In the last year or so, I’ve spent quite a bit of time writing about choosing a treatment for prostate cancer, and even more time writing about life after treatment in terms of recovery of erections and continence. What isn’t often discussed is the actual operation itself, and the several weeks of recovery that follow prostate surgery. This has been echoed in my patients, some of whom I have discovered are arriving for surgery poorly prepared as to what to expect after the prostate is removed.
I therefore wanted to spell out exactly what patients can expect during and after robotic radical prostatectomy, and the post below is a slightly modified version of what my patients receive themselves. If there is an area of the process that you’d like me to write more about, please reach out to us.
The day of surgery
Admission
You will be admitted on the day of surgery and will see the anaesthetist and surgeon before your operation. Inevitably, there will be some forms for both you and the nurses to fill in. You will already have attended the hospital a few days before to have some routine blood and urine tests done, in addition to an ECG (heart trace). This is the time to ask any remaining questions.
Preparing for anaesthesia
The anaesthetist will discuss with you the pros (better pain relief) and cons (1 in 500,000 risk of serious complications) of having spinal anaesthesia (an injection in the back that numbs you from the waist down for 4–6 hours) before your general anaesthetic.
This is induced in the Anaesthetic Room (adjacent to the Operating Room) by an injection in the back of the hand whilst you breathe oxygen and maintained during the operation by an anaesthetic gas. Once you are asleep, you are wheeled through into the Operating Room where preparations begin.
The operation
The robotic prostatectomy will take on average 2 hours, depending on the degree of complexity and/or difficulty. During this time the prostate and seminal vesicles will be removed, together with the lymph nodes that drain the prostate if indicated.
For an overview of the procedure itself, visit our Robotic Radical Prostatectomy page.
Immediately after surgery
The Recovery Room
When you wake up, the nurse looking after you will ask you if you have pain and/or sickness so that drugs can be given if needed to counter these. You will have a catheter in the bladder, a drip in the arm to provide you with fluids until you can drink freely, an oxygen mask or nasal prongs, a blood pressure cuff and a plastic clip on a finger to measure your blood’s oxygen saturation. If all of your observations are normal you will be wheeled back to your room after an hour.
The first night after surgery
Ring your bell if you need attention for pain relief or anti-sickness medicine. You will be allowed initially to drink only sips of water but if you don’t feel sick you will be allowed to drink whatever you want within a few hours. During the first night after your operation you will probably only sleep intermittently because of the blood pressure cuff on your arm and the staff checking on you. You can catch up on sleep the following afternoon by taking a nap.
The day directly after surgery
What to expect
On the first morning after your radical prostatectomy, the oxygen can be discontinued and the drip disconnected. A catheter (‘leg’) bag will be strapped to your thigh, which is part of standard catheter care after prostate surgery. You’ll also start pelvic floor exercises with a physiotherapist to help support erectile and bladder function in the months ahead. Drink plenty of fluids, but don’t eat too much, as this will cause abdominal distension.
2 – 3 days after surgery: Moving to home recovery
Day 2 post-op
Expect to increase movement. Discomfort may rise slightly — take prescribed painkillers as needed.
Day 3 post-op
Once home, remove dressings from your wounds and begin daily showering to keep the area clean. Dry the wounds gently.
Balancing rest and activity during recovery
In the early stages of radical prostatectomy recovery, fatigue is common. Take daily walks, rest often, and avoid strenuous activity for 6 weeks. According to our experience and Cancer Research UK, most men can return to normal activity within 6 to 12 weeks, depending on the type of surgery and individual recovery speed. No cycling for 3 months and no heavy (more than 10 kg) lifting for 12 weeks. For more information., read our guide on the role of exercise in prostate cancer prevention and recovery.
What to wear after prostate surgery
We recommend supportive underwear such as Y-fronts rather than boxers to help with any scrotal swelling and comfort during early prostate surgery recovery. This also supports the catheter tubing and helps to prevent it kinking.
Managing common post-surgery symptoms
Wound care
You will have dissolvable sutures both internally and externally. Most of the dressings will be removed prior to discharge from the hospital. Occasionally, there may be a small amount of oozing of blood-stained fluid from the wounds.
However, wounds heal faster when allowed to dry out, so ideally dressings should be removed after the first 48 hours, and you should get them wet in the bath or shower at least once a day.
Redness or heat could signal infection — contact us immediately if this occurs.
Scrotal swelling and bruising
Bruising and swelling of the abdomen, scrotum, penis or legs is common but will resolve in 2–3 weeks.
Discoloured urine
Expect to see some blood in your urine, especially if you are straining. Drink plenty of fluids until it clears. The NHS notes that blood in the urine is a common short-term side effect after prostate surgery and usually resolves with increased hydration and time.
Catheter care after surgery
Your catheter should be secured to your thigh by a strap or other device and should not be under tension. Clean off any crusty exudate that dries on it daily with moistened toilet tissue. If it stops draining urine, check the tubing for kinks. If the catheter drains little urine or stops draining altogether, then you must phone as soon as possible for advice.
