPROS
FREE VIAGRA FOR FREE VIAGRA FOR ONE YEAR!!!ONE YEAR!!!
CONSCONS• Daily trips to HHDaily trips to HH• 5-10 sessions5-10 sessions• 90 min in the room90 min in the room• Not everyone Not everyone
qualifiesqualifies
Day of SurgeryDay of Surgery First case of the day goes First case of the day goes
straight to OR, otherwise straight to OR, otherwise report to where the hospital report to where the hospital tells youtells you
NO NO food or drink, sips of water food or drink, sips of water to take needed medicationsto take needed medications
Shower with Hibiclens soap Shower with Hibiclens soap provided by the hospital, if not provided by the hospital, if not provided Dial works as wellprovided Dial works as well
Approximate length of surgery Approximate length of surgery is anywhere from 2-5 hours is anywhere from 2-5 hours depending on size of prostate, depending on size of prostate, level of difficulty and if there is level of difficulty and if there is lymph node dissectionlymph node dissection
Post OpPost Op
Diet - post op will be clear liquids, Diet - post op will be clear liquids, diet will be advanced when passing diet will be advanced when passing gasgas
Activity - Out of bed as tolerated, Activity - Out of bed as tolerated, minimum of at least onceminimum of at least once
Incentive spirometry -10x every hour Incentive spirometry -10x every hour while awakewhile awake
Post OpPost Op JP drain – To drain JP drain – To drain
any blood or fluid. any blood or fluid. Most likely will be Most likely will be removed prior to removed prior to leaving hospitalleaving hospital
5 bandages and/or 5 bandages and/or DermabondDermabond
Foley CatheterFoley Catheter
Tube coming out of the penis to drain Tube coming out of the penis to drain urineurine
Stays in until 1Stays in until 1stst post op visit post op visit 2 types of drainage bags2 types of drainage bags
2 Types of Drainage Bags2 Types of Drainage Bags
Large bag or Overnight bagLarge bag or Overnight bag Can hold more urineCan hold more urine
Leg bagLeg bag Easily hidden under clothes, smaller capacityEasily hidden under clothes, smaller capacity
Catheter CareCatheter Care
Clean hands prevent infection!Clean hands prevent infection! Gently clean around the catheter Gently clean around the catheter Place small amount of bacitracin Place small amount of bacitracin
ointment around catheter near ointment around catheter near opening of penis, do not allow it to opening of penis, do not allow it to cake up. This helps the catheter move cake up. This helps the catheter move easilyeasily
May shower, disconnect bag firstMay shower, disconnect bag first When switching bags, wipe When switching bags, wipe
connection of bag with alcohol swabconnection of bag with alcohol swab
Discharge HomeDischarge Home DietDiet
Slow progression as Slow progression as toleratedtolerated
Bowel RegimenBowel Regimen Daily or twice daily stool Daily or twice daily stool
softener such as Colacesoftener such as Colace If no bowel movement If no bowel movement
by 3 days take Milk of by 3 days take Milk of MagnesiaMagnesia
NO NO self placed enemas!self placed enemas! Any increase of Any increase of
abdominal pain, nausea, abdominal pain, nausea, or vomiting call the or vomiting call the officeoffice
Discharge HomeDischarge Home
May drive when off narcotics and May drive when off narcotics and catheter is outcatheter is out
May gradually resume normal May gradually resume normal activities and exercise as tolerated. activities and exercise as tolerated. Everyone will be at a different pace.Everyone will be at a different pace.
Start Viagra Start Viagra
No WorriesNo Worries
Leaking from around catheter – as long as Leaking from around catheter – as long as urine is draining into bagurine is draining into bag
Leakage from JP sites – if requiring frequent Leakage from JP sites – if requiring frequent dressing changes, call office for bagdressing changes, call office for bag
Scrotal and perineal pain and swelling, 3-5 Scrotal and perineal pain and swelling, 3-5 days after surgerydays after surgery
Bladders spasmsBladders spasms Bloody urine – increase fluidsBloody urine – increase fluids Small blood clots – increase fluidsSmall blood clots – increase fluids BruisingBruising
WorriesWorries Incisions that are red, Incisions that are red,
have pus, hot, worsening have pus, hot, worsening of pain or severe pain in of pain or severe pain in generalgeneral
Nausea/vomitingNausea/vomiting Temperature >100.5, Temperature >100.5,
chillschills Shortness of breath, chest Shortness of breath, chest
painpain Foley came out or not Foley came out or not
drainingdraining Large blood clots or Large blood clots or
heavy bleedingheavy bleeding Calf pain and or leg Calf pain and or leg
swellingswelling Both legs likely normal. Both legs likely normal.
