Robotic Simple Prostatectomy

ABOUT ROBOTIC SIMPLE PROSTATECTOMY

What is a robotic simple prostatectomy?

Robotic simple prostatectomy (RASP) is the removal of prostatic tissue which is blocking the flow of urine from the bladder, with the aid of a surgical robot.

Why is a robotic simple prostatectomy required?

Simple prostatectomy is a surgical treatment for the management of urinary symptoms which are due to enlargement of the prostate.

These symptoms may include:

- Waking through the night to urinate.
- Needing to pass urine frequently throughout the day.
- Having to pass urine urgently.
- Reduced urine flow.
- Difficulty starting urination.
- Stop-start flow.
- Dribbling after passing urine.
- A feeling of incomplete bladder emptying.

Simple prostatectomy is a good option for you if you have a large prostate (>100grams), and:

- You do not want to take or are unable to take medications for prostate enlargement (such as prazosin, tamsulosin, silodosin, dutasteride or finasteride); or
- Medications are no longer working; or
- You are catheter dependent due to urinary retention; or
- You have complications of your enlarged prostate including blood in the urine (haematuria), bladder stones, kidney failure or recurrent urinary tract infections.

Simple prostatectomy is a treatment for benign prostate enlargement. It is not a treatment for prostate cancer. Because the outer layer of the prostate remains intact, monitoring for prostate cancer is still required.

What is robotic surgery?

We perform RARP using the daVinci robotic surgical system.

This allows the operation to be performed with miniaturised instruments through small keyhole incisions in your abdomen. The robotic surgical instruments are under the control of your surgeon at all times.

The advantages of robotic surgery, compared with open surgery, include:

- Faster recovery and return to regular activities.
- Smaller incisions and scars.
- Less bleeding.
- Shorter hospital stay.

Prostate Enlargement

Prostate enlargement, also called benign prostatic hyperplasia (BPH), is a non-cancerous growth of the prostate gland that commonly occurs in men as they age. The prostate surrounds the urethra, so when it enlarges, it can press against the urethra and block urine flow.

PATIENT JOURNEY

What does a robotic simple prostatectomy involve?

Robotic simple prostatectomy 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 make a small incision in the bladder to access the inside of the prostate. The inside of the prostate is removed and the capsule (outer part) is left in place.

A sample of prostate tissue is sent to the laboratory for analysis.

What does a robotic simple prostatectomy involve?

We then close your bladder. A catheter is placed in your bladder, though the urethra, to drain urine until the join heals.

We close the incisions with dissolvable stitches or staples.

You may have a drain (a plastic tube coming out of the abdomen) for a few 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 either prior to going home or in 5 – 10 days after the operation.

What is the recovery after a robotic simple prostatectomy?

Robotic simple prostatectomy usually requires a one to two nights stay in hospital.

You can return to sedentary work 2 weeks after the operation or four to six weeks if your job involves physical labour.

You need to avoid lifting more than 10kg for six weeks following surgery. You also need to avoid constipation and straining your pelvic floor.

You can drive after one week if you feel safe and comfortable to do so.

You may have discomfort when urinating and blood in the urine intermittently for four to six weeks after the procedure.

What is the recovery after robotic simple prostatectomy?

Some patients experience transient urinary incontinence (leakage of urine). This usually resolves within three months with pelvic floor muscle exercises. We strongly recommend seeing a pelvic floor physiotherapist to learn pelvic floor muscle exercises prior to your simple prostatectomy and doing these exercises once your catheter has been removed.

You can usually return to sexual activity approximately two weeks after the operation.

You will experience retrograde ejaculation (ejaculate going into the bladder during orgasm) after a simple prostatectomy. This may affect your ability to father children naturally.

What are the benefits of robotic simple prostatectomy?

Robotic simple prostatectomy has some benefits over other surgical treatments for prostate enlargement. These benefits include:

- There is no risk of ‘TUR Syndrome’ which is an uncommon but serious complication associated with TURP.
- Compared with an open simple prostatectomy; there is less bleeding, faster recovery and return to normal activity, shorter hospital stay and smaller incisions.