Robotic prostatectomy

A prostatectomy is an operation to remove your: 

• Prostate 
• Seminal vesicles – the glands which make semen 
• Lymph nodes – the glands that filter substances and fight infection. Some men don’t have these removed.  

In the past, we did most prostate operations using the traditional ‘open’ method. During this, the surgeon made one large cut. Now, we do most operations using robotic equipment and a method called ‘keyhole’ surgery. This means we only make small cuts when we remove your prostate. 

At UCLH we use the Da Vinci® machine to do robotic prostatectomies. This operation is safe and effective and is now the best option for almost all UK men who need a prostatectomy.

If you have localised prostate cancer, a prostatectomy may be an option for you. Localised prostate cancer means that it is only within the prostate and hasn’t spread. Most men with localised prostate cancer who have a prostatectomy are healthy for many years. This is because a prostatectomy removes all the cancer and prostate.

A robotic operation has the following advantages over an open operation:  

• Smaller scars. You will have six small cuts in your tummy rather than one large one.  
• Less pain. We can usually manage your pain with painkiller tablets. Pain rarely lasts more than three days after the operation.  
• Less blood loss. You will be less likely to need a blood transfusion. 
• Shorter stay in hospital. Most men go home 24 hours after the operation.  
• Lower risk of complications. The 3D vision gives surgeons a clear view. Better control of instruments helps them work more precisely. This reduces the risks and helps the surgeon to remove all the cancer.  
• Shorter recovery time. Most men return to work four to eight weeks after the operation. The time it takes you to return to work will depend on the job you do.

All treatments have risks. Below are some risks of a robotic prostatectomy. We will discuss these and any risks specific to you in detail.  

Common (greater than 1 in 10)

• Problems ejaculating or infertility. This is because the surgeon removes the seminal vesicles, which produce seminal fluid. This happens to everyone who has a prostatectomy. If you want to have a child, we will offer you sperm banking. You can have a procedure to take sperm from your testes if you have not had your sperm banked. 

Occasional (between 1 in 10 and 1 in 50)

• Severe urine leaks. We also call this urinary incontinence. It could be temporary or permanent. If this happens, you will need to wear a pad or have another operation to fix it. One in 20 men will have this one year after the operation. 
• Shortening or curving of your penis. This can happen either straight away or a while after the operation. It can be permanent. 
• Hernia. A hernia is when part of the body pushes through a weak spot in the muscles. It may happen in your groin or at any of the surgical cuts. It often causes a lump or bulge and can feel uncomfortable, especially when you cough or lift something. You may need another operation to fix this. 

Rare (less than one in 50)

• Bladder scarring. This happens to 1 in 100 men. It will cause your urine to flow weaker. If this happens you may need another operation.  
• Severe blood loss. This happens to 1 in 100 men. If this happens you may need a blood transfusion. You may also need to have another operation. Or we may need to change the operation you’re having to an open one.  
• Swelling, pain and discomfort in your pelvis. If you had some lymph nodes removed, lymph fluid may build up in your pelvis. This can take a few weeks to get better. It will improve quicker if you keep moving and wear supportive underwear. 
• Lower limb swelling. This happens to 1 in 100 men. It can happen if the surgeon removes some of your lymph nodes and may be permanent.  
• Damage to your bowel or blood vessels in your abdomen. Your surgeon may notice this during your operation or the recovery period afterwards. If this happens, you will need an operation, or tubes inserted, to fix it.  
• Damage to your ureters. This happens to fewer than 1 in 100 men. Your ureters are the tubes that urine flows through from your kidneys to your bladder. If they get damaged, it may disrupt the urine flow into your bladder. We may need to insert small plastic tubes through your skin into your ureter.  
• Problems with the anaesthetic. If this happens, we may admit you into intensive care. Problems include chest infection, blood clots, stroke, heart attack or, rarely, death. You can visit the Royal College of Anaesthetists website for more information.   
• Surgical clip in your bladder. Sometimes a clip used during the operation can move into your bladder. If this happens, you will need an operation to remove the clip.  
• Narrowing of your urethra. If this happens, you will need an operation to widen your urethra. 
• Rectum injury. If this happens you may need to have a temporary colostomy. A colostomy collects your poo in a bag attached to your tummy. 
• Infections such as: 
  • MRSA – this affects 1 in 110 men. 
  • Clostridium difficile (c-diff) – this affects 1 in 500 men. 
  • MRSA bloodstream infection – this affects 1 in 1,250 men. 

