Patient information on laparoscopic radical prostatectomy.

Before the operation

You will be admitted either the day before or on the day of your operation. You will already have had the necessary pre-operative (e.g. blood, urine and ECG) tests. You will be visited by an anaesthetist and a surgeon before the operation to answer any remaining questions.

The operation

Although laparoscopic surgery avoids a large incision, laparoscopic radical prostatectomy is still a complex operation and takes 2-3 hours to perform through five 5-10 mm incisions.

Following the operation

When you wake from the anaesthetic you will have a catheter (a tube that drains urine from the bladder into a bag) in the penis, a drain in your abdomen and a drip in the arm. You will have minimal discomfort but may feel the desire to urinate. Patients are allowed to drink freely 6 hours following surgery and to eat after 12 hours. Patients are ready for discharge with their catheter after 2-3 days and are re-admitted after the 9th day for catheter removal. This is painless. Constipation is common after any major operation and should not be a concern to you. If you are uncomfortable take 2 senna tablets at night (they take 12 hours to work). Do not strain to open your bowels.

Continence

You may not be continent immediately. This is because the valve which normally keeps you dry (sphincter) is swollen and has sutures in it, preventing it from moving through its full range. The number of pads you need to use will reduce step-wise with time. Performing the pelvic floor exercises you will have been taught will hasten this process. Most (75%) of patients are dry by 3 months but a few take up to a year. If you are unfortunate enough to need a pad beyond a year (4% of patients) you will be offered insertion of an artificial sphincter.

Sex

Do not be afraid to experiment with erections and sex at any time after the operation, but remember that it can take up to 2 ½ years for erections to reach their maximum strength and that intercourse is much easier with adequate lubrication (e.g. KY jelly). You should also be aware that you do not need an erection to climax. Remember also that if erections do not return that all men can be made potent again somehow.

Resuming activities and follow-up

You should expect to return to most activities about 3 weeks after laparoscopic and 3 months after open surgery. You are safe to drive as soon as you are comfortable enough to brake hard to avoid a possible accident (usually by 10 days).

Your first outpatient appointment will be 4 weeks after the operation, when the results of the laboratory analysis (histology) of your prostate should be available. Your first PSA test will be done 2 weeks before your next outpatient appointment (3 months following surgery). You will be seen every 3 months for a year, every 6 months for 5 years and then annually until 15 years.

Pelvic floor (or Kegel's) exercises

• To do these exercises effectively, you need to first relax your abdominal and buttock muscles.
• To identify and correctly contract the pelvic floor muscles, imagine that you are trying to hold back bowel movements or from passing gas.
• During this action, you should feel the opening of the rectum contract.
• Tighten the muscles for 3-5 seconds and then relax for 6-10 seconds. Repeat this sequence 20-25 times.
• Do the set of 20-25 contractions 3-4 times daily.

During the first week of the programme, perform the exercises whilst lying down, but later while sitting and standing. After the initial learning period, perform the exercises when you need them, i.e.  just before sneezing, coughing or straining.