Robotic Surgery · Prostate Cancer
Robotic
Prostatectomy
Surgical removal of the prostate gland using a robotic surgical system. For men with localised prostate cancer, this is the main curative surgical option, combining cancer control with preservation of urinary and sexual function where possible.
01
Overview of the procedure
Robotic prostatectomy (robot-assisted radical prostatectomy, or RARP) involves the complete removal of the prostate gland, seminal vesicles, and — where appropriate — nearby lymph nodes, through 6 small keyhole incisions in the abdomen.
Surgical techniques are tailored to each patient and may include nerve-sparing prostatectomy to preserve the nerves responsible for erections, bladder neck-sparing, maximal urethral length preservation and Retzius-sparing techniques to optimise early urinary continence.
The procedure is performed under general anaesthesia. A catheter will be placed in the bladder during surgery and remains in place for approximately 10 days post-operatively.
02
Before your procedure
- Fast for six hours before surgery. Clear fluids (water, black tea) are permitted up to two hours prior.
- Blood-thinning medications must be stopped in advance — Dr Tan’s team will provide a specific timeline based on your medication.
- Pelvic floor exercises before and after surgery can significantly improve urinary continence recovery. Dr Tan’s team can refer you to a physiotherapist.
- Stopping smoking before surgery is strongly encouraged. Smoking increases anaesthetic risk and slows wound healing.
- Arrange for someone to accompany you on discharge and support you at home for the first 1–2 weeks.
03
Risks and benefits
Curative intent
Removal of the prostate offers the possibility of complete cure for localised prostate cancer.
Function preservation
Nerve-sparing and Retzius-sparing techniques aim to support recovery of continence and erectile function, though outcomes vary between individuals.
Quicker recovery
Compared with open surgery, robotic surgery is generally associated with less blood loss, less pain, and a shorter hospital stay (typically around 1–2 nights).
Expected
Temporary urinary incontinence
Almost all men experience some leakage after catheter removal. This improves significantly over weeks to months with pelvic floor exercises. Some men regain control within a few weeks, and most achieve pad-free continence between 6 weeks and 6 months.
Common
Erectile dysfunction
The nerves controlling erections run alongside the prostate. Even with nerve-sparing surgery, erections may be reduced initially. Recovery depends on age, pre-operative function, and surgical technique — it can take 12–24 months.
Expected
Dry orgasm (no ejaculate)
After prostatectomy, men no longer ejaculate (anejaculation). Orgasmic sensation is usually preserved. This also results in permanent infertility — sperm banking should be discussed beforehand if relevant.
Uncommon
Bleeding requiring transfusion
Blood transfusion is rarely required after robotic prostatectomy.
Uncommon
Anastomotic leak or stricture
The join between the bladder and urethra may occasionally leak (managed with extended catheterisation) or develop scarring (bladder neck contracture), which may need further treatment.
Rare
Injury to surrounding structures
Injury to the rectum, ureters, or blood vessels is incredibly rare. Very rarely a temporary colostomy is required.
04
Aftercare and recovery
1
Urinary catheter
A catheter is usually in place for 10 days. Dr Tan’s team will arrange catheter removal and check your urine flow. Guidance on catheter care will be provided before discharge.
2
Pelvic floor exercises
Begin pelvic floor exercises immediately after catheter removal. Consistent daily practice is the single most important thing you can do to improve continence recovery.
3
Activity restrictions
Light walking is encouraged from day one. Avoid driving for 2 weeks. Return to desk work at 2–4 weeks. Avoid strenuous exercise and heavy lifting for 6 weeks.
4
PSA monitoring
After successful surgery, your PSA should fall to undetectable levels. Regular PSA checks (typically every 3–6 months) are arranged to confirm the cancer has been fully treated.
5
Erectile rehabilitation
Early penile rehabilitation — with medications such as PDE5 inhibitors — helps maximise the chances of erection recovery. Dr Tan will discuss a tailored plan with you.
6
Pathology results
Your removed prostate is examined by a specialist pathologist. Results, including final staging and margin status, are discussed at your post-operative clinic appointment.
Before you consent
Questions to ask at your consultation
- Am I a candidate for nerve-sparing surgery?
- What technique will you use — nerve-sparing, Retzius-sparing?
- What is my likely chance of maintaining continence and erections?
- Should I bank sperm before surgery?
- What is the risk that cancer remains after surgery?
- How does surgery compare to radiotherapy for my cancer?
- What happens if the PSA rises after surgery?
Disclaimer
This information is for general education and is not a substitute for personal medical advice.
Content adapted from the British Association of Urological Surgeons (BAUS) and the American Urological Association (AUA) patient information resources.