Preparing for Surgery
Before scheduling you for surgery, your surgeon may want you to undergo some staging tests. Such tests are usually only ordered for patients with “high risk” disease characteristics such as a high serum PSA ≥ 20 or high Gleason score ≥ 8. These tests, including a bone scan, CT scan or prostate MRI, can help determine whether cancer has spread out of the prostate to the bone or to the lymph nodes. In addition, you will need to see your primary care doctor for a history and physical examination before surgery.
You will need to pre-register at the hospital a day or two before surgery. You can expect to complete paperwork for the hospital and blood tests. You will also need to get a chest x-ray and an electrocardiogram (EKG) to evaluate your heart. These tests are necessary prior to anesthesia and do not need to be repeated if your primary care doctor orders them at the time of your history and physical.
Because prostate surgery requires general anesthesia, you will usually speak with the anesthesiologist the night before surgery to discuss the details and logistics of your treatment. This is a good time to share your current medications and any questions or concerns you may have.
If you are currently taking aspirin, Coumadin, Plavix, Xarelto, Aggrenox, Pradaxa, Eliquis or other medications that can interfere with blood clotting, consult your primary care doctor or cardiologist about when to stop taking them. These medications usually need to be stopped at least one week before surgery.
Non-steroidal anti-inflammatories such as ibuprofen or naproxen should be stopped 1 week before surgery. If over the counter pain medications are needed, acetaminophen (Tylenol) is acceptable. Other than the previously stated medications, you should continue your other regular medications, unless specifically told not to do so by your surgeon, primary care doctor or anesthesiologist.
The Day Before Surgery
To avoid a bowel prep, we require patients only drink clear liquids for the day before surgery. Clear liquids include water, strained fruit juices without pulp (apple, white grape, or lemonade), Gatorade, black tea, black coffee, and ginger ale. For meals, we recommend a light liquid diet which includes clear soups, clear bouillon, Jell-O, popsicles, plus any of the clear liquids recommended above. You should not eat solid food or dairy products the day before surgery. Do not eat or drink anything (even water) after midnight on the day before your surgery. You should take a regular shower the evening before your surgery.
The Morning of Surgery
Do not eat or drink anything the morning of surgery. Unless specifically told not to do so, take your regular medications with a sip of water before coming to the hospital. The only exception is that you should not take Insulin or other diabetic medications, unless instructed by your doctor. You should confirm this with your anesthesiologist the night before surgery.
Your Hospital Stay
The hospital stay following radical prostatectomy is usually 1 night. There are several important things you can do to help speed up your recovery including walking early and often after surgery, controlling your pain and learning to manage your catheter so you can be comfortable before discharge.
Most patients will go to the regular surgical floor (4th floor West Wing) after leaving the recovery room, where your family can visit you. There may be specific rules regarding the length and timing of visits. Your nurse will inform you and your family of these rules, if they apply.
When you wake up, your small skin incisions will be covered with skin glue, which usually falls off after 1-2 weeks. You will also have a Foley catheter in your bladder. In general, the catheter stays in place for 1 week following surgery, and we will instruct you how to care for this catheter. In addition to the catheter, a small tube known as a Jackson-Pratt (JP) drain is left in the pelvis at the end of the surgery which exits through a small incision in the lower abdomen. This tube drains the remaining fluid in the pelvis. The JP drain is almost always removed the day after surgery, before the patient leaves the hospital to go home.