There are two approaches to this operation: open and robot-assisted.
In
open radical prostatectomy, we take out the entire prostate gland and the seminal vesicles that run through the prostate gland. We may also take a sample of the pelvic lymph nodes.
The prostate is a gland that surrounds your urethra, where your urethra meets your bladder. The seminal vesicles are two small fluid-filled sacs above your prostate that secrete fluid into ejaculatory ducts.
The
Robot-Assisted Laparoscopic Radical Prostatectomy (RALRP) has a special state‑of‑the‑art system that helps your surgeon see very important parts inside your body in 3-D (from all sides).
To do the procedure, the surgeon moves the robotic arms, which hold the instruments, and a high-resolution camera inside your body. The jointed-wrist design is called da Vinci and it has a better range of motion than the human hand. But, the surgeon always has complete control of the robot.
Because of this da Vinci Surgical System, surgeons can do even complex surgery using only 1 or 2 cm incisions (cuts). To remove the prostate, there will be a 1-inch cut near the belly button.
Stop smoking before your surgery
Read our guide to learn more about your radical prostatectomy, or click on the topic that matters most to you.
You will have an appointment at the Pre-Admission Clinic
within 2 weeks before your operation. This visit is very important to assess your health and help you prepare for your operation and recovery. Depending on your needs, this visit may take from
2 to 5 hours.
On the day of your Pre-Admission visit, take your medications and eat as usual, unless you were given other instructions.
Pre-Admission Clinic
Toronto General Hospital
Eaton Building – Ground Floor, Room 400
TGH Maps & Directions
- Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
- Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or a family member to offer you support and be a second set of ears.
- All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
- A copy of your power of attorney for personal care and/or advanced directives.
- A list of any questions that you may have about the operation and recovery.
- The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years. If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.
- You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
- You may also need an
electrocardiogram (ECG) to check your heart and a
chest x-ray to check your lungs.
- You will meet many health care providers during your preadmission visit. Please feel free to ask them any questions that you may have.
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A preadmission nurse will review your health history and give you information to prepare you for your surgery, including directions for cleaning your skin, eating before surgery, taking your medications, and pain management.
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A pharmacist will review your medications
- Depending on your needs, you may also meet:
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An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after surgery.
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A member of the medicine team, if you have other complex health problems.
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A Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific surgery. They will review any preparation that is required before your surgery, plans for discharge home after surgery and specific instructions regarding your recovery.
- Instructions to follow at home before your surgery
- Plans for your discharge home after your surgery
- Preparing your bowel with the fleet enema
- Activity after surgery
- Tubes and drains such as Foley catheter, J/P drain, PIV and DB&C
- Incentive spirometry and leg exercises
- Activity limits such as NO heavy lifting after surgery – nothing greater than 5 kilograms or 10 lbs for 6 weeks
- Return to work advice which will depend on your situation
- Dealing with pain after your surgery (taking Tylenol, Regional Tap Block, TORADOL, antispasmodics and oral pain medication)
- Return to work recommendations
- Review of follow-up appointments and what to expect
*The Urology Clinical Coordinator will review these with you, and talk about how to deal with them, during your pre-admission visit
- DVT (blood clots), rectal injury, blood loss
- Possible stress incontinence, use of incontinence products such as Depend® Guard for men or newborn baby diapers
- Kegel exercises and how to do them
- Possible urethral stricture with instructions about how to manage
- Possible erectile dysfunction (information about when to start penile rehabilitation after surgery, with a review of treatment strategies)
Do not eat or drink anything after midnight the night before your surgery. Your stomach has to be empty. -
DO NOT eat any solid foods or milk products the full day before your operation.
- Drink clear fluids only
for the whole day.
- Purchase a fleet enema at your pharmacy, and take it any time in the evening before your operation. Follow the instructions on the package.
- You must have a shower with soap and water to clean your skin the night before and the morning of your surgery to reduce the chance of infection after your operation.
- Remove all nail polish and body piercings.
- If you smoke,
DO NOT do so for 24 hours before your operation.
-
DO NOTdrink alcohol for 24 hours before your operation
- Examples of clear fluids you can drink:
- Apple juice
- Beef or chicken broth (no noodles or vegetables)
- Orange juice (without pulp)
- Grape juice
- Jello or popsicles
- Cranberry juice
- Pop (such as Ginger-ale, 7-Up, Coke)
- Lemonade
- Water
- Coffee or Tea
TIP: By drinking warm fluids such as tea or broth you may not feel as hungry.
Arrive2 hours before your scheduled operation time:
Surgical Admission Unit
Toronto General Hospital
Peter Munk Building – 2nd Floor
TGH Maps & Directions
All hospital entrances are open by 6 am. However, Elizabeth St. and University Ave. are easiest to access.
- We will prepare you for the operation.
- If you did not see the anesthetist in the Pre-Admission Clinic, you will meet them before your operation.
- We will shave and mark the area where we are doing your operation.
- We will give you a small needle with Heparin, a medication to help lower the chance of developing blood clots.
- We will give you an intravenous (IV) drip. This is a small needle that we put in a vein in your arm. We use it to give you one or all of the following: fluids; antibiotics; pain medications.
On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.
- You will wake up in the
Post Anesthesia Care Unit (PACU) and stay there for
1-2 hours.