If the operation isn’t successful, you may need another treatment, such as radiotherapy or hormones. If your PSA level doesn't decrease or starts to rise after being undetectable for some time, you may need further treatment.

This depends on whether your prostate cancer is low-risk or high-risk. Your doctor will explain which risk group you are in. If you’re not sure, you can ask your doctor or CNS to explain it to you. 

If you have low or medium-risk prostate cancer

You may not need treatment right away. Instead, we can monitor it with active surveillance for five to 10 years. This means having regular tests to check the cancer. If there are signs that your cancer is progressing, we will offer you treatment.  

At UCLH, 1 in 3 men with low to medium-risk cancer needed treatment after five years. Some men choose treatment right away because they feel uneasy waiting. However, studies show that survival rates are similar whether you have treatment now or later.   

Note: If your cancer is very low-risk and doesn’t show on an MRI scan, treatment may not be an option. 

If you have a high-risk prostate cancer

If you choose not to have cryotherapy or another treatment, there is a risk that the cancer could grow or spread. Delaying treatment might mean it is no longer an option later. Going without treatment could pose a serious risk to your life.

Alternative options include:  

• Active monitoring  
• Open prostatectomy  
• Focal treatment – such as HIFU or cryotherapy 
• External beam radiotherapy  
• Brachytherapy  
• Hormone therapy. 

Your urology doctor will tell you which of these treatments are suitable for you. They will arrange an appointment for you with the specialist team. If you want to find out more about these treatments visit our treating prostate cancer web page. Or ask your CNS for the information leaflet about the treatment.

A team of surgeons, nurses, and trainees will care for you. You may meet different surgeons during your treatment. We will make sure that your care is well-organised, so you always get the support you need.

Your surgical team includes: 

• Lead surgeon (who is responsible for the operation) 
• Surgical trainees 
• Surgical care practitioners 
• Scrub nurses 
• Anaesthetist (who is responsible for the general anaesthetic)

For two to three weeks before your operation

Your CNS will teach you pelvic floor muscle exercises. You should do these at least three times a day. These reduce urine leaks after the operation. If no one has shown you how to do these or you are unsure, please tell your CNS. Prostate Cancer UK have leaflets on pelvic floor muscle exercises. There are details on other organisations which offer advice on pelvic floor muscles in the ‘Where can I find more information?’ section. 

Your pre-assessment appointment

We will give you a pre-assessment clinic appointment several weeks before your operation. At the appointment, a nurse will check if you are well enough for the treatment and will: 

• Explain the anaesthetic you will have. 
• Tell you if you should continue taking your medicines. 
• Let you know when to stop eating and drinking. 
• Advise what to bring on the day. 

Please tell your urology doctor at this appointment, or before it, if you have or have had any of the following: 

• Acute angle glaucoma 
• Stroke  
• Peripheral vascular disease of your legs 
• Artificial heart valve 
• Coronary artery stents  
• Heart pacemaker or defibrillator  
• Artificial joint  
• Artificial blood vessel graft  
• Brain shunt  
• Implant 
• MRSA infection  
• High risk of variant CJD (if you've had a corneal transplant, brain operation with dural transplant or human-derived growth hormone injections) 
• Or if you take blood thinning medication including warfarin, aspirin, rivaroxaban, apixaban or clopidogrel. 

