Robotic Prostate Cancer Surgery

Before undergoing robotic-assisted radical prostatectomy, you will have a thorough preoperative assessment to ensure the surgery is safe and carefully planned for your individual needs. This assessment helps confirm the extent of your prostate cancer and allows your surgical team to tailor the operation to you.

Your work-up may include blood tests such as PSA, a review of your prostate biopsy results, and imaging scans (such as MRI or specialised PET scans) to better understand the cancer. Your general health will also be assessed with routine blood tests, heart tests if required, and possibly a consultation with the anaesthetist.

You may be advised to begin pelvic floor exercises before surgery, and you will receive clear instructions regarding medications, fasting, and what to expect during your hospital stay. Our goal is to ensure you feel informed, prepared, and supported throughout your surgical journey.

On the day of your robotic-assisted radical prostatectomy, you will be admitted to hospital a few hours before your scheduled operation. After arrival, you will be welcomed by the nursing team and shown to your room.

You will meet Dr. Farag and your anaesthetist, who will answer any final questions and confirm the planned procedure. A small intravenous line (drip) will be placed in your arm, to allow for the administration of medications. You will then be taken to the operating theatre, where you will be given a general anaesthetic so you are asleep and comfortable throughout the surgery.

The operation is performed using robotic assistance through small keyhole incisions in the abdomen. The prostate is removed with precision, aiming to minimise blood loss and protect surrounding structures where possible. The surgery typically takes several hours.

After the procedure, you will wake up in the recovery area, where you will be closely monitored. Once stable, you will be transferred back to your room. You will have a urinary catheter in place, which is normal and temporary. Pain is usually well controlled with medication, and most patients are encouraged to start moving and drinking fluids later the same day.

Dr. Farag will review you regularly, explain how the operation went, and guide you through the next steps in your recovery.

Most patients recover steadily after surgery. Initial recovery usually takes 5–7 days, although full recovery occurs gradually over several weeks. Gentle walking is encouraged as soon as you return home, as this helps circulation and healing.

Most men can return to normal daily activities and light work duties after 2–3 weeks, but only after the urinary catheter has been removed. Heavy lifting and strenuous exercise should be avoided for approximately six weeks. Driving is generally safe two weeks after surgery, provided you are pain-free, no longer taking strong pain medication, and the catheter has been successfully removed.

Catheter and Wound Care

You will be discharged home with a urinary catheter and leg bag. Before leaving hospital, you will be shown how to care for and empty the catheter at home. It is important to drink plenty of water to keep your urine clear. A small amount of blood in the urine is common and usually not concerning.

The catheter typically remains in place for 7–10 days after surgery. Your wound sutures are dissolvable and do not require removal.

Pain Control and Bowel Care

Pain after surgery is usually mild and well controlled with paracetamol and ibuprofen. Stronger pain relief is rarely required. To prevent constipation, laxatives, a high-fibre diet, and adequate fluid intake are recommended.

Urinary Control

After the catheter is removed, temporary urinary leakage is very common. While this can be distressing, it is expected and usually improves over time. You should recommence your pelvic floor exercises, as these play an important role in regaining urinary control.

Sexual Function and Penile Rehabilitation

Sexual activity is generally safe to resume around six weeks after surgery. However, many men find that erections take several months to recover while the nerves heal. This is normal.

Dr.Farag may prescribe sildenafil (Viagra) immediately after surgery as part of penile rehabilitation. Your urology nurse and Dr. Farag will also discuss additional strategies to support recovery of erectile function.

When to Seek Urgent Medical Attention

Most men recover without complications. However, you should seek urgent medical advice from your GP or attend an Emergency Department if you experience any of the following:

• No urine draining from the catheter, which may indicate blockage

• Heavily blood-stained urine or large clots (small amounts of blood are normal)

• High fever (above 38°C) or uncontrollable shaking, which may indicate a serious infection

• The catheter falls out — this should only be replaced by a urologist

• Severe abdominal pain, which is uncommon and requires assessment

Robotic-assisted radical prostatectomy is a well-established and commonly performed procedure. Most men recover without significant complications. However, as with any surgery, there are potential risks and side effects. Dr. Farag will discuss these with you in detail before surgery.

Common or Expected Side Effects

• Urinary leakage (incontinence): Temporary leakage of urine is common after catheter removal. This usually improves over time, particularly with pelvic floor exercises. A small number of men may have ongoing leakage.

• Erectile dysfunction: Erections may be reduced or absent for a period after surgery while the nerves recover. Improvement can take several months and varies between individuals. Treatments are available to assist recovery.

• Dry orgasm: After prostate removal, semen is no longer produced. Orgasms can still occur but will be “dry”.

Less Common Risks

• Bleeding: Significant bleeding is uncommon, and blood transfusion is rarely required.

• Infection: This may involve the urinary tract, wound, or deeper tissues and is usually treatable with antibiotics.

• Pain or discomfort: Most pain is mild and temporary, but some men experience ongoing pelvic or groin discomfort.

• Scarring or narrowing of the urinary channel (bladder neck contracture): This can affect urine flow and may require further treatment.

Rare but Serious Risks

• Injury to nearby structures, such as the bowel, bladder, or ureters

• Blood clots in the legs or lungs

• Anaesthetic-related complications

• Need for further surgery

Your individual risk depends on factors such as your general health, prostate size, cancer characteristics, and whether nerve-sparing surgery is possible. The aim of robotic-assisted surgery is to maximise cancer control while minimising side effects.

If you have any concerns or questions, these can be discussed with Dr.Farag at any stage of your care.

You will be given an appointment for removal of your urinary catheter 7–10 days after surgery. Dr. Farag will also arrange a follow-up appointment to review your recovery and discuss the results of the surgery, including the pathology findings.

Your first PSA blood test and follow-up appointment will take place approximately two months after the procedure, with ongoing monitoring at regular intervals for 3–5 years to ensure your continued recovery and long-term cancer control.