General

Q. How many robotic procedures have been performed by physicians at Urology Centers of Alabama?

A. To date Urology Centers of Alabama has performed 3570 surgeries reinforcing multiple studies that show high volume centers have better outcomes.

Q. What is the learning curve for robotic prostatectomies?

A. Hundreds. We have performed 3570 and continue to modify our technique.

Q. How long does the operation take?

A. The procedure usually takes 2- 3 hours.

Q. When will I go home from the Hospital?

A. The morning following surgery your drain will be removed and you will go home with a catheter in place.

Q. When will the catheter be removed?

A. You will return to the office in one week and if there is no leakage the catheter will be removed.

Incontinence

Some patients have normal urinary control immediately upon removal of the catheter one week after the surgery. We wish that all patients would do so well; however, some will not. Part of the reason why some patients are not totally continent after the surgery is basically that their pelvis muscles are weak and their bladder has changed from being blocked by a large prostate. We request that you be very diligent about doing your Kegel exercises and keep up with the diaries as to how your continence is progressing. This will be in your brochure and will be a way you can monitor your progress.

Please note that it may take a number of months to become totally continent. Most patients do extremely well in two to three months, but Kegel exercises are very important initially in helping to get you to a stable point.

Erectile Dysfunction

When most patients undergo the robotic prostatectomy, a specific type of nerve sparing procedure is performed. It should be expected that many patients will resume a fairly normal or stable erectile function level. Treatments include oral medication (Viagra, Levitra or Cialis), vacuum devices, penile injections, etc. and are used in order to prevent damage to the penile tissue and help the time frame diminish. Erectile function may return in as little as several months. Erectile function varies with each person, basically according to the function prior to the surgery and the amount of dissection needed because of the cancer that you might have. Therefore, this may be a rather slow process for some and it may be rather rapid for others.

Even if your erectile function returns on its own with time, there is no need to wait for the return. Use of oral medications, the vacuum device or injection therapy can provide interval help and speed the process. Then when erectile functions return on their own, you can put aside these aids.

We realize that the frustration level can be fairly high when it comes to sexual function. However, patience and proper usage of all things we have available hopefully will prevent the frustrations and bring function back to a satisfactory level within one year.

Kegel Exercises

KEGEL (Kay-Gull) exercises are exercises that strengthen the pelvic floor muscles. These exercises should be started immediately after your initial cancer consultation with your robotic surgeon. These muscles contract and relax under your command to control the opening and closing of your bladder. When they are weak, urine leakage may result. However, through regular exercise you can build up their strength and endurance and, in many cases, regain bladder control.

Begin by locating the muscles to be exercised:

1. As you begin urinating, try to stop or slow the urine without tensing the muscles of your legs, buttocks, or abdomen. It is very important not to use these muscles because only the pelvic floor muscles help with bladder control.
2. When you are able to slow or stop the stream of urine, you have located the correct muscles. Feel the sensation of the muscles pulling inward and upward.

TIP:

1. Squeeze in the rectal area to tighten the anus as if trying not to pass gas. You will then be using the correct muscles.

Now you are ready to exercise regularly:

1. When you have located the correct muscles, set aside time each day for exercising: morning, afternoon, evening and at bedtime.
2. Squeeze your muscles to the slow count of 10 seconds and relax for 10 seconds. This makes one set.
3. Complete 10 sets starting off with maybe just 2 times a day, then increasing to 3 to 4 times.
4. When you feel that leakage may occur, squeeze and hold for 10 seconds and relax. If it starts again, repeat until the leakage has quit.

TIP :

1. In the beginning, check yourself requently by looking in the mirror or by placing your hand on your abdomen and buttocks to ensure that you do not feel your belly, thighs, or buttocks move. If there is movement, continue to experiment until you have isolated just the muscles of your pelvic floor.

Pre-Operative Questions & Instructions

TWO WEEKS PRIOR TO SURGERY: Stop all medications listed below (check with your doctor before stopping these medications):

Please do not take PLAVIX at least three weeks prior to surgery.