On the day of your operation

• We usually admit you on the day of your operation. 
• You should have a shower before you leave your home.  
• Please try to do a poo in the morning. If you can’t do a poo, we may give you a suppository. 
• You don’t need to shave any area of your body. We will shave you in the anaesthetic room once you are asleep if we need to.  
• You should not eat for six hours before the operation.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead, by law we must ask you to sign a consent form. This confirms that you agree to have the operation and understand what it involves. Staff will explain the risks, benefits and alternatives before you sign a consent form. If you are unsure about any aspect of the operation, please speak with a senior member of your urology team.

Before your operation

• You will meet your doctors and nurse after we admit you. 

• The anaesthetic team will visit you to make sure that the are no issues with giving you the anaesthetic.  

  Please tell them if you have any concerns or issues about having the anaesthetic. Or if you have any allergies.

• The ward staff will fit you with compression stockings. These will help prevent clots in the veins of your legs.  
• Before you go for the operation, we will ask you to change into a surgical gown. 
• You will have a general anaesthetic before the operation. This means that you will be asleep throughout it.  
• The anaesthetist will also put a tube into your arm. This is so they can access your blood vessels during the operation.  
• Once you’ve had the anaesthetic we’ll take you into the operating theatre.  

During your operation

• During the operation, you will get an injection of antibiotics. This helps to reduce the risk of you getting an infection. 
• You will lie on your back on the operating table. We tilt the operating table so that your head is lower than your feet. This is the best position for pelvic operations. 
• We’ll put the robotic surgical console beside you. Attached to the console are four robotic arms. Three hold the instruments and one has a high-magnification 3D camera on it. This is so the surgeon can see inside your abdomen. 
• The surgeon attaches the instruments to robotic arms. They insert them into your abdomen through small cuts. They then sit at the console to control the robot. They perform the operation with precise and careful movements. The instruments are about 7mm wide and can move more freely than a human hand. Their small size allows the surgeon to work through the tiny cuts in your body. 

Straight after your operation

• We will take you to the recovery area. 
• You will wake up with: 
  • an oxygen mask on your face 
  • a catheter in your bladder (to drain urine) 
  • possibly a wound drain from your abdomen  
  • six small, closed cuts.  
• Some men have a slight swelling of their face and eyes when they first wake up after the anaesthetic. This goes sooner if you sit rather than lie down. Try not to rub your eyes as this can cause you pain if they are swollen. 
• Some men have a sore throat after the operation. This is due to the tube in your throat that helps you to breathe during the operation.  
• Very rarely men have numbness over their knee or in their fingers. This should get better after two weeks.  
• Some men have bruising across their abdomen.

• Once the surgical team have agreed that you are well enough, we will take you back to the ward.  
• We will encourage you to sit in a chair as soon as possible. We know that sitting up straight after your operation will support your recovery. If you find it uncomfortable to sit, please let the staff know and we can change your position.
• We will give you clear fluids to drink. 
• You can start eating four hours after your operation.  
• We will also encourage you to start moving around as soon as four hours after your operation.  
  • First, you should sit in your chair for short periods. 
  • Soon afterwards you should start moving around your bed. 
  • You can also go for a wash or have a walk along the ward.  
• The day after your operation we will change your catheter bag to a smaller leg bag. 
• We aim to discharge you the day after your operation. So, we will ask you to dress by then.  
• If you live far from the hospital or if you have an extra medical need, you might need to stay in the hospital longer. 
• We discharge you once: 
  • You are eating and drinking. 
  • You are walking around as well as before your operation. 
  • You can care for your catheter and leg bag. 
  • Your pain is well managed using tablet painkillers.  

If we discharge you during the week, your CNS will give you more advice before you leave. 

You must arrange for someone to take you home from the hospital. You should also have help to look after you at home.

• Issues with the catheter. Everyone will have a catheter for seven to 14 days after this operation. The catheter might cause infection or bleeding, or it might fall out. 
• Urine leaks. For most men this will improve within three months. Three months after the operation, 8 in 10 men either wear no or one pad a day. 
• Problems with erections. All men will have trouble getting or keeping erections after the operation. It can take up to two years for your erections to recover. Permanent erection problems depend on whether the surgeon saves your nerves: 
  • 95 in 100 men have permanent erection problems if the surgeon can’t save the nerves. 
  • 6 in 10 men have permanent erection problems if the surgeon only saved one nerve. 
  • 2 to 3 in 10 men have permanent erection problems if the surgeon saved both nerves. 