- Once you are ready to leave the PACU, you will be moved to the
Urology Surgical Oncology Inpatient Unit, at Toronto General Hospital.
- You will be attached to some or all of these tubes:
IV - We usually take the IV out as soon as you can drink fluids and pass gas.
Oxygen - Oxygen helps you breathe. We use either nasal prongs or a clear plastic mask.
Jackson Pratt (JP) - The JP is a drain that we put in your lower abdomen (below your belly button) to drain any extra fluid that you have there after your operation. We usually take it out in 1 to 3 days.
Catheter - This tube goes up the penis to drain urine from your bladder. It stays in for about 2 weeks. The catheter might make you feel like you have to urinate. It is important to keep the catheter clean. A nurse will show you how to do this before you go home from the hospital.
- You might feel muscle spasms in your bladder because of the catheter. Let the nurse know if you are having pain in your bladder area. We have medication available to take away the bladder spasms.
- You might feel gas pain in your stomach after the operation. Walking will help you get rid of this pain. Only walk when a nurse determines that it is safe.
- Your scrotum may be swollen and bruised for a few days to one week. This is normal. If your scrotum is swollen, we will show you how to rest your scrotum on towels when you are in bed. When you are out of bed, you can use a scrotal support or wear form fitting underwear.
- To manage your pain, the nurses will give you a medication called Toradol, a non-steroidal anti-inflammatory, through the IV, every 6 hours until you are eating and drinking well. The first dose of this medication is given to you when you wake up from surgery. If you feel that you need more medication, your nurse can help you.
- Once you are eating and drinking, we will prescribe pain pills that can be taken as needed.
- Start some deep breathing and coughing exercises. We'll show you an exercise called
Incentive Spirometry. We will give you a pamphlet on how to do Incentive Spirometry.
- We encourage you to start walking the evening of your operation. We will help you.
- You will shower while you are in the hospital. Once you are at home, showers are better than baths because you should not be soaking in a bath with a catheter.
- Wiggle your toes and move your feet. This helps the blood in your legs to circulate.
- When your catheter is taken out, start doing
Kegel exercises. They will strengthen the muscles in your pelvis. We will give you a pamphlet on how to do Kegel exercises.
- You can expect to be in the hospital for up to 2 days. Your health care team will talk to you about your stay once you're out of the PACU.
Learn more about your stay
Go to your nearest emergency department if you have pain, redness or swelling in the back of your calf or inner thigh area.
- Don't strain when you're having a bowel movement. Eat food that is high in fibre (bran, fruits, and vegetables) so that you don't get constipated. You can take mild laxatives like Metamucil, Prodiem, or Milk of Magnesia.
- Do not use suppositories or a fleet enema for at least 6 weeks after your operation.
- You may notice that your urine in the drainage bag is at times dark red. This is normal. Drink more water to help clear the urine.
- You may find that at times you may leak urine around the catheter. This is normal.
- You might get tired easily. Listen to your body and don't do more than you can handle.
- Don't lift heavy things for 6 weeks after your operation. Anything over 5 kilograms or 10 lbs. is too heavy.
- Don't take anti-inflammatory medication such as Advil® or Ibuprofen for 2 weeks after the operation unless your surgeon has asked you to continue taking them. These medications may cause bleeding.
- Do not drive for 2 or 3 weeks after operation.
- Do not take long car trips. If you are travelling a distance, stop every 2 hours to stretch your legs.
- You can shower while your incision clips are in place.
- Use a pure, mild soap without perfumes or chemicals. Then pat the area around the incision with a dry towel.
- Do not put any creams, lotions or powder on your incision for at least 6 weeks.
Learn
how to care for – and clean – your catheter.
Watch our video:
Call 416 340 3521 (Gynecologic Oncology/Urology Inpatient Unit at TGH) if:
- You bleed heavily and the blood is bright red (not dark old blood) when you urinate and the bleeding does not decrease when you try resting and drinking more water.
- Your temperature goes higher than 38ºC (100ºF), and/or you feel chills.
- There is significant redness or increased pain where your incision is.
- There is a notable decrease in the flow of your urine or if you cannot pass urine at all.
Please
DO NOT call your surgeon's clinic with post-operative questions.
Before you leave the hospital we will give you 2 follow-up appointments:
Your first appointment
When
10-14 days after your operation.
What to Expect
Your catheter will be taken out during this appointment. Nurses will go over how to do
Kegel exercises with you.
What to Bring
Incontinence pads, which you can purchase at your local drug store.
*
Do you live outside the GTA?
If you would like the catheter removed closer to home, you will need to plan this with your family doctor or referring urologist.
When
About 7 weeks after the operation.
Where
Prostate Centre
Princess Margaret Cancer Centre
4th Floor
PM Maps & Directions
How to Prepare
Before coming in for the 7-week appointment that was made for you, you need to arrange to have a PSA test (prostate specific antigen) done anytime during week 6. This test after surgery is done to detect residual prostate cancer.
We recommend that you do this test at a LifeLabs Medical Laboratory Services. You can find your nearest location at
www.lifelabs.com. We will give you a requisition before you go home from the hospital.
What to Expect
Your surgeon will talk to you about your PSA and will review the surgical pathology results.
* Scheduling Your PSA Test
If you decide to have the PSA test done at
Toronto General Hospital or
Princess Margaret Cancer Centre you will need to call your surgeon's office to put the order in the computer.
