Robotic Simple Prostatectomy

Understanding the operation

Robot-assisted simple prostatectomy (RASP) is for men with large (80–150 cc) or very large (>150 cc) prostates causing significant urinary symptoms — the size range where the American Urological Association guides patients toward this operation. Through 5–6 tiny incisions, the surgeon removes the obstructing inner prostate tissue while leaving the prostate's outer shell (the "capsule") in place — the key difference from a radical prostatectomy, and the reason risks to erectile function and continence are much lower here.

One honest number to know: in about 15–20% of cases, pathology finds incidental prostate cancer in the removed tissue — almost always an early, slow form that is simply monitored on a surveillance protocol. Efforts are made beforehand (MRI and/or biopsy when indicated) to catch anything that would change the surgical plan.

Practice Kegel exercises before surgery — they speed the recovery of urinary control afterward (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; most patients go home the day after surgery (24–48 hours), up and walking within hours, 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

• You'll go home with a Foley catheter draining to a leg bag; it typically stays 7–14 days while the bladder heals. An X-ray of the bladder ("cystogram") is usually done before the removal visit to confirm healing.
• Overnight, use the large night bag — not the leg bag, which can fill and back up.
• Pressure, spasms, and a little blood in the urine or around the catheter are normal; keep the tubing unkinked.
• If the catheter falls out, call us or go to the ER — and don't let a non-urologist replace it soon after this surgery; tell every clinician who treats you that you've just had a simple prostatectomy.
• Leaking around the catheter is usually a spasm (medication can help); a catheter that stops draining may 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.
• Mild abdominal distension, constipation, or bloating for 1–3 days — stool softener, then a Dulcolax suppository or enema if needed.
• Scrotal or penile swelling and bruising, up to 2 weeks — elevation, supportive underwear, Tylenol or Motrin.
• Small amounts of blood around the catheter or in the urine after activity or bowel movements.
• Perineal or testicular discomfort for several weeks.

Urinary control, erections & Kegels

• Some men leak at first — have pads on hand before catheter removal, and bring them to that appointment. Control returns much faster and more completely than after radical prostatectomy.
• Erectile function typically returns to your pre-operative baseline; PDE-5 medications (Viagra/Cialis) can help during recovery if needed.
• Kegels: find the muscles by stopping your stream once (then don't make stop-start a habit — finish in one go). Squeeze 5, relax 5; sets 3–4 times daily once the catheter is out. If perineal pain, wait for it to settle first.

Pathology & follow-up schedule

• Pathology takes 5–7 business days; results may appear in the hospital's online portal before your visit — bring questions to us for interpretation.
• Visit 1 (7–14 days): cystogram, catheter removal, pathology discussion.
• Visit 2 (~3 months): PSA a few days beforehand — this becomes your new post-surgery baseline. Because the prostate's capsule remains, PSA monitoring continues over time.
• Visit 3 (6–9 months): PSA and functional recovery review.

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.