Tablets can help you get erections if they were good before the operation or if the surgeon saved at least one nerve. If appropriate, we may offer you medications like Viagra or Cialis. You’ll get these when you're discharged or during your appointment to remove your catheter. Follow the instructions to improve blood flow and support your recovery. We may also offer a vacuum pump to help. 

If you didn’t have good erections before or if your nerves weren’t saved, you can use: 

• A vacuum pump 
• Injections, such as Caverject or Invicorp, 
• Muse, a pellet which you put into the tip of your penis.  

These can help you to get an erection that is firm enough for sex. We may also offer you an appointment with a doctor who specialises in men’s sexual health. 

If possible, start having sex about a month after your operation. It is unlikely that you will lose your sex drive after the operation. The sensations you feel will not change and sex can still be pleasurable. You should still be able to orgasm even if you can’t get an erection.    

• Pain. Although you will have a ‘keyhole’ operation, you may have some pain. If so, we will give you simple painkillers. Please let the staff know if you feel pain.  

  • Pain around the cuts. Most of the cuts in your abdomen are small – about five to 10 millimetres wide. One cut by your tummy button is wider because the surgeon removes your prostate through it. The size of this cut will depend on the size of your prostate.  

    The anaesthetist will inject a local anaesthetic into the cuts. They will also give you a large dose of painkillers before you wake up. When you are awake, we will give you tablet painkillers. Taking these painkillers speeds up your recovery. So, you should be able to get out of bed and move around sooner. If you take painkillers regularly, you should remain pain free and can go home sooner. Most men don’t need painkillers three days after the operation. We recommend you have paracetamol and ibuprofen at home if you can take these. We may give you medicines to stop bladder spams or manage your pain if you need them. However, these may cause side effects. 

  • Abdominal pain. We fill your abdomen with gas during the operation so that the surgeon has space to do the operation. Your abdomen may feel stretched and bloated afterwards.  
  • Shoulder tip pain. Although we let the gas out after the operation, some men feel pain in their shoulders. This is due to the gas stretching their diaphragm. Your diaphragm is a large muscle found above your abdomen. 
• Peeing when you orgasm. We also call this climacturia. You will only pee a small amount. It is not harmful to you or your partner. 
• Constipation. We will give you medicine for this. If you have had piles before, you need to be careful to avoid constipation. This is to stop more blood loss. Drink at least 2 litres of fluid each day and eat a high-fibre diet.  
• Swelling, inflammation or bruising in your scrotum. Your scrotum can become swollen and dark purple. This is due to bruising. This usually lasts four to six weeks. If your scrotum is painful, very hot or tender you may have an infection. If this happens, please contact your GP.  
• Infection. Sometimes you may get an infection where you had the cuts.

Your catheter

• You will go home with your catheter in. We will teach you how to look after your catheter before you go. You can find detailed instructions on our Caring for your urinary catheter webpage. Ask your CNS or ward nurse if you’d like a paper copy of the information. 
• Your urine will continuously drain into the catheter bag until the catheter is removed. 
• We remove some men’s catheter in the clinic seven to 14 days after their operation. If we tell you that this will happen, make sure that you get the appointment before you leave the hospital.  
• We ask some men to remove their catheter at home. We will arrange a phone appointment to tell you what to do. We will arrange this for seven to 10 days after your operation. We will also give you written instructions and a video link which shows you how to remove your catheter. You can discuss removing your catheter at home with your ward nurses and CNS. 
• We ask some men who live in other countries to have their catheter removed at their local hospital. If you do, you should get your catheter removed seven to 14 days after the operation.

