Robotic Radical Prostatectomy

Understanding the operation

Robot-assisted radical prostatectomy (RARP) removes the entire prostate gland and seminal vesicles through 5–6 tiny abdominal incisions. Your surgeon operates from a console with a magnified, 3-dimensional view, directing miniaturized instruments with precision that matches having hands inside the body — with the aim of results comparable to open surgery, generally with less pain, less blood loss, and a shorter recovery.

Depending on your risk profile (PSA, biopsy, exam, imaging), pelvic lymph nodes may also be removed — typically when there's more than a 2% chance of lymph node involvement; this adds roughly 30–45 minutes to the operation. Occasionally a tissue sample is checked by the pathologist during surgery ("frozen section") to guide decisions in real time.

Practice Kegel exercises before surgery — start 4–6 weeks ahead if you can. They're the single best preparation for regaining urinary control afterward (full instructions below).

Before surgery: your work-up

Depending on your other health conditions, a consultation with a cardiologist or another physician may be needed to make sure you're healthy enough for the operation. The pre-operative evaluation includes a history, physical exam, blood tests, and a urine sample — and may add a chest X-ray, EKG, or further imaging as needed. You may also meet with an anesthesiologist and/or your primary care physician before surgery; follow their advice carefully.

Before surgery: medications

• Blood thinners must be stopped before surgery, always in coordination with your prescribing physician: aspirin, Aggrenox, ibuprofen, naproxen, Indocin, or Bufferin — 7 days before; Plavix — typically 5–7 days before; Coumadin, Xarelto, Eliquis, Pradaxa, heparin, or Lovenox — typically at least 3–5 days before, as your prescriber recommends.
• Avoid dietary supplements and over-the-counter medications for 2 weeks before surgery — they can cause bleeding or unexpected reactions.
• Make sure we know every medication and supplement you take at home.

The day before surgery

• Eat only light meals, with only clear liquids after breakfast. Clear liquids are anything you can see through: water, apple juice, Jell-O without fruit, black coffee, tea, soda. Milk, creamer, dairy, orange or grapefruit juice, and juices with pulp are NOT clear.
• Take two tablets of Dulcolax (bisacodyl) in the afternoon the day before surgery, to clear your bowels. (If you have constipation problems, follow your primary care physician's or gastroenterologist's guidance instead.)
• Nothing to eat or drink after midnight. Cape Cod Hospital calls you the day before to go over final diet instructions — follow them carefully.
• Take your morning-of-surgery medications only as instructed by your surgeon, anesthesiologist, primary care physician, or the hospital staff.
• Bring a relative or friend to assist you on the day of surgery.
• Deep breathing, meditation, or gentle exercise help you arrive relaxed — and if you're overweight, even modest weight loss before surgery can make the operation easier and improve results.

The operation & hospital stay

The operation typically lasts 3–5 hours, and most patients go home the day after surgery (24–48 hours). You'll be up and walking within a few hours of surgery, and you'll go home with a urinary catheter in place.

In the hospital

• Walking is critically important — in most cases you'll be up and walking the same day as surgery. The goal is about 2–3 hours of hallway walking per day while awake: it wakes up your bowels, protects your lungs, improves circulation, and prevents blood clots.
• You'll get an incentive spirometer — a plastic breathing device to expand your lungs. Use it about 10 times per hour while awake.
• Compression sleeves (SCDs) on your lower legs inflate and deflate to keep blood moving; simple foot-pump exercises (point your toes down, then up toward your face, repeat often) add to the protection.
• You may have a small abdominal drain after surgery; it's typically removed in your hospital room before discharge — briefly uncomfortable, not significantly painful.
• Pain is managed with a combination of medications — many patients never need opioids after robotic surgery.
• Diet starts with liquids right after surgery; if you're progressing, regular food typically resumes the next morning.

Your catheter — the most important part

• You'll wake with a Foley catheter draining your bladder into a bag. It protects the newly created connection ("anastomosis") between your bladder and urethra while it heals — typically 7–10 days. Your surgeon sets the removal date.
• Overnight, always use the large night bag — not the small leg bag, which can fill, back urine up, and endanger the healing connection. You'll get both bags and instructions at discharge; ask if anything is unclear.
• Pressure, discomfort, bladder spasms, and a little blood in the urine or around the catheter (especially after bowel movements) are normal. Keep the tubing unkinked and flowing.
• If the catheter falls out, call your doctor or go to the emergency room immediately — and tell every clinician who treats you that you've had a radical prostatectomy.
• DO NOT allow a non-urologist to replace your catheter right after surgery — it could damage the healing connection between bladder and urethra.
• Leaking around the catheter is usually a bladder spasm; a prescription can help. But a catheter that stops draining could be blocked — call us.

Eating, drinking & your bowels at home

• Start with small, frequent meals and build back to three meals a day — your appetite will be lower than usual, and that's fine.
• Avoiding constipation is a priority: straining puts pressure on the surgical sites and raises hernia risk. Stay hydrated, add roughage, and use the stool softener we prescribe (docusate/Colace); MiraLAX is a safe over-the-counter addition as needed.
• Drink 8–10 glasses of water or fluid daily (unless you have a fluid restriction).
• Avoid carbonated drinks for the first few days.
• If you notice blood in your urine, increase fluids to dilute it.

