Robotic radical prostatectomy
Keyhole surgery, done with a surgical robot that your surgeon controls, to remove the whole prostate and the seminal vesicles (and often nearby lymph nodes) to treat prostate cancer that has not spread.
Also called RALP, RARP, Robot-assisted laparoscopic prostatectomy, Robotic-assisted radical prostatectomy, da Vinci prostatectomy, Radical prostatectomy, Nerve-sparing prostatectomy, Retzius-sparing prostatectomy
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (fully asleep)
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Usually one night; some men go home the same day
- Going home with
- Urinary catheter for about 7 to 10 days; sometimes a small drain for a day or two
- Back to normal
- About 4 to 6 weeks
- Back to work
- Desk work in about 2 to 3 weeks; heavy physical work in about 6 weeks
Overview
A radical prostatectomy removes the entire prostate gland, along with the seminal vesicles, two small glands attached to its back. Radical means the whole gland comes out with a thin layer of tissue around it, to give the best chance of removing all of the cancer. The bladder is then sewn down to the urethra, the tube that carries urine out through the penis.
In the robotic version, your surgeon works through about six small keyhole cuts in your belly. The surgeon sits at a console in the operating room and controls a 3D camera and thin instruments that bend like a wrist. Every movement of the instruments comes from your surgeon's hands on the controls. Compared with open surgery, the robotic approach usually means less blood loss, a shorter hospital stay, and a quicker return to daily life.
Most men go home the next day with a urinary catheter, which stays in for about a week. The two effects men worry about most are urine leakage and erection problems. Both are common at first and usually improve over months. How much they improve depends on your age, your health and erections before surgery, how close the cancer is to the nerves, and your surgeon's experience.
When done by experienced surgeons, robotic and open surgery give similar long-term cancer results. After surgery, your PSA blood test should drop to an undetectable level. That makes follow-up simple: a PSA that starts to rise is an early sign that some cancer cells remain, usually found years before any symptoms, while further treatment can still work well.
The parts of your body involved
The prostate is a walnut-sized gland that sits just below the bladder and in front of the rectum. The urethra runs straight through its middle, so removing the prostate means cutting the urethra above and below it and then joining the bladder to the lower urethra. Just below the prostate is the urinary sphincter, the ring of muscle that keeps you dry. Along the back and sides of the prostate run thin bundles of nerves that control erections.
- Prostate
A gland about the size of a walnut that adds fluid to semen. Most prostate cancers start in its back and outer part, close to the rectum.
- Seminal vesicles
Two small glands attached to the back of the prostate that make much of the fluid in semen. They are removed with the prostate because cancer can grow into them.
- Bladder neck
The funnel-shaped bottom of the bladder, where it meets the prostate. After the prostate is removed, this is the part sewn to the urethra.
- Urethra and urinary sphincter
The urethra carries urine out through the penis. The sphincter is a ring of muscle around it, just below the prostate. Protecting it is the key to urinary control after surgery.
- Erection nerves
Thin sheets of nerves and small blood vessels, called neurovascular bundles, that run along both sides of the prostate toward the penis. They are needed for natural erections. Feeling in the penis and the ability to reach orgasm use different nerves.
- Pelvic lymph nodes
Small bean-shaped filters along the large blood vessels on each side of the pelvis. Prostate cancer that spreads often goes here first, so they may be removed and checked.
Why it’s done
Surgery is one of the main ways to cure prostate cancer that has not spread beyond the pelvis. Your urologist weighs the cancer's grade (how aggressive the cells look), its stage, your PSA, your MRI, your age and your overall health before recommending it.
- To cure cancer inside the prostate
For intermediate-risk and many high-risk cancers, removing the whole prostate offers a long-term cure for most men. In large studies, treatment with surgery lowered the chance of the cancer spreading compared with monitoring alone.
- A complete report on the cancer
The whole prostate goes to the pathologist, who reports the exact grade, whether cancer reached the cut edge (the margin), and whether the lymph nodes contain cancer. This guides any next step more precisely than a biopsy can.
- Simple follow-up with PSA
With the prostate gone, the PSA level should fall to undetectable. Any later rise is easy to spot early, while radiation can still cure many men.
- Radiation stays available
If cancer comes back, radiation to the area where the prostate was can still be given. Surgery after radiation is possible but harder and has more side effects.
- Relief of a weak stream
Men who had a slow stream from an enlarged prostate often find their flow stronger once they have healed, because the prostate no longer squeezes the urethra.
- A good fit for longer life expectancy
Surgery tends to suit men who are expected to live at least 10 more years, because the benefit of treating prostate cancer builds slowly over time.
