Robotic Radical Prostatectomy

RARP is performed under a general anaesthetic (completely asleep).

We inflate your abdominal cavity with carbon dioxide gas to create space to perform the operation.

We usually make 6 keyhole incisions in your abdomen, through which we insert the surgical instruments.

We separate the prostate and seminal vesicles from surrounding structures, including the bladder, urethra (waterpipe), and pelvic floor.

Sometimes we also remove the lymph glands draining the prostate (pelvic lymph node dissection).

Often, we will try to preserve the nerves to the penis which allow you to get an erection (nerve sparing). These nerves lie very close to the prostate and it is only possible to preserve them if the cancer doesn’t come too close or grow into the nerves.

You will usually be in hospital for one to two days after the operation.

You will have a catheter after the operation. The catheter will drain urine into a bag. The bag can be secured to your leg and can be concealed under your trousers. The catheter will usually be removed 5 – 10 days after the operation.

You will have mild pain for several weeks after the operation. You will be given pain relief medication in hospital and at home to help control the pain.

You will usually be able to return to driving once the catheter has been removed.

Depending on your job, you can usually return to work around four weeks after the operation.

You won’t be able to do vigorous exercise or heavy lifting for 6 – 8 weeks after the operation.

You will usually have leaking of urine (urinary incontinence) after the catheter is removed. You will need to wear continence pads. This will improve for the majority of men but can take 3-12 months to improve.

Some men will continue to have leaking of urine beyond 12 months and may require further surgery to improve the leaking, such as a urethral sling, adjustable transobturator male sling or artificial urinary sphincter.

It is very common to have erectile dysfunction (impotence) after the operation, even if a nerve-sparing procedure is performed. This may be temporary or permanent. You may or may not be able to get an erection by using medications such as Viagra, injections into the penis, or a vacuum erection device.

After the operation, you will not make semen when you orgasm. Some men will leak urine when they orgasm. Some men will have pain when they orgasm, however this usually improves over time.

You will be infertile after the operation.

You may notice that your penis is shorter after the operation.

The majority of men with prostate cancer which is confined to the prostate (localised) will be cured by the operation.

The prostate is sent for further tests after the operation (histopathology). The results from these tests will allow us to tell you how likely it is that the operation has cured the cancer.

Sometimes this testing shows that the prostate cancer abuts the edge of the surgical specimen (positive surgical margin). This may increase the risk of the cancer recurring.

We will monitor your PSA for several years after the operation. Your PSA should reduce to an almost undetectable level. If your PSA rises after the operation, it may be a sign that the prostate cancer has recurred.

If the prostate cancer recurs, you may need further treatment, such as:

• • Radiation therapy.
  • Hormone therapy.
  • Chemotherapy.