In the gay pornography industry, which uses amateurs as well as professional actors, the term gay-for-pay refers to actors labeled or believed to be straight but who engage in same-sex sexual activities for money. Arcane or occult pornography involves sexualized situations with an occult or magical tone or performers who costume themselves in keeping with the theme, for example, a male performer dressed as a wizard. When used as an alternative to penile-vaginal penetration, the goal may be to preserve virginity or to prevent pregnancy. Double penetration of the vagina, anus and mouth, can involve: Simultaneous penetration of the anus by two penises or other objects. Boots are seen as the perhaps most fetishistic of all footwear and boots may be the most popular fetish clothing attire. The strategies and tactics that are used to smuggle one of the couple into and out of the toilet undetected are as important or almost as important as the urination. Interactive pornography, available in CD-ROM and DVD format, allows the viewer to select the particular acts performed at any one time, sometimes with the camera providing a first person view. Some pornographic films use an artificial semen substitute to simulate or enhance creampie shots. Additionally, the buttocks give an indication of the shape and size of the pelvis, which impacts reproductive capability. The industry generally refers to such films as adult films, which is part of adult entertainment. Commenting on why real milfs there are not as many female macrophiles, psychologist Helen Friedman theorized that because women in most societies already view men as dominant and powerful, there no need for them to fantasize about it. If one person is penetrated by two objects, it is generically called double penetration . On May 27, 2010 the television program The Doctors discussed the topic with dozens of teens, parents, and professionals. Point of view pornography is adult entertainment filmed to look as if the watcher were experiencing the sex act themselves. Post-Op Instructions: Robotic Radical Prostatectomy

Following robotic radical prostatectomy, your attention to proper post-operative follow-up will contribute to the success of your surgery.  You are being provided with written instructions and information that addresses common questions and concerns.  Please review this information at home.

Wound Care

  • The sutures utilized for this procedure dissolve on their own and do not need to be removed.
  • A "skin glue" is used to cover the incision so it is okay to get the incisions wet. You are encouraged to shower daily at home.
  • The catheter collection bag may be removed during showering. Gently pull the clear plastic tubing of the bag from the green catheter and allow urine to run into the shower.

A small amount of redness at the edges of the incision, as well as a small amount of clear or bloody leakage from the wound, is acceptable.

Drainage of sufficient quantity to soak dressings or redness greater than ½ inch from the incision should be reported to Dr. Ornstein.

Catheter Care:

  • You will be released from the hospital with a urethral catheter in place.
  • Application of a small amount of numbing jelly (Xylocaine jelly 2%) to the urethral meatus (tip of penis where catheter exits) and will reduce discomfort. (see Medications, pg 3)
  • You will be provided with two catheter collection bags, a smaller bag to be worn during the day beneath trousers, and a larger bag to be used a night. These bags can be removed and exchanged as needed.

Should your catheter fall out on its own, it is critical that you notify Dr. Ornstein or one of his associates immediately.  Do not allow a non-urologist (nurse or doctor) to replace it.

Activities

  • Following discharge from the hospital, you will be fully ambulatory and are encouraged to walk at least 3 times a day.
  • You are advised to refrain from driving until the foley catheter has been removed.
  • You can return to moderately strenuous activity such golfing and slow jogging 4 weeks after surgery.
  • You should refrain from vigorous activity (running, bicycling and heavy lifting) for 6 weeks after your surgery. After 6 weeks, you may resume full activities except for bicycling which you can resume 3 months following surgery.

When you return to work depends on your occupation and your recovery from surgery.  Typically most patients return to work 2 - 4 weeks after the surgery.

Urinary Control:

  • Most men have difficulty with urinary control for a limited time following catheter removal. You should bring an adult urinary pad with you the day your catheter is removed.
  • You should expect to wear pads for a while because normal urinary control may not be regained for several months from the time of your surgery.
  • Keep in mind that everyone is different; some men achieve control within one week while others require 6 months to achieve normalcy. Don't be discouraged!
  • Things will get better with time. You will typically leak more when standing up, moving, coughing and laughing than when sitting or lying down. Leakage is also typically worse later in the day.
  • Restricting fluid intake, particularly caffeine and alcohol can reduce the amount of leakage. Voiding frequently can also help.

The operation removed your prostate and affected your secondary urinary control mechanisms. Your external sphincter muscle must now take over all responsibility for control.  You may be able to help this muscle by doing regular exercises that we call Kegels.