Other options
- Active surveillance
For low-risk and some favorable intermediate-risk cancers, regular PSA tests, MRI scans and repeat biopsies watch the cancer closely, with treatment only if it changes. This is the preferred choice for most low-risk cancers, and many men on surveillance never need treatment.
- External beam radiation
Radiation aimed at the prostate from outside the body, given over about 1 to 9 weeks depending on the schedule, often with hormone therapy for higher-risk cancers. Cure rates for many cancers are similar to surgery. Side effects differ: less early leakage, more bowel and bladder irritation, and erection problems that tend to develop gradually.
- Seed implant (brachytherapy)
Tiny radioactive seeds placed inside the prostate in a single outpatient procedure, used alone for lower-risk cancers or with external radiation for higher-risk cancers.
- Open radical prostatectomy
The same operation done through one cut in the lower belly. Cancer control and long-term function are similar in experienced hands, with more blood loss and a slightly longer recovery.
- Focal therapy
Treating only the part of the prostate that contains cancer, for example with focused ultrasound (HIFU) or freezing. Side effects are usually fewer, but long-term cancer control is less certain and regular follow-up biopsies are needed.
- Watchful waiting
For older men or those with serious other health problems, no active treatment, with hormone therapy only if the cancer causes symptoms.
Getting ready
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Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and tilting head-down
In the operating room, the anesthesiologist puts you fully to sleep and places a breathing tube. After you are asleep, a soft catheter is placed into your bladder. Your arms are tucked and padded at your sides, and the table is tilted so your head is lower than your feet. This lets your bowel slide up and away from the deep pelvis, where the prostate sits.
More detail
The tilt is steep, usually about 25 to 30 degrees, and it stays for most of the operation. The team pads every pressure point, protects your eyes, and secures you so you cannot slide. Many anesthesiologists limit IV fluids during this part to reduce swelling, but your face and eyelids may still look puffy for a few hours afterward.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
Right afterward
- The recovery room
You are watched for 1 to 2 hours as you wake. Your throat may be sore from the breathing tube and your face puffy from the head-down position. Both settle within about a day.
- Walking the same evening
Nurses help you sit up and walk the evening of surgery. Walking eases gas pain, wakes up the bowels, and lowers the risk of blood clots.
- Eating and drinking
You can usually drink clear liquids the same day and eat light food by the next morning.
- Pain control
Most men do well with acetaminophen (Tylenol) on a schedule, sometimes with an anti-inflammatory medicine, and only a few opioid pills for bad moments. Many programs keep opioids low because they slow the bowels.
- Learning catheter care
A nurse shows you how to switch between a small leg bag for the day and a larger bag for the night, how to empty them, and how to keep the tip of the penis clean.
- Blood clot prevention
You may get blood thinner shots in the hospital. Some men go home with daily shots for up to about 4 weeks, especially after lymph node removal or with other clot risks.
- Going home
Most men go home the next day once they are walking, eating and comfortable. If a drain was placed, it is usually removed before you leave.
At home
- Pain
Expect soreness at the cuts, most at the larger one near the belly button, and shoulder-tip pain for 1 to 3 days. Take acetaminophen as directed. Walking and a heating pad on the shoulder help the gas pain.
- Wounds and showering
You can usually shower after 24 to 48 hours. Let soapy water run over the cuts and pat them dry. Skin glue peels off on its own in 1 to 2 weeks. Avoid baths, hot tubs and swimming until the cuts are healed and the catheter is out, often about 2 to 4 weeks.
- Catheter care
Keep the bag below the level of your bladder. Wash the tip of the penis with soap and water daily and put a little lubricant or petroleum jelly where the tube enters. Strap the tube to your thigh so it does not tug. Pink urine or small clots are common, especially after a bowel movement or more activity.
- Bladder spasms
Sudden cramping behind the pubic bone or at the tip of the penis, with urine leaking around the catheter, is a bladder spasm. It is common and harmless. Ask about a spasm medicine if they are frequent.
- Diet and fluids
Eat normal food as your appetite returns. Drink enough that your urine stays light yellow, usually about 6 to 8 glasses of fluid a day.
- Bowels
Take a stool softener while on pain pills and avoid straining. A first bowel movement usually comes within 2 to 4 days. Do not use enemas or suppositories unless your surgeon says so, because the rectum lies right next to the new join.
- Activity and lifting
Walk several times a day and build up gradually. Avoid lifting more than about 10 to 15 pounds (4.5 to 7 kilograms), hard exercise, and bicycle riding for about 6 weeks.
- Driving
Most surgeons ask you not to drive while the catheter is in or while you take opioid pain pills. Many men drive again 1 to 2 weeks after surgery.