• Lab work cannot be done more than 14 days prior to your surgery date.
• Be sure and notify your surgeon if you are on any types of blood thinning medications (Coumadin, aspirin or Plavix).
• Stop all multivitamins or herbal supplements two weeks prior to the procedure.

If you have any questions, you may call the robotic surgery scheduler at 205-445-0177.

Instructions for the Day Prior to Surgery

1. You may have a light breakfast, then clear liquids the rest of the day (no solid food; clear liquids also includes popsicles, Jell-O and chicken broth)
2. Take all of your normal medicines except those containing aspirin, Coumadin, vitamin E or other blood thinners.
3. Bowel preparation.

• 6:00 p.m. - Fleet’s enema

This can be purchased at your local pharmacy.
Nothing to eat or drink after midnight.

For any questions please call 205-445-0177.

Post-Operative Questions

Q: How long can I plan on being in the hospital after the procedure?

A: Normally, 98% of the patients are able to go home the day after the surgery.

Q: After the surgery will I be able to resume my normal activities?

A: The major advantage of the robotic procedure is decreased bleeding and decreased pain, which results in an easier recuperation period. Most patients undergoing this procedure will be able to resume normal activities within one to two weeks. However, each individual heals differently.

Q: After the surgery, when will I have complete urinary control?

A: While some patients regain control more quickly, most men require a period of time before their control returns. By three months after surgery, 94% of men are using 0-1 pad per day.

Q: Following surgery, will I be able to have sexual relations?

A: The return of erections after surgery is usually slower than the return of urinary control. The average time until recovery of erections is 6 to 18 months, and it can improve for as long as 2 to 3 years after the operation. However, each patient is different. While patients are waiting for the return of erections that are spontaneously firm enough for vaginal penetration, several methods can be used to help induce and improve erections. These include oral drugs (Viagra, Levitra, or Cialis), penile injections, vacuum erection devices, and urethral suppositories (such as Muse).

Q: How long can I expect to be off work?

A: This varies with each individual. Some patients return to light work as early as two weeks after surgery; however, recovery times vary from individual to individual as do work requirements. In some cases, you may be authorized for medical leave for up to six weeks.

Benefits

Q: Is it true that the robotic surgeon uses excessive cautery around the neurovascular bundles and that this may damage the bundles? How does this effect potency results?

A: We do not use cautery around the neurovascular bundles. We use a combination of hemoclips and cold scissors around the neurovascular bundle. This has resulted in earlier return of and better quality erections in many patients. Please ask your physician if you are a candidate for this procedure.

Q: Many urologists feel the benefits of robotic surgery are unproven. What is your opinion as a surgeon?

A: Robotic surgery achieves identical oncology and functional outcomes when compared to the best open surgery. With robotics it is accomplished while minimizing bleeding and faster recovery period and functional recovery of continence and potency.

Q: My current surgeon also performs the robotic procedure. Why should I come to Urology Centers of Alabama for my surgery?

A: If your surgeon uses the robotic procedure, you may be fine. As with any surgery, the experience of the surgeon performing the procedure is critical to its success. At Urology Centers of Alabama our team is one of the most experienced in the world at performing robotic surgery, having performed over 3570 surgeries to date. We are constantly altering the surgery to improve outcomes based on past experience.

Insurance Coverage

Q: Does insurance cover a robotic prostatectomy?

A: Blue Cross Blue Shield of Alabama does cover a robotic prostatectomy. Other insurance carriers cover it as well, but verification is needed prior to the procedure.

Lodging For Hospital Stay

The Centennial Lodge is used by most of our patients. At this lodge their personnel know our normal routine regarding patients who will have a robotic prostatectomy. The Centennial Lodge is on the St. Vincent Campus.

It is best to make your reservations directly with the lodge once you know your surgery date.

Centennial Lodge, 266l - l0th Avenue South,Bham, Ala. 35205 - Phone 205-558-3800.

The Trinity Inn across the street from Trinity Hospital. The Trinity Inn is associated with Trinity Hospital and is used by many of our patients. The phone number for the Trinity Inn is (205) 592-1489. You may call them directly to make a reservation. Check-in time is 3 p.m. and check-out time is 11 a.m.

These facilities are not covered by your insurance.