Activity rules

• Walk — short, frequent walks, gradually longer each day. Rest on purpose between them. Your own body is the best gauge.
• Don't sit in one place longer than 90–120 minutes.
• No lifting over 10 pounds (about a gallon of milk) for 4–6 weeks — this protects against hernia at the incisions. Avoid strenuous activity for at least 2–4 weeks.
• Brace a hand over your largest incision when coughing, straining, or during bowel movements.
• Absolutely no biking, motorcycling, or horseback riding for 4 weeks.
• Shower 48 hours after surgery — let soapy water run over the incisions, no scrubbing, pat dry. No tubs, swimming, or submerging the incisions for 4 weeks.
• No driving while a catheter is in place or while taking pain medication — and not until pain wouldn't stop you from braking suddenly.
• Bend at the knees, not the waist.
• Stairs are fine — take them slowly, use the rail.

Your incisions

• You'll have several small "port" incisions closed with absorbable sutures and skin glue (Dermabond) — the glue flakes off on its own. If staples were used instead, they're removed at your follow-up.
• Remove any gauze dressings within 48 hours after surgery.
• A small amount of drainage can happen. No lotions, creams, alcohol, or hydrogen peroxide on the incisions — they interfere with the protective glue. Don't scrub.
• Pus, foul-smelling drainage, or an incision that turns red and painful are infection signs — call the office immediately.

What's normal in the first weeks

• Bruising around the incisions — resolves on its own.
• Mild abdominal distension, constipation, or bloating for 1–3 days. No bowel movement 48 hours after surgery? Take your stool softener or laxative; a Dulcolax suppository or enema is safe if still nothing.
• Scrotal and penile swelling and bruising — sometimes starting 24–48 hours after surgery, occasionally to the size of an orange, taking up to 2 weeks to settle. Elevate the scrotum on a small towel and wear supportive underwear; Tylenol or Motrin help unless contraindicated for you.
• Small amounts of bloody drainage around the catheter or in the urine, especially after activity or bowel movements.
• Perineal pain (between scrotum and rectum) or testicular discomfort for several weeks — Tylenol, warm compresses, or cold compresses help.
• An abdomen too distended for your regular pants — elastic waistbands and one-size-up underwear are the move for a couple of weeks.

Urinary control & Kegel exercises

• Expect leakage at first — nearly all men need pads initially. Buy them before your catheter-removal appointment and bring them with you (men's guards or brief-style protection; some men briefly need more).
• Many men reach reasonable control within about 4 weeks; improvement continues for 6–18 months. Roughly 90–95% of men have control by one year.
• Kegels are how you get there: find the muscles by stopping your urine stream mid-flow (that's the location exercise — once found, don't make a habit of stop-start voiding; finish in one go). Squeeze 5 seconds, relax 5 seconds — that's one set. Do sets 3–4 times a day once the catheter is out, hooked to routines: meals, TV, red lights.
• If you have perineal pain, let it settle (sometimes 2–6 weeks) before starting Kegels.

Erectile function & penile rehabilitation

Recovery of erections takes time — typically 12–18 months, and it varies with age, pre-surgery function, and health conditions. Two permanent changes to know plainly: there is no ejaculation after prostatectomy (the structures that produce it are removed), which also means natural conception is no longer possible. The sensation and pleasure of orgasm, however, are expected to be preserved — climax happens with or without an erection.

Starting around 6–8 weeks after surgery, our rehabilitation protocol works like conditioning after a sports injury:

• A PDE-5 inhibitor (sildenafil/Viagra or tadalafil/Cialis) at least 3–5 days per week — heart patients may need clearance first.
• A vacuum erection device (VED) once or twice daily for 10 minutes — it pumps oxygenated blood into the tissue and helps prevent shrinkage. We can order one, or you can purchase independently.
• From about 6 months, additional options if needed: MUSE (a urethral suppository) or penile injections (e.g., TRIMIX) — we teach the technique in the office.
• If nothing else succeeds — or pre-surgery function was already poor — a penile implant is the definitive option, and that program lives right here at UACC.
• Penile fullness or partial erections in the early months are a good sign: nerves are waking up.

Pathology results & follow-up schedule

• Pathology takes about 5–7 business days — you'll be home before it's final. Results may appear in the hospital's online portal before we've discussed them; you're welcome to look, but bring your questions to us for interpretation.
• Visit 1 (5–10 days): catheter removal, pathology discussion.
• Visit 2 (~6 weeks): healing check — have a PSA drawn a few days beforehand.
• Visit 3 (3–6 months): PSA again, functional recovery review.
• Visit 4 (9–12 months) and beyond: frequency depends on your pathology and recovery.
• A PSA before every follow-up is the pattern — call us for a lab order if you need one.

Getting fit before surgery (it genuinely matters)

Major surgery has been compared to running a marathon — and the fitter you arrive, the fewer the complications and the faster the recovery. Between now and your surgery:

• Eat heart-healthy: lean protein (fish, poultry, beans, eggs), whole grains, fruits and vegetables; skip sugary and processed foods. Add a high-protein shake twice a day (Ensure High Protein, Fairlife Core Power, Boost High Protein, and similar).
• Hydrate — multiple 6–8 oz glasses of water daily. Limit alcohol to no more than 2 drinks a day, and none in the 24 hours before surgery.
• Move: work toward walking 3 miles a day (three 1-mile walks count), plus simple resistance exercises — squats, bridges, planks. Even a few weeks of this improves your recovery.
• If you smoke: stopping cuts your complication risk dramatically — smoking raises post-surgical complications by 40%. Within 72 hours of quitting, breathing already improves.