Life After Robotic Prostatectomy
Recovery After Robotic Prostate Cancer Surgery
Recovery after robotic radical prostatectomy is different for every patient. Although robotic surgery uses a minimally invasive approach, removal of the prostate is still a major operation and your body needs time to heal.
In the first few weeks, recovery is focused on healing from surgery, managing the temporary urinary catheter and gradually returning to normal activity. Over the following weeks and months, attention increasingly turns to urinary continence, erectile function and longer-term monitoring of your prostate cancer.
Understanding what to expect can help you prepare for your recovery and recognise that improvements in urinary and sexual function often take place gradually rather than immediately.
Going Home After Robotic Prostatectomy
Following robotic radical prostatectomy, patients are encouraged to begin mobilising as soon as it is safe to do so.
Before leaving hospital, you will be given specific advice about your recovery, including caring for your catheter, looking after the small surgical wounds, medication and gradually increasing your activity.
You may feel more tired than usual during the early stages of recovery. This is normal following major surgery, and it is important to balance gentle activity with appropriate rest.
The Urinary Catheter
During radical prostatectomy, the prostate is removed and the bladder is reconnected to the urethra. A urinary catheter is left in place temporarily to allow this new connection to heal.
The catheter continuously drains urine from the bladder into a collection bag. Before leaving hospital, you will be shown how to look after the catheter and manage the drainage bags.
The catheter is normally removed after a period of healing, although the exact timing will depend on your operation and individual circumstances.
Some bladder discomfort, spasms or leakage around the catheter can occur. You will be given information about what to expect and when you should seek medical advice.
Urinary Control After Catheter Removal
It is common to experience some degree of urinary leakage when the catheter is first removed.
The muscles involved in urinary control need time to recover following prostate surgery. Initially, leakage may be more noticeable when standing up, coughing, sneezing, exercising or undertaking physical activity.
Most patients see their urinary control improve progressively following surgery, but the rate of recovery varies considerably between individuals.
Some men regain good control relatively quickly, while for others improvement continues over several months. A smaller proportion of patients can experience longer-term urinary incontinence requiring further assessment or treatment.
Pelvic Floor Exercises After Prostatectomy
Pelvic floor exercises are an important part of recovering urinary control following radical prostatectomy.
The pelvic floor muscles help support the bladder and control the passage of urine. Strengthening these muscles can assist recovery of continence after prostate surgery.
Patients are commonly advised to learn pelvic floor exercises before their operation so that they are familiar with the correct technique.
Following surgery, you will be advised when to restart the exercises. They should not normally be performed while the urinary catheter remains in place unless specifically advised otherwise by your clinical team.
Regular, correctly performed pelvic floor exercises can then form an important part of your rehabilitation over the following weeks and months.
Erectile Function After Robotic Prostatectomy
Changes in erectile function are another important consideration following radical prostatectomy.
The nerves involved in producing erections run very close to the prostate. Where the position and extent of the cancer allow, it may be possible to preserve some or all of these nerves during surgery.
This is known as nerve-sparing prostatectomy.
Even when nerve-sparing surgery is possible, erections will usually be affected immediately after the operation. The nerves can take time to recover from surgery, and improvement in erectile function may continue for many months.
The likelihood of recovery varies between patients and is influenced by factors including:
- Erectile function before surgery
- Age
- General and cardiovascular health
- Whether nerve-sparing surgery was possible
- Whether the nerves could be preserved on one or both sides
- Individual recovery following surgery
Nerve-sparing surgery can improve the opportunity for erectile function to recover in appropriately selected patients, but it cannot guarantee a return to erections at the same level experienced before surgery.
Find out more about Nerve-Sparing Robotic Prostatectomy
Sexual Rehabilitation After Prostatectomy
Where appropriate, treatments can be used to support erectile function following prostatectomy as part of sexual rehabilitation.
Depending on your circumstances, these may include:
- Tablets used to support erectile function
- Vacuum erection devices
- Penile injections or other treatments where required
The most appropriate approach will depend on your erectile function before surgery, whether the nerves could be preserved and your recovery following the operation.
It is important not to judge the long-term outcome too early. Recovery of erectile function after prostatectomy can be gradual, particularly while the nerves recover following surgery.
