In this section, I'll talk very specifically and very graphically about my post-surgery experience in a means to help educate and inform other prospective robotic prostatectomy patients so they have at least one patient's perspective on what happened.
Surgery
My surgery ran between 3:00 PM and around 7:00 PM, taking a full four hours to complete. There were no surprises or expectations that slowed the surgeon down.
The surgeon did explain that the surgical table would be tilted with my head down so that gravity would pull my innards away from the prostate, giving him more room to operate. He said that this would cause my head to be quite swollen at the end of the surgery. He was right. The photo my sister took with her iPhone was something else.
I don't have a true sense of the timing, but I believe that I wasn't moved to my room until somewhere between 10:00 PM and 11:00 PM.
I was hooked up to a morphine drip and able to press on the dispense button when I felt the pain increase and there was a drainage bag inserted in my left side to allow blood and other fluids to drain into a little plastic bag.
Next Day
I had not had anything to eat since around 8:00 PM on Sunday night, and it was now Wednesday morning. The nutrition team had me on a clear liquid diet and served me a cup of some sort of broth for breakfast. Despite my hunger, I was only able to take a couple of spoonfuls before giving up.
I was confined to my bed by my IV and the compression leggings wrapped around my legs, filling each legging with compressed air to keep blood clots from forming in my legs.
By late morning, I was willing to try and walk around. With the assistance of the nurse (to disconnect my leggings), I was able to stand, using my IV stand for some support. I was pretty wobbly at first. My sister tagged along as I had my catheter bag hanging from the IV pole and walked up and down the hallways, pushing the IV stand as I went. I probably lasted about 30 minutes before getting tired and heading back to the bed.
Lunch was another round of clear liquids, and this time I ate a little bit more of the broth and tried some of the cool sherbert. Still, I didn't have much of an appetite.
My surgeon forewarned me that he'd be pumping gas into my body during the surgery to make it easier for him to perform the operation, and that that gas would remain behind and cause a bloated feeling for several days after the surgery. He was right.
Not only did I have a bloated feeling, but there were moments of intense abdominal pain as the gas made its way through my intestines. For whatever reason, I just couldn't pass any of it out of me that first day after the surgery. The gas pain was more intense than the pain at the incision points.
I was supposed to be released from the hospital around 2:00 PM, but when the doctor came in and noticed my urine output (or, more specifically, the small volume of output), he decided to keep me another night to make sure that all the plumbing was working as intended.
I continued to walk the hallways later that afternoon and again in the evening. I thought walking might help me pass gas, but it didn't. My stomach still had occasional acute bouts of pain from the gas.
That night, I was hooked up to IV fluids to help produce more urine, and I was drinking water on my own at that point. By morning, my urine bag was full.
I went for an early morning walk in hopes of passing the gas, and I actually stopped to sit on the commode in hopes that that might help. It did. I was able to let some of the gas out and the relief was instantaneous.
Not long after, the surgeon came in, reviewed my charts, and released me from the hospital. He was soon followed by a nurse who instructed me on the changing and care of the catheter bags.
Through all of this, I had been using the large capacity (about 2 liters) bag, but for the trip home, I had to change over to the smaller capacity leg bag.
This is where the one size larger than normal boxers and sweat pants came in really handy. They were loose enough to allow for the extra room needed for the leg bag, and not tight around the waist where the incision points were.
Before leaving, I asked the nurse for the maximum dose of painkiller for the hour-long drive home. It definitely helped.
Driving Home
The hospital offered to have a wheel chair brought up to get me to the entrance, but I opted to walk to the car instead. I wasn't a speed demon, but I got there.
Getting into my sister's Nissan Altima was a slow, deliberate process, and I made it okay. She had brought a pillow along to put over my belly (at the suggestion of the nurse), and that really helped. In fact, I had the seatbelt go over the pillow without any problem or additional pain.
Of course, I felt every crack and pothole in the highway for the entire trip home.
Catheter
When they inserted the catheter, they cemented a cloth and plastic hose clamp to my inner right thigh. This would clamp the free end of the catheter hose in place so that, if I had snagged the bag hose on something, it would pull on my thigh and not the hose my penis. That feature came in handy a couple of times when I had the drainage bag hanging from a drawer handle and walked away, leaving it behind. It did its job quite effectively!
I opted to leave the large drainage bag connected to the catheter pretty much the entire time it was in place. I did this because changing from the leg bag to the large drainage bag on arrival home was a bit of a tricky affair.
You have to somehow handle three hoses at once without spilling any urine from two of the three. You have to pinch off the hose coming out of your penis to prevent anything from leaking out as you swap bags; you have to make sure that the bag you're disconnecting (with urine in it) doesn't spill; while at the same time try to connect the new hose to the fitting on the hose coming out of your penis.
The urine color for the first several days was tinged red with blood, and I would see clots ocassionally travel through the tube. With drinking enough water, by the middle of the period, my urine was turning less red and more yellow in color and, by the end of having the catheter, my urine was nearly clear.
I did keep a plastic bucket beside my bed to hang the bag over just in case it sprung a leak. It didn't.
