My Robotic Prostatectomy Experience
The purpose of this essay is to give as much insight as possible beforehand to anyone who may go through this procedure. I was fortunate to have been very well coached before my procedure and that alleviated most if not all of my concerns and I hope this will do the same for others.
First I am white, male of course, 49 years old,5’10” and at the time of my diagnosis weighed 290 pounds. My biopsy was in mid April of 2009 and my meeting with Dr. Saltzstein, my urologist, was in very early May. In that meeting he told my wife and me many details about my cancer which was limited to 2 and maybe 3 of the biopsy samples and I had a Gleeson score of 6, so for all intents and purposes it had been caught early and I was in good shape. We went over various treatments and were recommended robotic Prostatectomy and agreed with that conclusion as well. It is important to note that Dr. Saltzstein’s beside manner did a great deal to calm my wife’s fears and get her more comfortable with what we were facing.
In addition the only other point worth noting to come out of that consultation was the very strong recommendation, which was later reinforced by Dr. Kella to lose weight and to get in as good a shape as I could in the time that I had. I immediately began a strenuous training program that I am convinced led to the speedy recovery I have experienced. I will elaborate more on that in a moment.
Shortly after that meeting when Dr. Saltzstein referred us to Dr. Kella we had our meeting him at which time we asked and he answered many questions we had concerning the pre-operative and post-operative periods. Dr. Kella, like Dr. Satlzstein was a very calming influence. However the best thing that happened to me was to contact the friends and acquaintances that I knew had been through the procedure. This more than anything the Dr.’s could do, prepared me to the best level I could think of. All of the folks I knew that had been through this procedure were willing to become coaches and hand-holders throughout and for that I am grateful. I cannot begin to give you all the information they passed on to me in this forum but I want to reiterate that the best thing you can do for yourself is find two or three people who have been through this to talk to before the procedure. You will need to contact them several times and you may even want to go to lunch with them.
I would say that along with physical fitness having a coach that has been through this before are the two main ingredients to dealing with this procedure. You are already in great hands from the stand point of the team of Dr.’s you have working for you but I think it’s up to you to become informed and understand what you are about to go through.
When I started exercising more aggressively I had already begun riding my bike during the spring. However from the time I met with Dr. Saltzstein in early May to the day of my surgery I only missed 5 days in the gym. I did cardio everyday and worked up to 70 minutes on either my outdoor bike or the stationary bike at the gym. In addition I worked with a very good personal trainer 3 days a week who focused my strength training on weight loss and I also participated in Weight Watchers online. By the time I weighed in at the hospital I was down to 252 pounds and was in very good cardiovascular condition. I cannot stress this point enough about getting in and being in good shape to get back to normal as fast as possible as you will see in just a moment.
The day of surgery came and I was to arrive at the hospital at 10:30 for a 1:00 surgery time. The folks at St. Luke’s Baptist were terrific and once they took me in the surgical prep room Marilyn was my nurse and she took great care of me. My wife was me throughout this period and although it actually got a little boring at times it was a calm environment that helped again to ease the tension of the situation. Surgery got started a little late as I recall. Dr. Kella, his surgical nurse Criselda and the anesthesiologist all came to visit with me ahead of time and in particular I told the anesthesiologist about my previous surgical experience that had resulted in a severe sore throat. He anticipated the problem this time and consequently had no adverse consequences of that nature. The lesson here is talk to your Dr.’s and any of the other healthcare professionals to let them know of anything you might be concerned with and there just might be an alternative.
I presume a few minutes before surgery the anesthesiologist came back in to see me and gave me a shot that he said would relax me. A minute or two later I remember kissing my wife and that was it. Next stop the recovery room.
I began to wake up in the recovery room and the nurses were in constant contact with me. My mouth was extremely dry and they began feeding me ice chips. The only unexpected side effect of the procedure came now. My eyes were on fire. They were burning as badly as I had ever experienced and I was told by the nursed that apparently the anesthesiologist puts something in your eyes during the procedure. As soon as I got to my room later that evening I put some saline solution in my eyes periodically and that eventually relieved the pain.
When I woke up in recovery it was about 5:00. I was pretty alert for the most part and not in any pain. I began to feel around and noticed the JP tube hanging off of me, the Q-ball laying beside me and of course the catheter which I traced all the way back to, you guessed it, my penis. Although the catheter was expected it was a bit of a reality check to actually have it coming out of that part of your anatomy. The JP tube is a drain from the surgical area and Q-ball is device that administers a pain reliever I guess like a morphine drip. The Q-ball is about the size and weight of a baseball and is laying next to you when you start feeling around. The JP tube is a rubber tube that goes in your belly and is connected to a fist size rubber syringe ball that it drains into. Over the next 24 hours the Q-ball empties out and the JP is emptied several times by the nurses. The catheter, your friend for the next eight days has a long hose that runs to a rather large bag that hangs off the bed. It also is secure to your leg by a tight but not uncomfortable garter that has a Velcro band that holds it in place.