To perform Kegel exercises:

  • Try to identify and control the muscle you use to stop the urinary stream and then relax it and let the urine flow again.
  • Then try to tighten and relax this muscle over and over again (after identifying the proper muscle, do not continue to interrupt your urinary stream).
  • Establish a daily routine to work this muscle throughout the day.
  • This may hasten the day when your control returns to normal.

Sexual Function

  • The operation will affect sexual function in several ways, but it should not prevent you from having a fulfilling sex life when you recover.
  • There are three components to sexual function in men: sexual drive, sensation, erection and climax (orgasm). Although these three normally occur together, they are really separate functions.
  • Erections occur due to a complex sequence of events involving stimulation of the cavernosal nerves and engorgement of the penis with blood.
  • The cavernosal nerves run alongside the prostate, only millimeters away from where cancer often occurs. Even if these nerves have been successfully spared they are often bruised or damaged during the surgery.
  • It often takes more than one year from the time of surgery for these nerves to completely heal. It is for this reason that it usually takes anywhere from 3 to 18 months for erections to return.
  • The use of Viagra, Cialis or Levitra can hasten the healing process, as well as help to obtain an erection during sexual stimulation.
  • While you are waiting for erections to return, a number of different therapies can be used to achieve satisfying erections. This include a vacuum erection devise (ie VED or Erectaide), urethral suppository (MUSE) or inter-cavernosal injections (Caverject).
  • Climax will not be affected by the surgery, but ejaculation (the release of fluid during orgasm) will no longer occur. This is because the seminal vesicles, which store fluid for ejaculation, and the vasa deferens, the tubes that carry sperm to the prostate, are removed and cut during the operation. In addition to creating a dry ejaculation, this means that you will be infertile (no longer be able to father children).
  • Some men experience mild penile shortening after the operation. However, the penis typically stretches to the pre-surgery length during an erection.

Scrotal Care

  • The scrotum may be swollen and or black and blue when you leave the hospital or within a few days after.
  • Do not worry this should resolve in 7-14 days. To help alleviate any swelling elevate the scrotum when you are at rest.
  • This can be accomplished by using a towel as a sling under the scrotum and across the top of your thighs.

Bowel Care

  • Patients often experience constipation and or bloating following the surgery.
  • To help alleviate this home take the Colace as prescribed unless you are having loose bowel movements or diarrhea.
  • If constipation remains a problem for more than 2 days after you have left the hospital you can take Milk of Magnesia to helps move things along.
  • DO NOT use an enema or a suppository as this could risk disrupting the connection between the bladder and the urethra.

Medications

  • Most patients have minimal discomfort that can be controlled with Tylenol (acetaminophen), Motrin (Ibuprofen).
  • If you still have significant pain despite Motrin or Tylenol, call Dr. Ornstein or one of his associates.
  • If needed, your physician can call into your pharmacy a prescription for a stronger pain medicine.

At the time of discharge you will receive a prescription for the following medications:

  • Levaquin 500 mg take one tablet daily for 3 days starting day before catheter removal.
  • Colace (docusate sodium) 250 mg orally twice a day - stool softener
  • Xylocaine (lidocaine) jelly 2% use as needed - for catheter comfort
  • Cialis 5 mg take one table daily for at least 1 month (for patient who are potent prior to the surgery and underwent a nerve sparing procedure)

Follow-up

  • You will be seen in the office 6 - 8 days after surgery for catheter removal.
  • The catheter will be removed by one of Dr. Ornstein's nurses.
  • Dr. Ornstein will call you with your pathology report as soon as it is available (typically within 5 - 7 days from the time of surgery).
  • You will be seen by Dr. Ornstein personally 6 weeks and 3 months following surgery. Your first post-operative PSA will be obtained just prior to your 6-week visit.
  • You should then have a physical exam including a digital rectal exam and have your PSA levels checked again 6 months following surgery and every 6 months thereafter. You can see Dr. Ornstein for these visits or see your local urologist.

You should alert Dr. Ornstein or one of his associates if your catheter does not drain well, or if you develop fevers of > 101 degrees, chills, nausea, vomiting, severe abdominal pain, flank pain, chest pain, shortness of breath, or leg pain or swelling in the first few months after your surgery.

If you have any additional concerns or questions, please do not hesitate to call our office (239) 403 - 9503 or call Dr. Ornstein on his cell phone (239) 218 - 5340.