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Preoperative preparation

Before surgery, we ask all patients to meet with our physiotherapist.

Our physiotherapists have a special interest in prostate cancer and urinary continence and discuss pelvic floor exercises prior to the operation. Pelvic floor exercises are recommended to build strength and can be commenced up to 8 weeks prior to surgery. Information about these exercises may be found under post operative care.

We also ask all patients to meet with Dr Michael Gillman, a doctor who specialises in penile rehabilitation post robotic prostatectomy. Patients’ erections may be diminished immediately post surgery and there is increasing evidence that early medical interventions can aid in both early recovery and eventual recovery of erectile function.

Dr Swindle will advise you regarding getting as fit as possible for your surgery and may discuss losing weight prior to surgery. There is evidence to suggest that patients who are fit and not overweight have less post operative complications from surgical procedures.

Dr Swindle will also perform a flexible cystoscopy procedure on you a few weeks prior to surgery. This is a simple procedure but is important as it enables him to check the anatomy of the prostate and also to ensure that there is no other sinister pathology.

You will see Dr Swindle the week or so prior to the operation to ensure that all necessary investigations are up to date and that all important preoperative consultations and appropriate investigations have taken place.

The following things will be double checked: blood and urine test results (FBC, ELFT’s, MSU), x-ray results (CXR, CT scan and possibly bone scan and MRI of the prostate), flexible cystoscopy results and that a physiotherapy and penile rehabilitation consultation has taken place.

Diet

You are required to commence a bowel preparation 24 hours before your admission. Begin a clear liquid diet (no solid foods) 24 hours before the operation and take nothing by mouth after midnight the night before. Use two Microlax Enemas 1 hour before bedtime the night before the operation to help cleanse the lower intestine (Microlax enemas can be purchased over the counter at your local pharmacy)

It is important to keep your fluid intake high in the 24 hours before surgery. It is very important that you do not eat 8 hours prior to your surgery, as during an anaesthetic there is a risk of vomiting and the stomach contents can enter your lungs. You will, however, be encouraged to drink water up until six hours before the operation.

Medications

You are usually able to continue taking your prescribed medications during the course of your surgical procedure however it may however be necessary to cease some medications. Be sure to bring all medications that you are currently taking with you to the hospital, including inhalers and sprays, in their labelled containers. Please advise Dr Swindle and your anaesthetist who will discuss with you which of these medicines you should take on the day of surgery as some may need to be avoided.

Many medications can thin the blood and cause excessive bleeding during surgical procedures. It is very important that you cease any blood thinning medications 7-10 days prior to some surgical procedures. However, do not cease any of these medications without first discussing with Dr Swindle.

Generally, anti-coagulant medications should be ceased 5 days before the surgical procedure (and you may need to start on other medications when you’re not taking these). A blood test should be performed on the morning of the procedure to ensure that the blood is clotting appropriately. Your medications should not be resumed until 1-2 weeks after the surgical procedure and Dr Swindle will discuss the exact timing of restarting these medications with you.

You should stop taking all natural therapy preparations as these may interfere with the clotting ability of the blood.

Please ensure Dr Swindle is aware of all drugs, pills and medications that you take, whether on prescription or not, even if they are not on the list of medications to avoid.

Admission to hospital

It is recommended you bring loose-fitting and comfortable clothing such as pyjamas for after surgery. If you wear contact lenses, glasses or dentures, bring a case so these can be stored during surgery. You will be given a surgical gown to wear and anti-thrombus compression stockings will be fitted after you have showered. Though these can come off to shower during your hospital stay, they must remain on at other times to reduce the risk of blood clots forming in the legs. The stockings are removed when you are ready to be discharged from hospital.

You need to be ready one hour prior to theatre. You will also be fitted with sequential compression devices (SCD’s). These compress your legs using specially designed air bags and help prevent blood clots, known as deep vein thrombosis (DVT), forming in your legs. Generally unless there are significant problems, you will see the anaesthetist on the morning of surgery. Once you are due to go to theatre, the nurses will complete a checklist and escort you to the theatre. You will enter the theatre anaesthetic room where you will be once again check-listed by the theatre staff and anaesthetist. A drip will be placed in your arm to allow them intravenous access during the operation.

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