Monitoring
Immediately on arrival home, I started a little log in a notebook to document everything that was going on with me--when I took my pills; how much urine I emptied from my drainage bag; what my temperature was; and even when I had bowel movements. I figured if something went awry and I had to be taken back to the hospital, it would have been helpful information for them to have.
My temperature in the first 48 hours out of the hospital was a tad elevated--usually in the 99.0 to 99.7 range; the highest it got was 100.0 degrees. I thought that, maybe with the drainage bag out of me, some of the fluids were building up inside me and my body was trying to fight off any infection.
Walking
I made it a point to be up and walking around several times each day. Initially, on my second day home, I'd say I was up 3 times for about 30-40 minutes each time, just walking circles around my living room and kitchen. With each passing day, I was up a little more and a little longer each time. When I felt tired, I went back into bed.
As I walked, I made it a point to do deep breathing exercises, inhaling very deeply as I went in circles.
Bowel Movements
It took several days before I attempted my first bowel movement, in part because I simply hadn't had anything solid to eat for nearly five days. When I did eat something, I had some fresh fruit to hopefully make that first movement easier. Of course, I was taking the stool softener religiously, too.
When you sit on the toilet, you can't point the tip of your penis down into the toilet bowel because of the catheter hose. This geometry causes a bit of a mess if you're not careful.
When I strained to try to move my bowels, blood seeped out the end of my penis on the outside of the catheter tube onto the toilet seat. It is not a pleasant experience, both from a discomfort perspective and from a cleanliness perspective. Sometimes that happened when I strained to pass gas in those first couple of days at home, too.
After one or two messes, I learned to take a wad of toiler paper and wrap it around the end of my penis to capture any blood that leaked out. Interestingly, later in the week, some urine would also seep out the end of my penis when straining to have a BM.
Afterwards, I made sure that everything was very clean around the tip of my penis, using alcohol wipes to get rid of any blood or urine, and then applying the prescription antibiotic cream that I was given when I left the hospital.
Sometimes there would be dried blood on the outside of the catheter hose and that typically washed off with some hot water in the shower.
Showering
I had a gauze pad over the drainage hole and Steri-strips over all other incision points. The first morning after returning from the hospital, I was in the shower. It felt great. The Steri-strips held in place just fine, and I simply applied a new gauze pad over the dtainage hole along with some antibiotic cream.
To help with the showering, I had installed two S-hooks with a string between each in the shower for the drainage bag. One hung from the shower curtain rod and the other I hung the drainage bag from.
Drainage Hole
The drainage hole covered in gauze on my left side generally posed no problem. However, late on the second day home, I brought my laptop computer to my bed and, rather than put it over my incisitons and catheter, had placed it on the mattress to my left.
I rolled slightly on my left side to get better access to the keyboard and sprung a leak from the drainage hole in a process. The gauze pad was soaked with blood and pus-like fluid.
The drainage hole sprung another minor leak the next day, and that was the last of it. It's closed up and healing nicely now.
Apetite & Diet
My appetite was very slow to return, mainly because of the bloating from the gas in those first three or four days. Once I was able to expel the gas, things began to return to normal.
I made a concerted effort to eat healthful things that would help with my first BMs. The Percocet was constipating enough--I didn't need to be munching on a block of Vermont white cheddar cheese.
Friends and family stopped by with quite a bit of food. There hearts were in the right places; my stomach just wasn't ready for all of it so soon. I did my best to make sure that it didn't go to waste by eating what I could and freezing what I couldn't.
Post-catheter Incontinence
I've only had my catheter out for a little more than 48 hours as I write this, and I'll have to admit that I wasn't quite ready for the effects of having the catheter out.
Sure, it's great to be free of all that extra plumbing, but I've traded that annoyance for another annoyance.
On the whole, I have control of my bladder. I'm not peeing in my pants willy-nilly. Most of my incontinence seems to be stress incontinence, specifically caused when I stand up from a seated position.
I have worn both a full Depends diaper and the guards in my underwear. I've worn the diaper at night not knowing what might happen, especially on that first night home. Both nights were dry nights.
I will admit, however, the first night I got up to use the bathroom four times and the second night I made it through with only two trips to the bathroom.
I went through four guards on the first day and I'm only working on my second guard so far on the second day. In most cases, I have a small squirt of urine that's probably less than a tablespoonful. There were two instances where it was significantly more requiring immediate changing of the guards.
Today is slightly better than yesterday in terms of frequency and volume of squirts; with a little luck, tomorrow will be better than today.
Penile Shrinkage (Added 2 March 2013)
So let's talk about penile shrinkage. "What?!? They didn't mention that in the glossy full-color photo brochure!"
Apparently it's not something that every patient reports or experiences, but, for me, let's just say things down there aren't quite what they used to be.
The first few weeks and months after the surgery, my flacid penis was considerably shorter than usual. Over time, that has changed and things are back to normal. I don't know the mechanics behind it, but I'm guessing that when the surgeon removes the prostate and has to reattach the bladder to the urethra, things are pulled together to close the gap.
As far the length of my penis when erect, I'd say it's about half to three quarters of an inch shorter than before the surgery. Does it bother me? Not really. I'm just glad to be able to have my erections return after having one nerve bundle removed.
Summary
That's what I've experienced after my radical prostatectomy so far. I'll add to it if I think of anything that I omitted or as things progress.
