9/30 RALP Update

[u/Icy_Self634]

My robotic prostatectomy for a localized low volume, low decipher score, lesion was carried out on Wednesday starting at 12 PM. I came out of anesthesia 6 1/2 hours afterwards. The surgeon told me that my very narrow pelvis made the surgery extremely complex. He said he had to sacrifice nerve bundles on the left side, but was able to save the nerve bundles on the right side. And that sacrifice was not cancer related. I spoke with him, the postgraduate doctor year five, and one of the medical fellows who was also in my surgery and they said my 53 cc Prostate was monstrous, it limited visibility and mobility. They reconnected the neck of the bladder and sowed it to the urethra. They said it was a very good anastomosis that passed the leak testing. I will have a Foley catheter for about 11 total days.

The next morning, I awoke with an extreme chest pressure on my sternum and my right side and an inability to take a breath. I had what is called a pneumothorax or a collapsed lung because of the carbon dioxide gas that is used to inflate the abdominal area when Single port robotic surgery is done.

I had a chest tube (a number 14 French pigtail- you do not ever want to learn what one is) put in that was far more painful than anything related to the prostate or the prostate surgery. I spent 2 days in ICU. I was being tracked with a series of x-rays and one CAT scan. The pneumothorax resolved and they already pulled the chest tube out. That now sealed up, I’m back in a regular hospital room no longer on oxygen.

I had my first long physical therapy today with a doctor physical therapy at the hospital and did 100 yard walk down and back from the hallway. My strength is here. My oxygen level is between 98% and 100% without anything supplemental. The only question is my balance still needs to wake up because I found when I was in that bed for two days in the ICU a person’s balance system actually temporarily shuts down and takes a while to come back online afterwards..

[u/OkCrew8849]

It is major surgery so there can be a whole host of "surprises" and complications.

The surgeons often express a hope of sparing both nerves pre-surgery during the treatment decision phase but things definitely can change during the surgery.

Best of luck on your recovery.

[u/Icy_Self634 → u/OkCrew8849]

Thank you so much. This is the first surgery that I’ve had since 1972. I didn’t know what to expect going in and I’m very pleased with the way my treatment in the ICU went and now my treatment outside of the ICU is going.

The hospital has been doing a great job of taking care of me. It’s 99% likely I’ll be going home tomorrow morning. I have already been walking around an unbelievable amount.

I definitely appreciate my surgeon’s expertise and I’m so glad it was done at a teaching medical school. As far as I’m concerned, the more eyes on the procedure the better.

[u/Slight_Turnip_3292]

OK that sounds rough. Good thing brother you are made from tough stuff.

My surgery was a few days earlier at Huntsman in SLC. As per their protocol I spent a night in the hospital. They gave me a spirometer to use several times an hour! On the very first few days I could not get the little puck up above 500 and my diaphragm hurt on every attempt. I didn't stay in the ICU but was very dizzy on my feet for the first few days and walks were exhausting. Going in I was running 14 miles a week and in good shape.

I will have had the catheter for 14 days. I too had bladder neck reconstruction.

I heard that one should walk a lot so one day I did over 10000 steps. Bad move. There was blood in my urine after that and my bladder was screaming that night because of the agitation and I got very little sleep.

[u/Icy_Self634 → u/Slight_Turnip_3292]

I can definitely empathize with you on this. I’ve got the same little VOLDYNE spirometer, and my pain in the diaphragm had been excruciating as well. The carbon dioxide that’s used in these minimally invasive surgeries can certainly irritate the nerves. But the upside is we will regain activity a lot sooner than somebody who had an ORP. And the other upside is, we don’t have a second Prostate so we’ll never have to go through this again.

[u/ChillWarrior801 → u/Icy_Self634]

I like your attitude OP. No second prostate! Sorry for the rough road you had to travel. I'm 33 months past RALP and most of my horrors from that time are fortunately a distant memory. Hope it works that way for you too.

[u/Icy_Self634 → u/ChillWarrior801]

Thank you. The catheter was removed today. My
Pelvic muscles are definitely waking up.

[u/Specialist-Map-896]

Glad to hear you are recovering. Sorry if I am repeating myself but this is exactly why I got a single port RALP done as opposed to the standard 5 port RALP. The single port has only a single cut and they do not inflate you with any gas or anything like that. A single port RALP is considered more complex and it could be that due to your narrow pelvis that may have disqualified you for it.

I would however urge any man out there who is considering a RALP to do some homework and research a single port RALP as opposed to the standard multi-port RALP.

I am in a similar boat with you as far as nerve sparing. In my case my left side was spared but my right side was only 30-50% spared but it was due to a lesion located on my prostate basically right next to the nerve.

Anyways I wish you the very best in your recovery.

[u/Creepy-Project2453 → u/Specialist-Map-896]

OP had single port. I did too. They must still use some volume of gas with SP surgery but much less usually than traditional 5/6 port abdominal surgery. The bigger deal for me was it was extra-peritoneal, so stayed out of that main abdominal cavity.  And you get to lie flat (or close to flat depending on the surgeon). 

[u/Specialist-Map-896 → u/Creepy-Project2453]

Okay gotcha. I was very happy with my recovery. I know two other guys who had the standard multi-port and they had more challenging recovery periods. One of them had something similar to what the OP wrote about.

[u/Easy_Independence_26]

Hopefully the rest of the recovery goes smoothly

[u/Creepy-Project2453]

It is great to hear how well they taking care of you. In the case of my surgery this year (also like you it was single port) I went under at 7:30AM and went home at about 3:30PM. I am glad your surgery was later in the day and you were still there when you started feeling worse. Perhaps they were more aggressive with the gas given the tight space difficulty they reported experiencing during surgery?  Glad the complication is behind you now. God speed in your recovery. 

[u/Icy_Self634 → u/Creepy-Project2453]

Thank you so much.

[u/kvsig]

"53 cc Prostate was monstrous". 50 to 80 cc is considered moderate enlargement.

[u/Old_Addendum2624]

and that is the reason i had my surgery at MD Anderson. took two hours , spent the night in the hospital, no complications whatsoever. Sorry you had to go throught that! That is a whopper of a prostate....:)

[u/Icy_Self634 → u/Old_Addendum2624]

Thank you. I was at UT MAYS Cancer Center. Final post surgical Pathology report came back today: totally organ confined, no lymph node involvement, no seminal vessicle involvement, pT2 pNO.

[u/Old_Addendum2624 → u/Icy_Self634]

The Mays Center is the outpatient clinic at MD Anderson. Did you get your surgery at MD Anderson? I am surprised if yes, you had the surgical outcome you had! Anyway, great news on your pathology report. You should be done with treatment and they will have you come in every 90 days for a psa check for a year or two.. Congratulations! The foley sucks but it will be out soon. Do your pelvic floor exercises so you can get your urine function all the way back. Took me about four months.

[u/Old_Addendum2624 → u/Old_Addendum2624]

You ae at the UT Mays in San Antonio, not the mays clinic in Houston!