Robotic Prostatectomy

About the Procedure

A Prostatectomy is a procedure performed to remove the prostate gland or a section of it as a result of a diagnosis of cancer or benign prostatic hypertrophy (BPH). The purpose of the prostate is to secrete a milky fluid which is discharged into the urethra when a man ejaculates. Cancer of the prostate is the most common cancer in American men and is the second highest cause of death. Cancerous tumors in the prostate grow slowly, are unlikely to metastasize for many years, and may exhibit few or no symptoms. Benign prostatic hyperplasia is an enlargement of the prostate which occurs with aging as a result of hormonal changes.

There are a number of treatment options available for prostate cancer which include surgery, radiation therapy, hormonal therapy, cryotherapy, and laser therapy. The most common surgical procedures are a radical prostatectomy in which the entire gland is removed through an incision in the lower abdomen or perineal area, a laparoscopic or robotic surgery, and a transurethral resection of the prostate (TURP) in which a part of the prostate is removed using an instrument inserted through the urethra. Potential complications of a total prostatectomy are impotence and incontinence. Treatment is available for both conditions should they occur.

A radical prostatectomy can be performed with either general or regional anesthesia and may take between two to four hours. The surgeon inserts a catheter through the urethra into the bladder, makes an incision or several small cuts for a laparoscopic procedure. As the prostate is being removed, the surgeon may remove some lymph nodes for biopsy as a precaution. Drains are then placed around the site and the incision is closed. The patient will stay in the recovery room for about two hours.

What to Know Before the Procedure

Choosing a surgeon to perform a prostatectomy may be a more important decision than the type of procedure. With the concerns many men have over erectile dysfunction and urinary incontinence following the surgery, the more skilled and experienced the surgeon, the less likely there will be damage to the nerves and bladder.

Preparation for the procedure requires a liquid diet followed by a bowel cleansing, a health assessment, blood work, x-rays, changes/additions to medications to avoid excess blood loss during surgery, and instructions from the physician about food and water intake just prior to the operation. The hospital stay is expected to be two to three days for an uncomplicated procedure and recovery.

What to Know After the Procedure

The abdominal drains are usually removed the following morning while the catheter remains in place for two weeks after the procedure, and dressings will be removed once the incisions are dry. In the first 48 hours, there may be blood in the urine which should go away. After the catheter is removed, some men experience difficulty urinating which may require re-insertion of the catheter for a few days. In general, the procedure is well-tolerated, the results are excellent, and patients recover quickly.

At home, the patient will need to clean the urethral opening around the catheter. He will likely experience swelling in the scrotum, bladder spasms, and a delay of normal bowel function for a few days. Showers are permitted but baths must be avoided until the incisions are healed. Patients resume most routine activities in ten days and can engage in all activities in three to four weeks. Returning to work depends on the activities required. Patients with a sedentary job typically return after four weeks; and a more physical job requires about eight weeks. If the surgery was laparoscopic, the patient may be ready to return to work in two to three weeks. Regular follow-up visits with the physician for observation will be required for cancer patients.