Coping with urine leaks

• You may have urine leaks after the catheter is removed. This is common and tends to get better within three to six months. You may need to wear absorbent pads while you have urine leaks. You should make sure that you have some at home before you have your catheter removed. It is better to get pads designed for men’s underwear. 
• You can bring pads with you to your catheter removal appointment. We will give you some at the appointment too.  
• You will need to wear or bring supportive underwear for the pads to stick to. We recommend briefs rather than boxers.  
• Your nurse will tell you where you can get the pads from. Do not buy too many until you know how severe the urine leaks are.  
• If you have severe urine leaks, we will give you a follow up appointment and more support.  
• We recommend you do pelvic floor exercises to help regain your urine control. You will need to do the exercises once the catheter is removed and for up to a year afterwards.  
• Do not do pelvic floor exercises when your catheter is in place. 

Managing your pain

• Take mild painkillers such as paracetamol or ibuprofen unless you are allergic to them.
• Try to avoid taking dihydrocodeine for a long time as it can cause constipation. Only use it if your pain is moderate or severe. 

Blood thinning injections

• Use the blood thinning injections for 28 days to prevent blood clots.  
• Some injections are done once a day and others twice a day – follow the instructions on your discharge summary. 

Caring for your cuts

We seal the cuts with a surgical glue, so they don’t need special care or dressings. The glue will wear off in 10 to 15 days.  

Compression stockings

Wear your compression stockings all day, every day for six weeks after your operation. These help to prevent blood clots.  

• Remove them when you are bathing or showering.  
• You can also remove them to let air get your legs but for no longer than one hour.
• You can wash them. 
• You can still use moisturiser on your legs. 

Clothing

Wear loose clothes such as tracksuit bottoms, joggers and loose-fitting t-shirts. These will feel more comfortable. 

Bathing

You may shower and bathe as normal.  

Eating

Eat small, frequent meals. Eat lots of fibre, protein, fruits, vegetables and whole grains. 

Pelvic floor exercises

• Restart your pelvic floor exercises once your catheter is removed.  
• These help to strengthen your pelvic floor muscles so that you reduce the risk of urine leaks.  
• You should do these regularly.  
• At the end of this information are details of organisations which offer guidance on pelvic floor muscle exercises. 

Staying active

• It is important to stay active after your operation. Staying active reduces the risk of problems such as a chest infection or blood clot.  
• Do a little bit of gentle exercise, such as walking, each day.  
• After two weeks, you can do gentle jogging and aerobic exercise, if you like.  
• Do not do vigorous activity for up to 12 weeks after your operation. After that, you can slowly restart normal activities. 

Lifting and carrying

• After four weeks, you can restart light lifting such as carrying a small bag of shopping.
• Avoid heavy lifting for six weeks.
• Do not lift anything heavier than 2kg during this time. This is to prevent injuries to your abdomen, such as a hernia. It also means that your healing won’t be delayed.  

Driving

• Don’t drive while you have a catheter.  
• You can start to drive again when it feels comfortable to you. This will usually be about two weeks after your operation and when you feel you can make an emergency stop.  
• Check when your insurance company covers you from after having operation.  

Flying

• Short flights – After two weeks, you can take a flight if it is less than three hours.
• Long flights – We do not recommend you take a flight longer than three hours until eight weeks after your operation. 
• We recommend that you use flight socks, compression stockings and a ring pillow for all flights.  
• Move around regularly and drink lots of fluids during the flight.  
• Check when your travel insurance will cover you after your operation. 

Returning to work

• Please allow at least two to four weeks before you return to work.
• Everyone recovers at a different rate and some men may need longer.
• Most men feel ready to return to work after six weeks.

Taking care of yourself

Most importantly, you must look after yourself. Although you are in hospital for a short time, you must remember that you had a major abdominal operation. Listen to your body and report any concerns to your CNS.

Your first follow-up appointment will depend on where your catheter was removed: 

• If we remove your catheter in the clinic – your first appointment will be seven to 14 days after the operation. Your next appointment, when you get your test results, will be five to six weeks after that. 
• If you remove your catheter at home – your first appointment will be six to eight weeks after your operation. This is when you get your test results.  