Orgasm, Ejaculation and Fertility
Radical prostatectomy permanently changes ejaculation and fertility.
The prostate and seminal vesicles contribute much of the fluid that makes up semen. Because these structures are removed during radical prostatectomy, you will no longer produce semen when you orgasm.
This is sometimes described as a dry orgasm.
It may still be possible to experience the sensation of orgasm following prostatectomy, although this can feel different after surgery.
Natural fertility is lost following radical prostatectomy. Men who may wish to have children in the future should therefore discuss fertility preservation and sperm storage before undergoing treatment.
Returning to Normal Activities
Gentle walking is usually encouraged during the early stages of recovery and can be increased gradually as your strength and energy return.
You should avoid heavy lifting and strenuous exercise during the initial healing period and follow the specific advice provided by your surgical team.
The timing of returning to work will depend on the nature of your occupation and how quickly you recover. Someone with a desk-based job may be able to return sooner than someone whose work involves significant physical activity or heavy lifting.
Similarly, you should only return to driving when you have recovered sufficiently to control the vehicle safely, can perform an emergency stop comfortably and are no longer affected by medication that could impair driving.
Your individual discharge instructions should always take priority over general recovery guidance.
Pathology Results After Prostatectomy
The prostate removed during surgery is sent to a specialist pathologist for detailed examination.
This examination provides further information about the prostate cancer, including its extent within the prostate and whether cancer cells are identified at the surgical margins.
If lymph nodes were removed during the operation, these will also be examined for evidence of cancer.
The final pathology results provide important information about the cancer and help determine the most appropriate follow-up after surgery.
PSA After Radical Prostatectomy
PSA monitoring is an important part of follow-up after radical prostatectomy.
Because the prostate gland has been removed, the PSA level would normally be expected to fall to a very low or undetectable level following successful surgery.
A PSA blood test is therefore performed after an appropriate interval following the operation and then monitored over time.
If PSA remains detectable or subsequently begins to rise, further assessment may be required. This does not automatically mean that additional treatment will be necessary, but the result needs to be considered alongside the pathology findings and other clinical information.
Will I Need Further Treatment?
For many patients, surgery will be the only active treatment required for their prostate cancer.
However, some patients may require additional monitoring, investigation or treatment depending on their final pathology results and PSA levels following surgery.
If further treatment is considered necessary, options may include radiotherapy, hormone therapy or other treatments depending on the individual circumstances.
Long-term follow-up is therefore an important part of prostate cancer care even when recovery from the operation itself is complete.
When Should I Seek Medical Advice?
You will receive specific discharge information explaining when and how to contact your surgical team following your operation.
You should seek appropriate medical advice if you develop concerning symptoms during recovery, particularly symptoms such as:
- A high temperature or feeling significantly unwell
- Increasing redness, swelling or discharge from a surgical wound
- Significant or worsening pain
- Problems with the catheter draining urine
- Significant bleeding
- Increasing swelling or pain in a leg
- Chest pain or difficulty breathing
If you experience severe or rapidly developing symptoms, urgent medical assessment may be required.
Life After Prostate Cancer Surgery
Recovery from robotic prostatectomy is not simply about healing from the operation. For many patients, the longer-term priorities are returning to normal activities, recovering urinary control, managing changes in sexual function and receiving reassurance through ongoing PSA monitoring.
Some aspects of recovery happen relatively quickly, while others can continue improving for many months.
Mr Oakley will discuss the potential effects of prostatectomy before surgery so that you have realistic expectations about recovery and can make an informed decision about treatment.
Find out more about Robotic Radical Prostatectomy
Follow-Up for Patients from Sheffield and South Yorkshire
Patients from Sheffield, South Yorkshire and surrounding areas can have their initial consultation and assessment with Mr Oakley in Sheffield, with robotic prostate cancer surgery undertaken in Manchester where appropriate.
Following surgery, arrangements will be made for appropriate post-operative care and follow-up, including review of your recovery, pathology results and PSA monitoring.
Find out more about Robotic Surgery for Sheffield Patients
Considering Robotic Prostate Cancer Surgery?
If you have been diagnosed with prostate cancer and would like to understand more about robotic prostatectomy, recovery and what life may be like after surgery, you can arrange a private consultation with Mr Neil Oakley in Sheffield.