The prostate can be removed for prostate cancer (robotic radical prostatectomy) or for urinary symptoms (robotic simple prostatectomy).

Robotic Radical Prostatectomy

Prostate cancer, the most common cancer among men aside from skin cancers, varies from non-aggressive to highly aggressive forms, including metastatic diseases that spread beyond the prostate.

One effective treatment option for intermediate and high-risk prostate cancer is robotic radical prostatectomy. This procedure uses a robotic system to enhance magnification and precision. Through just a few small incisions, surgeons control robotic instruments to remove the entire prostate and surrounding lymph nodes for thorough pathological examination. Following the removal, the bladder is meticulously reconnected to the urethra.

Post-operative results are carefully evaluated during follow-up visits, where the prognosis is typically very promising. In cases of highly aggressive disease, more intensive follow-up and additional treatments, such as hormone therapy and radiation, may be necessary.

Recovery

Recovery is typically 1 night in the hospital with a urinary catheter at home for 5-7 days. It is normal to feel some crampy pain for up to 1 week with full recovery in 4-6 weeks. Removal of the prostate can improve some urinary voiding symptoms although it is associated with temporary incontinence. Kegels are important to help with recovery of continence. Incontinence can be expected to be resolved within the year for at least 90% of patients. Erectile dysfunction is another side effect of the surgery. Medications may be needed to help achieve adequate function.

Robotic Simple Prostatectomy

Robotic simple prostatectomy is a surgical procedure performed to alleviate urinary symptoms caused by an enlarged prostate gland. Unlike robotic radical prostatectomy, which is primarily used to treat prostate cancer, robotic simple prostatectomy focuses on addressing benign prostatic hyperplasia (BPH), also known as enlarged prostate. Instead of removing the whole prostate, only the prostatic adenoma is removed, limiting side effects.

Recovery

Recovery remains similar to radical prostatectomy. Hospital stay is usually one night and the urinary catheter stays for approximately one week. Discomfort or crampy pain can remain for up to one week following surgery, with full recovery expected within 4-6 weeks. Side effects such as urinary incontinence are much less as is erectile dysfunction although there may be temporary issues. Urinary voiding symptom improvement should be seen immediately following removal of catheter.

Risks

Risks of robotic surgery include those with any surgery: bleeding, infection, and damage to surrounding structures. The above is only for medical information and does not constitute medical advice. Please contact your doctor if you have any questions.

Frequently Asked Questions

1. What is the estimated/normal length of time that the catheter will be needed?

You can expect the catheter to be in place for approximately 7 to 10 days.

The primary reason for the catheter is not just to drain urine, but to act as a stent or a mold. During the surgery, we remove the inner part of the prostate gland, leaving the outer capsule. The catheter ensures that the channel through the prostate, the urethra, heals open and smooth. Think of it as a splint for the urinary tunnel, allowing the new lining to heal properly. We will schedule your follow-up appointment for its removal before you are discharged from the hospital.

2. Are there instructions to keep the catheter clean?

Yes, absolutely. Catheter care is crucial for preventing infection. Our nursing staff will give you detailed instructions and supplies before you go home, but here are the key points:

• Hand Hygiene: Always wash your hands with soap and water before and after touching the catheter or drainage bag.

• Secure the Catheter: We will provide you with a leg strap or a special adhesive device (like a StatLock) to secure the catheter tubing to your upper thigh. This is very important as it prevents the catheter from pulling, which can cause significant pain and injury.

• Drainage Bag: Keep the drainage bag below the level of your bladder at all times to ensure urine flows downhill and doesn't back up. Do not let the bag touch the floor. Empty it when it is about two-thirds full.

3. Can he wear support pads with the catheter?

Yes, and I actually encourage it. It's very common to have some bladder spasms while the catheter is in. These are involuntary contractions of the bladder muscle, which can feel like a sudden, intense urge to urinate. When this happens, it's possible for a small amount of urine to leak around the catheter. Wearing a light absorbent pad inside supportive, brief-style underwear can provide peace of mind and keep you dry and comfortable.

4. When do we return to have the catheter removed?

We will schedule that appointment for you, typically 7 to 10 days after your surgery. The removal process itself is quick and done here in the office. We will deflate the small balloon that holds the catheter in place and then gently slide it out.

After it's removed, we will perform what's called a "voiding trial." We'll ask you to drink some fluids and then urinate on your own. We then use a small, non-invasive bladder scanner (like a portable ultrasound) on your lower abdomen to make sure your bladder is emptying well. It’s normal for urination to be a bit hesitant, frequent, or urgent at first. This improves significantly over the following days and weeks.

5. Can he expect much pain afterwards?

With the robotic approach, the large open incision is avoided, which significantly reduces post-operative pain. However, you should expect some discomfort. The pain is typically managed well and comes from three sources:

1. Incision Soreness: You will have 5 small, keyhole incisions on your abdomen. They will feel sore, similar to having done a strenuous abdominal workout. This is usually the most noticeable for the first few days.

2. Bladder Spasms: As mentioned, the catheter can irritate the bladder and cause cramping or a strong urge to urinate. We will give you a prescription for medication specifically to help relax the bladder and reduce these spasms.

3. Gas Pain: We use carbon dioxide gas to inflate the abdomen during surgery to give us room to work. Some of this gas can remain and irritate the diaphragm, which can sometimes cause a temporary, sharp pain in your shoulder. Walking is the best way to help your body absorb this gas.

Overall, most patients find the pain to be quite manageable.

6. What is the best OTC to relieve the pain?

For the incisional soreness, the best over-the-counter option is Acetaminophen (Tylenol). It's important to keep track of the total dosage and not exceed 3,000 milligrams in a 24-hour period.

I generally recommend alternating with NSAIDs like Ibuprofen (Advil, Motrin) and Naproxen (Aleve) for the first week after surgery. Most men only need this medication for the first week or two.

7. Is there swelling expected? If so, how do we reduce the swelling?

Yes, some swelling is completely normal. You can expect it in two main areas:

• Abdominal Incisions: You'll notice some minor swelling and bruising around the small incision sites. This is normal and will resolve on its own.

• Scrotum and Penis: This is very common and can be alarming if you aren't expecting it. Due to gravity and the body's fluid shifts after surgery, it's normal for the scrotum and penis to become swollen and bruised.

How to reduce the swelling:

• Supportive Underwear: Wear snug-fitting, brief-style underwear rather than boxers. This provides gentle compression and support.

• Ice Packs: For the first 48 hours, applying an ice pack to the scrotal area for 15-20 minutes at a time, several times a day, can be very helpful. Be sure to wrap the ice pack in a thin towel to protect the skin.

• Elevation: When you are resting, you can place a small, folded towel under the scrotum to keep it elevated.