Before Robotic Prostate Surgery

In addition to eating well, staying physically active, and getting plenty of rest, there are important steps you need to take in the period leading up to your robotic prostate surgery to ensure that you are as prepared as possible. The most important thing to remember is that you are in excellent hands. You have chosen an outstanding hospital and one of the foremost robotic prostate surgeons to perform the procedure.

Medications

Some medications interfere with the clotting and coagulation of the blood (such as blood thinners) and can increase the risk of bleeding before and after surgery. With the approval of your prescribing physician(s), please stop taking the following medications 30 days before your surgery:

Aspirin
Non-steroidal anti-inflammatory drugs (e.g., Motrin, Advil, Celebrex, and Arthotec)
Vitamin E, fish oil, fax seed oil, and all supplements
Plavix

We also recommend you stop taking Coumadin seven days prior to surgery, with the permission of your prescribing doctor.

Medical Clearance

We need to be certain that you are strong enough for the procedure, so you will need to get medical clearance from your primary care physician in advance. If you don’t have a primary care doctor, we can recommend one for you.

Pre-Admission Testing

Your surgeon will give you a list of required pre-admission testing. We can do the testing here at Mount Sinai, or you can work with your internist or cardiologist. If you are having this done with your personal physician, we need to have the test results back within seven days of surgery so that we can properly prepare to meet all of your needs.

These tests generally consist of blood tests, urine analysis, radiologic exams, and an electrocardiogram. We will email you a pre-admission testing direction sheet once you have scheduled your procedure, which will list all the tests you need. These tests are essential since the surgery is performed under general anesthesia.

Activity Levels

We recommend that you do moderate exercise and activity before surgery, which will promote healing. If you are already exercising regularly, you should maintain a moderate level of exercise prior to surgery. If your lifestyle is more sedentary, you might want to begin walking one to two miles daily to prepare your body.

After surgery you will be in “Prostate Bootcamp” and we will ask you to walk up to three miles daily. This exercise will be easier if you are already walking regularly. (In addition, “Prostate Bootcamp” requires drinking eight to 12 glasses of water daily for one month after surgery.)

The Day Before Surgery

The day before surgery, you will need to make certain dietary and bowel preparations.

Bowel preparation helps clean the intestine and reduce risk of infection. The day before the procedure, please make sure to do the following bowel prep:

Drink one bottle (10 ounces) of magnesium citrate in the morning (magnesium citrate is available at most pharmacies)
Take one Fleet enema in the evening

Diet is key. Drink plenty of fluids throughout the day as the bowel prep will make you lose fluid. Clear liquids are best. You should stop eating or drinking by midnight.

Blood Banking

We do not ask you to donate your own blood before the procedure because the blood loss during surgery is minimal. If you would like to do so, we can make arrangement for you. You will need to donate no more than two units three to four weeks before the operation.

Banking Sperm

After the prostatectomy, you should continue to have normal desire and orgasm. The question about whether you will have an erection is a little more complicated and depends on a number of factors including the stage of your cancer and the strength of your erections before surgery. The ART surgery is designed to eradicate the cancer while minimizing damage to the nerves responsible for erectile function. Most patients do regain the ability to have erections, but it is a gradual process and can take up to a year (or more), with erections usually improving with time.

After the prostatectomy, you will not ejaculate anymore. This is because we will have removed the prostate and seminal vesicle, which produce most of the seminal fluid. Men who have had a prostatectomy are not able to father children. If you are considering the possibility of fathering children in the future, banking sperm is an option. The cost is covered by most insurance companies.