Pain and discomfort
Take pain relief regularly for the first 48 hours after discharge. Paracetamol and ibuprofen are usually sufficient. Discomfort is most common around wound sites and the perineum.
Bowels and digestion
It may take 3–4 days to have a bowel movement. Reduce food intake if bloated, but keep drinking fluids. A cooked breakfast (such as bacon and eggs), gentle movement, and laxatives can help.
Pelvic floor exercises
Continue your pelvic floor exercises as advised. Discomfort in the perineum may mean postponing them until your catheter is removed.
General advice for radical prostatectomy recovery
- Take adequate rest periods — it allows your body to heal.
- Take pain relief as required.
- Contact us with any concerns — no question is too small.
Driving a car after prostate surgery
You should avoid driving after prostate surgery for at least 7 days and only resume once you can comfortably perform an emergency stop. Some insurers may require a longer wait — always check your policy.
Avoid drinking alcohol and caffeinated drinks
These can irritate the bladder after prostate surgery and are best avoided for the first few weeks following catheter removal.
Returning to work
Most patients need 3–6 weeks off work, depending on your role and how quickly you recover. Please request a certificate if needed.
Catheter removal: at 2 weeks after the operation
Patients with a urethral catheter
You will need to attend the hospital for approximately 3 hours for catheter removal and observation to monitor the urine output and the efficiency of the bladder to empty satisfactorily. This is assessed by measuring the volume of urine that you pass on a chart and by using a bladder ultrasound scanner.
What to expect after catheter removal
Incontinence
- You may experience some incontinence of urine and the amount of leakage of urine varies greatly from person to person. The main reason for the incontinence is the presence of stitches in the valve, which prevents its normal range of movement. Once the stitches weaken and dissolve (this process starts at 6 weeks) this tethering of the valve reduces and continence improves, plateauing a year after surgery.
- In all but 1-2% of patients, the incontinence is temporary. If you fall into this group then a small operation may be necessary to resolve the problem.
- It is advisable to wear the incontinence pants supplied in the first few weeks. If there is little leakage a small pad is ideal for day to day wear. These pads shouldn’t be flushed down the toilet as they will block it.
- You will initially want to pass urine quite frequently – this will improve over the course of the following 2 weeks.
- Reducing fluid intake after 7 p.m. and avoiding too much caffeine (in tea and coffee), fizzy drinks and alcohol will also help.
- Don’t be alarmed if when passing urine you see some suture material or a blood clot. This is all normal.
- It is important that you continue to do your pelvic floor exercises regularly. I can recommend downloading the NHS Squeezy app.
- Macmillan Cancer Support confirms that temporary incontinence is common, improving steadily with time and pelvic floor rehabilitation.
Erectile function
- For patients who have had either partial or full nerve sparing operations, it can take up to 3 years for your erections to plateau. You may begin experimenting trying to get erections following the removal of your catheter. It is beneficial to get the blood flowing into the penis early as this will aid recovery of sexual function. Don’t be too discouraged if nothing happens initially. See our blog article Taking Viagra after a prostatectomy for more information on this aspect of rehabilitation.
- If you agree, your GP will be asked to prescribe Viagra, Levitra or Cialis when you see the Consultant at your follow-up consultation.
- You may attempt sexual intercourse when you feel comfortable. You will experience normal sensations during intercourse but when you climax no fluid will come out.
The NHS highlights that full recovery of erectile function can take up to two years, and treatment options vary depending on whether nerve-sparing techniques were used. In patients who have had both nerves removed for reasons of cancer control, unfortunately erections won’t return to normal. However, you can be made potent again with either an injection or pellet inserted into the penis. Your Consultant, Urology Practice Nurse or GP will be able to discuss these with you further.
Wound care
- The bruising and swelling will be subsiding by now but it may take at least another week or two to completely go.
- All internal and external stitches dissolve after about 6 weeks. Your wounds will gradually soften, flatten and become less noticeable during the first 12 months.
Histology results and follow-up appointment
You will have an appointment 4 weeks post-operation. Between your operation and this date, your prostate will have been sent to a laboratory where it is thoroughly inspected to produce a final report on the precise details of your cancer. This is called a ‘histology report’. During this appointment you will be given the histology results, detailing the final Gleason grade (aggressiveness) and stage (extent) of tumour, which is very important in determining your prognosis and the probability of the need for additional treatment, such as radiotherapy.
Longer-term follow-up
Your first PSA test should be done at your GP practice at 10 weeks post-op and you should obtain the result and email it to us in good time for your 3-month check-up with your surgeon. This PSA test and check-up needs to be repeated every 3 months during the first year, every 6 months for the next 2 years and annually thereafter. Learn more about PSA follow-up and monitoring from Cancer Research UK.
Final words
This may have been a rather long list to digest, but I hope that it makes things a bit clearer for all men considering surgery as an option!
Our team is here to guide you through every step of the journey, from surgery to full recovery.
If you have questions about robotic prostatectomy recovery or want to book a consultation with Professor Eden, get in touch with our team here.
