RC/IC Surgery Detailed Experience

Because I was seriously concerned, to say the least, about how I would do with the Robotic Arm, Nerve Sparing RC, now that its over I thought I'd write up my experience for others about to have the same procedure. If you've had this already, or not having it, probably boring to you. First, I am 51, 275lbs, 6'4, stage 2 at diagnosis, being treated at UAB in Birmingham by Dr. Nix.

I went in Friday, 10.23.15, at 5am for my RC. I was brought back almost immediately and they prepped me and X marks the spot for my Stoma. I chose the left side. I chose the left side because I sleep on the right side of the bed, lay on my right side, and didn't want to have to switch sides. Now that I have it; messed that up - didn't understand how the bag and night bag would "hang" so wife and I gotta learn a new side of the bed after 30 years. My bad.

FRIDAY: Anyway, I went back on time at 7am. About the only thing I remember nothing about the procedure. Not even being wheeled into the operating room. They gave me a shot before taking me back and I was out 2 minutes later. Woke up in the recovery room about 5:30pm. My actual surgery was 9.5 hours. I was told is was much longer than usual because, 1) some people have more lymph nodes than others, 2) some people have more fat and tissue surrounding theirs than others (skinny people have a lot of fat, skinny people have little, fat people (like me) have a lot, also some have little - no correlation they said). I had a lot of tissue I was told and they wanted to get everything south of where the major vein (artery?) splits at the top of the abdomen. Also, took out the bladder, of course, the prostate, and the tip of the urethra. Not sure why the top of the urethra as I don't think that was mentioned before, but might be standard.

Was not in pain when I woke up but could tell I had been in surgery could feel tightness in my abdomen. Took me to my room pretty quickly. I had the Holister Bag on that will be a new part of my body from now on, and in it were two stents, or very thin tubes, each going directly from the bag through the stoma, each tube then going through one of the ureters and into a kindey. I had a JP drain on my right side with a tube attached to a rubber ball that was sucking fluid out of my abdomen. I had one IV apparatus with two needles in my left wrist, one needle for the drip and one for access point for pain medicine and whatever else. I had a 4" straight line suture below my belly button from where they removed the organs and tissue. I also have two closed and sutured 1" holes on my front left side, one in my belly button, and one on my right front side. The surprising thing was I was in slight discomfort but no real pain. I slept from about 8pm until 3am. I slept pretty good. 

SATURDAY: I had numbness on my right calf about half way down on the right side to the top of my foot all the way through my 3 inner toes. They did a bedside ultrasound and didn't see a clot but did see some fluid build up. I did have some blisters on the back of my left shoulder. The next day, I got out of the bed for the first time to walk about 7am. I was pretty steady on my feet, but again, surprised at little to no pain. I put on my PJs and walked around the hall way for about 5 minutes. Went back to sleep. Woke about about 2pm, felt really good, zero pain, and strong while prone. Got up, walked around the ward for about 30 minutes. Then sat in a chair for about 3 hours. Back to bed for a bit. I was eating each meal, appetites was good, but filled up quickly and didn't finish everything. Walked again later. Didn't feel any real pain but hit the pain button when I saw it available because I read to stay ahead of the pain. Started passing gas early Saturday; no poop.