When you get your test results, we will also tell you your care plan. This will be a telephone or an in-person appointment, depending on your needs.  

We will check your PSA levels every three months for the first year after your operation. We will check them regularly after that.  

The hospital that referred you will take over your care, once we’re happy with your recovery. This is usually three months after the operation. You will have further follow-up appointments at the hospital that referred you. 

At UCLH, we are happy for you to bring a family member, friend or carer with you to your appointments. We know this can be a stressful time and so you may need their support.

We will send you weblinks on MyCareUCLH to complete a questionnaire. The questionnaire is called ‘EPIC-26’. By completing this questionnaire, you can tell us about how you are getting on. We will send it to you: 

• Before your operation 
• Three months after your operation 
• One year after your operation. 

The questionnaire takes around five minutes to complete. We’d be very grateful if you could fill it in. Your answers will help us to give you the best care as you recover from your operation. They will also help us improve our service for other patients.

A cancer diagnosis can affect your finances. You might need to stop or reduce work or spend more money on things like travelling to the hospital. You may be eligible for benefits or other types of financial support. A benefits advisor can help you find out which benefits you may be eligible for. Call Macmillan Cancer Support on 0808 808 00 00 and ask to speak to a benefits advisor. Or ask your CNS to refer you to the UCLH Welfare and Benefits team. 

Macmillan Cancer Support have free booklet called Help with the Cost of Cancer. You can get a copy at the UCLH Macmillan Support and Information Service. Or download it from the Macmillan website.

Prostate cancer treatments choices  

A video developed by North Central and East London Cancer Alliance to help you learn about prostate cancer treatments.

UCLH Macmillan Support and Information Service 

0203 447 8663 (general enquiries) 

0203 447 3816 (support and information helpline)   

They provide:

• Emotional support, advice and information
• Welfare and benefits advice 
• Complementary therapies 
• Diet and nutritional advice 
• Psychological and emotional care 
• UCLH Prostate Cancer Support Group is on the second Thursday of each month, from 12.30pm to 2.30pm. You can attend either online or in person. Email uclh.supportandinformation@nhs.net or visit our support group web page for more information.

Prostate Cancer UK

0800 074 8383  

Provides support and information for patients and their families. 

Tackle

Provides information, support and access to a network of support groups.

LGBT Walnut

07947 826 853  

A London-based support group for LGBT people affected by prostate cancer.

Macmillan Cancer Support

0808 808 00 00  

Provides information and support to anyone affected by cancer.  

Cancer Research UK

Provides information about prostate cancer and treatments. 

Infopool. Prostate Cancer Research

The infopool has been co-designed with healthcare professionals and patients. Supporting patients and healthcare professionals with a new educational website. 

Squeezy app 

Support with pelvic floor muscles. Includes exercise videos. 

Your Pelvic Floor 

Information on pelvic floor exercises. 

5K Your way – Move Against Cancer 

This program invites anyone affected by cancer—patients, loved ones, and cancer care workers—to take part in a 5k Your Way parkrun. Whether you want to walk, jog, run, cheer, or volunteer, you’re welcome to join on the last Saturday of each month. 

UCLH cannot accept responsibility for information provided by other organisations.

Prostate Clinical Nurse Specialists (CNSs) (Mon – Fri, 9am to 5pm) 

Contact through their support worker: 

Tel: 07984 391126  

Email: uclh.prostatecancercns@nhs.net 

Pathway Coordinator for admin queries (for example changing your appointment) (Mon – Fri, 9am to 5pm) 

Tel: 020 3447 8454 

Email: uclh.urology.roboticprostate@nhs.net  

Out of hours, please contact your GP or go to your nearest Emergency Department (A&E).

We used the following sources to develop this information: 

• Consensus panels
• British Association of Urological Surgeons
• Royal College of Anaesthetists
• Department of Health.

With this expert advice, you can trust we follow the best care practices in the UK