If one leg is painful, If one leg is painful, red, hot, more swollen red, hot, more swollen could be a blood clotcould be a blood clot
11stst Post Op Visit Post Op Visit 7-1o days after surgery7-1o days after surgery Start antibiotics the day Start antibiotics the day
before, morning of, and before, morning of, and the day afterthe day after
Catheter removal !Catheter removal ! Incontinence/Stress Incontinence/Stress
IncontinenceIncontinence Please bring pads or Please bring pads or
adult diaper to this visitadult diaper to this visit Leaking will improve, Leaking will improve,
be patientbe patient!!!! Avoid excessive fluids Avoid excessive fluids Best if able to avoid Best if able to avoid
caffeine and alcohol caffeine and alcohol consumptionconsumption
11stst Post Op Visit Post Op Visit
May resume sexual activityMay resume sexual activity Kegel exercisesKegel exercises
Continue!! Continue!! 4x/day, 10 sets each4x/day, 10 sets each Muscles need exercise, helps improve strength Muscles need exercise, helps improve strength
of pelvic musclesof pelvic muscles Pathology reportPathology report
Pathology report will be discussed with you Pathology report will be discussed with you and the MD. If you are seeing the RN and not and the MD. If you are seeing the RN and not the MD for catheter removal, the MD will call the MD for catheter removal, the MD will call to discuss report.to discuss report.
IncontinenceIncontinence BE PATIENT!BE PATIENT! Limit alcohol and caffeine, which can irritate the Limit alcohol and caffeine, which can irritate the
bladderbladder Will gradually improveWill gradually improve Lucky patients will regain control in a few weeksLucky patients will regain control in a few weeks Average patient in 3-6 monthsAverage patient in 3-6 months Unlucky patient 6-12 monthsUnlucky patient 6-12 months By month 12By month 12
93% no pads93% no pads 6% pads6% pads 1% severe leaking that may require another 1% severe leaking that may require another
interventionintervention TIME IS THE GREATEST FACTOR!TIME IS THE GREATEST FACTOR!
Penile RehabilitationPenile Rehabilitation
Oral Medications Oral Medications Viagra - 50mg daily Viagra - 50mg daily
(1/2 dose) or 100mg (1/2 dose) or 100mg (full dose) 1 hr before (full dose) 1 hr before sex and works better sex and works better on an empty stomachon an empty stomach
Cialis – taken 2 hrs Cialis – taken 2 hrs before activity and can before activity and can be taken with or be taken with or without foodwithout food
Levitra – taken 1 hour Levitra – taken 1 hour before activity and can before activity and can be taken with or be taken with or without foodwithout food
Oral MedicationsOral Medications
Side effectsSide effects HeadacheHeadache Facial flushingFacial flushing LightheadednessLightheadedness Upset stomachUpset stomach Muscle achesMuscle aches Visual disturbancesVisual disturbances Auditory distubancesAuditory distubances Erection lasting more Erection lasting more
than 4 hrs, call MDthan 4 hrs, call MD
Penile RehabilitationPenile Rehabilitation Vacumn Therapy Vacumn Therapy
SystemSystem User friendlyUser friendly 98% effective98% effective Some insurances coverSome insurances cover www.stamenmedicalsystems.www.stamenmedicalsystems.
comcom
Penile RehabilitationPenile Rehabilitation Injection TherapyInjection Therapy
Needle injected in the penisNeedle injected in the penis Relaxes penile blood flow which allows blood Relaxes penile blood flow which allows blood
to flow freely into the penis to cause an to flow freely into the penis to cause an erectionerection
MuseMuse Medicated pellet inserted into the urethra via Medicated pellet inserted into the urethra via
an applicatoran applicator Opens bloods vessels to increase blood flow Opens bloods vessels to increase blood flow
into the penisinto the penis Penile implantPenile implant
Not until all other efforts are exhausted, at Not until all other efforts are exhausted, at least 2 years afterleast 2 years after
11stst Year Follow up Year Follow up
0
3
6
9
12
1 Month 3 Month 6 Month 9 Month 12 Month
PSA
Office Visit
22ndnd Year Post Op Year Post Op
Lab work Lab work PSA and PSA and Office Visit Office Visit every 6 monthsevery 6 months
0
1
2
3
4
5
6
7
8
9
10
11
12
6Month
12thMonth
PSA
Office Visit
33rdrd, 4, 4thth, & 5, & 5thth Year Year
Yearly PSA and Office visitsYearly PSA and Office visits May resume care with usual urologist May resume care with usual urologist
whenever desiredwhenever desired