SUNDAY: The JP Drain leaked bloody fluid all over me overnight so the next morning the dr. clip the ball off the end and put the tub in another holister bag on the right side. So now I was double bagging. They took off the IV this morning and the pain pump as I wasn't using it and I walked a lot this day. When down to the starbucks about 2 blocks away (all inside the hospital via walkways - this is a huge complex.). Later this evening I started getting significant pain in my lower abdomen/upper groin, started getting chills. I went to take a walk to see if it would warm me up. I realized my bag was way full and I needed to go empty it before walking. (ooops, too full right now, brb) Anyway, as I was emptying it I lifted it up and it became dislodged from my body on the bottom side and started spilling all the urine down my pajama leg and onto the floor. YIKES! I was pretty frantic. I called the nurses, took off the soiled clothes, cleaned up, put on another bag and got in bed exhausted, Pretty immediately starting feeling pain in my lower abdomen above my pelvic bone. Resident came, didn't know why I would feel pain there so they have me a pain shot and said to watch it. It got worse and then pain started in my right back side. The pain in my back right side got significantly worse pretty quickly so we called the resident again. Within about 30 minutes of the pain starting I started to get really nauseous. I got out of the bed to lean over it to see if that helped, didn't, and I began to throw up into a pan. With each "heave" a very large stream of bloody water would shoot out of my penis; this is the same fluid that is collected in the drain on my right side. (I had had the top of the urethra sutured so this was both terrifying and shocking). I was this time covered in bloody water goo. This fluid is called seroma? and is a normal part of the healing process. The resident took about 3 hours to arrive and I was in the worst pain I had ever experienced. The nurses kept calling and telling me they got no answers to their calls. I was nauseated, in excrutiating pain, and no relief in sight. Finally, my wife asked for a wheelchair because she was going to take me to the emergency room. They said the resident on call finally called back and said he'd be there in 10 minutes. 30 minutes later he came in and took off my hollister bag with the stents going to my kidney, put a needle into one stent, suck some little bloody clot thing out (again, the stent tubes are very small) and IMMEDIATELY I began to feel relief. Basically, the stent going to my right kidney got a clog and wasn't letting my kidney drain. It was like having a kidney stone when the urine flow is blocked and the kidney becomes painfully clogged with urine. Slept like a baby this night. No poop.

MONDAY: Great day, no pain. Walked about 5 times; 30 minutes each and sat up a lot. Walking pooped me out and I napped this afternoon. Dr. said when I poop, I can go home as everything else is great. Nothing really to report anymore. No more pain - at all. Struggled to poop a dinky bit; didn't count.

TUESDAY: Woke up, put on street clothes and walked about 1.5 miles; all inside the large complex, with walkways over the streets connecting the buildings. This tired me out and was probably too much. Oh, POOPED before I took a nap at 10am. Got released from the hospital about 3pm. The wife wasn't thrilled with me getting out so soon, but I felt really good. She got a room to stay in town overnight, we live 4 hours a way. Went to a Hooters and picked up 10 wings, breaded, fried, and hot, salad, curly fries, bowl of chili, and coke. Ate...it....all. Was curious how the wings would feel going over those parts of my small intestine that were cut and restiched together. Nothing, pain free.

WEDNESDAY: Drove home. About halfway home I noticed my drain - they left the stents and the drain inuntil I go back for follow up next week - was not really draining near as much as the day before. I thought maybe the fluid is decreasing as expected. Then my penis started leaking this "seroma". A lot. Got home, pain free, and had to change my underwear twice and couldn't keep up with the fluid coming out my penis. Then fluid started coming out of my belly button where I had a hole stitched from the surgery. A lot of fluid. I had to put a cut up diaper in my underwear and tape the other half over my belly button to sop up the fluid. Very little fluid in my collection bag. I could be I had fluid on inside me building up on my hips and I think when the level rose from my pubic area to my belly button, it just started flowing from there. Osmosis.

THURSDAY: When I woke up, today, I noticed that there was a lot of fluid on the belly button diaper, but very little in the diaper in my underwear. My collection bag had filled up much, much more than the previous day, about 3 times as much, just overnight. I logged the amount, and the bag filled up over the next 3 hours about 4 times. THAT WAS A LOT OF FLUID and belly button and penis dried up. Turns out, I had another little clog, this time in the drain tube, and I was filling up with this fluid on the inside. Once that cleared, the faucet was turned on. As of now, Thursday afternoon, the fluid seems to have resolved and I have counted about 800 ml of fluid from 7am to 3pm. But, I think I might be drying out as it has back way off on draining to more "normal" levels.

Bottom line is; I feel really good. I don't have any pain to speak of. I can eat, walk, etc. I get tired relatively easily but rest up quickly just by sitting down for a bit. Now its the waiting game. I am incredibly nervous, and a little pessimistic waiting for the results of the pathology of the lymph nodes and tissue removed. The prognosis is sooooooo different, drastically, based on lymph node positive or negative. So I wait. Waiting is harder than the surgery and recovery to date; not even close.