My only bad experience if you will, with the hospital came in the recovery room where I was the last to leave and was there past 7:00. I was told they were delaying taking me to my room because of the shift change with the nursing staff. Although normally no relatives are allowed in the recovery room they did bring my wife back to be with me since I was the only one left there.
That night in the hospital was fairly uneventful but nevertheless miserable. You have a blood pressure band around your arm that automatically takes a reading every 30 minutes all night long. On each leg are these Blood Pressure Cuff types of things that inflate and deflate constantly to prevent blood clots. The IV drip machine alarm went off what seemed like constantly and for the most part you get very little sleep. There is some discomfort but really very little pain that night although you are feeling the gas everyone warned me about. Without a doubt the gas is the worst part of the experience. At 5:30 the next morning it was up and out of bed and walking down and around the halls. You are a bit wobbly but the nurse is right there with you and you do survive. You are mainly concerned about not pulling anything out of you because of all the tubes that are attached. Again other than some concern for the abdominal incisions you are still in no pain.
When you finally look at your incisions you will be surprised to learn that there are not stitches in the four smaller wounds and the larger wound is sewn up internally. The first 24 hours I experienced some leakage from the incisions but nothing notable.
That morning I was allowed to eat a liquid breakfast of coffee, juice and cream of wheat. I dozed off and on as the blood pressure device and the IV machine kept waking me up. By noon the pain from the gas was becoming intense and you obviously cannot strain to try and force it out. By 1:00 it was necessary for them to give me a suppository which finally began working about 3:00. By 6:00 I was on my way to being discharged and headed home. Overall though you have little appetite.
My surgery was on a Wednesday and that first day back home on Friday was great. The first night in bed was a little concerning because of the catheter and once I determined the best place to hang it and got situated I slept very well Thursday night. Friday was a day of rest although I was able to sit in my living room, watch TV and reply to e-mails on my laptop. In addition as we had done in the hospital I kept up my walking. 20 minutes at first but by the time I went back for my follow-up visit with Dr. Kella 8 days after surgery I was walking 45 minutes in the morning and for an hour in the afternoon. The week went by pretty quickly but there is no doubt that you count the minutes until you can get rid of the catheter. Just FYI, the catheter is not painful. It is however something you are always conscious of and yes a little uncomfortable. At times you just feel like you constantly need to pee especially when you are standing. Once you get home you are able to shower with it and soon it just becomes something you are just wanting to get rid of as soon as possible.
The follow-up visit finally arrives and one of the questions I asked everyone I talked to was about the catheter removal. Everyone told me it did not hurt and although I was still a bit nervous they were right. However they don’t just remove it. They first take the short tube coming out of your penis and attach what is essentially a funnel to end and begin filling you up with saline so that when the catheter is removed you urinate into the cup they place under you. Again not painful at all but a little uncomfortable. They finish filling it up as much as they can or rather as much as you can hold and drain the balloon at the end of the catheter and it seemed like it just fell out and you were draining into the cup. Ah what a relief to have that thing gone.
Next you get dressed and I made the mistake of buying the wrong Depends product. All you need are the pads, not the full diapers. The pads must be worn with briefs so if you are like me and have worn boxer for 40 year go out and get a couple of 3-packs. And since I have to wear boxers I simply put them on over my briefs. Fortunately Dr. Kella’s office had some of the pads and that was all I needed and have been using since my surgery which was 12 days ago.
After getting dressed you do feel great not having that catheter in you. Dr. Kella came in for a nice lengthy visit at which time he went over my pathology report, examined my incisions and went over what we should expect the next few weeks. My results were great with no cancer in the margins and I have to go back for blood work every 90 days this first year.
I returned to work the day I had the catheter removed 8 days after my procedure and have felt great ever since. Again I have to stress that I believe the physical conditioning I did ahead of time was the reason I could come back so soon.
I am anxious to get back to my workout routine and continue my weight loss but for the first 6 week after surgery you are to nothing more strenuous than walking and avoid lifting anything over 10 pounds. Still I cannot wait to get back at it but to insure I have no setbacks I am in 100% compliance with Dr. Kella’s instructions.
Experience Matters. Over 2000 Robotic Surgeries. Naveen Kella MD has performed more robotic prostatectomies than anyone in Texas.
A patient's experience
Below is a story taken verbatim from one of my patients. He describes his experience prior, during and right after surgery.