- Work
Desk work is often possible after about 2 to 3 weeks, sometimes sooner from home. Jobs with heavy lifting usually need about 6 weeks.
- Sex and erections
Sexual activity can resume when you feel ready after the catheter is out. Your team may start you on an erection pill or a vacuum device within the first weeks as part of a recovery plan.
Recovery timeline
- Day 0Surgery day
Surgery takes about 2 to 4 hours. You wake with a catheter and small dressings, and you take a short walk that evening.
- Day 1Going home
Most men go home the next day, walking and eating, with a catheter and a leg bag.
- Days 2 to 7The catheter week
Shoulder and belly soreness fade. Energy is low and naps help. Your bowels settle back to normal.
- Days 7 to 10Catheter out
A nurse removes the catheter in clinic in a few seconds. Leakage is expected at first, so bring pads. You begin daily Kegel exercises.
- Weeks 1 to 2Pathology results
Your surgeon reviews the full lab report: grade, margins, seminal vesicles and lymph nodes. This decides whether anything more is needed now.
- Weeks 4 to 6Back to most activities
Most men are back to daily routines and desk work, with heavier lifting and cycling after about 6 weeks.
- Weeks 6 to 12First PSA test
Your first PSA after surgery is usually checked between 6 and 12 weeks. It should be undetectable.
- 3 to 6 monthsLeakage improving
Many men are dry or need only a light pad by now, though the pace varies. Erection recovery is slower and is often just beginning.
- 1 to 2 yearsLong-term recovery
Most men reach their final level of urinary control by about 1 year. Erections can keep improving for 2 years or more. PSA checks continue, often every 3 to 6 months at first and then yearly.
What it feels like
Most men say the operation itself was easier than they expected, and the weeks after were harder in quieter ways: a catheter, leaking, and waiting for blood test results. Knowing what is normal at each stage makes it less frightening.
The night before
Many men feel a mix of dread and relief that the waiting is almost over, and sleep is often poor. Some worry most about the cancer, others about leakage or sex, and many feel embarrassed to say which.
What helpsWrite down your last questions. Set out pads, loose clothes and your recovery chair ahead of time so the morning is simple. Tell your partner or a friend what you fear most; saying it out loud often makes it smaller.
Waking up
A sore, scratchy throat from the breathing tube, grogginess, and a constant urge to pee from the catheter even though your bladder is empty. Your face and eyelids may look puffy from the head-down tilt. Some men feel queasy.
What helpsTell the nurse early about nausea or pain; both are easier to treat before they build. Ice chips help the throat. The urge from the catheter usually fades within a day as you get used to it.
Shoulder-tip pain
A sharp or aching pain at the top of one or both shoulders, sometimes worse when you sit up or breathe in deeply. It surprises many men because nothing was done near the shoulder. It comes from leftover gas under the diaphragm and usually fades in 1 to 3 days.
What helpsWalk often, which helps the gas absorb. A heating pad on the shoulder and lying flat for a short while ease it. Regular acetaminophen helps.
The catheter week
The catheter is the part most men dislike. The tip of the penis can get sore, and the tube tugs when you move. Some urine or blood may leak around the tube, especially with a bowel movement. Many men feel self-conscious and stay home.
What helpsStrap the tube to your thigh with a little slack and put lubricant where it enters the penis. Wear the leg bag under loose sweatpants by day and use the large bag at night, hung below the bed. For most men this lasts about a week.
Bladder spasms
Sudden, strong cramps low in the belly or at the tip of the penis, with an urgent need to pee and urine squirting out around the catheter. They can come in waves and are startling the first time.
What helpsCheck that the tubing is not kinked and the bag hangs below your bladder. Avoid constipation. Ask about a spasm medicine, which often makes a large difference. Spasms usually stop once the catheter is out.
The day the catheter comes out
Relief, and then often frustration. Most men leak when they stand up, cough, laugh, lift or walk, and many leak more later in the day as the muscles tire. It can feel like a step backward, especially for men who expected to be dry right away.
What helpsBring pads and a spare set of clothes to that visit. Start Kegel exercises as your team teaches you. Cut back on caffeine, alcohol and fizzy drinks, and drink less in the 2 hours before bed. A pelvic floor physical therapist can help a lot. Count pads week by week rather than day by day, because progress shows over weeks.
Erections, orgasm and intimacy
Erections are usually weak or absent at first, even with nerve sparing, because the nerves are stunned. Orgasm still happens but is dry, with no semen, and some men leak a little urine at climax. Many men grieve this quietly, and partners may not know how to bring it up.
What helpsAsk your team for a penile recovery plan, which may include pills such as sildenafil or tadalafil, a vacuum device, or injections. Studies have not proven that any one plan brings natural erections back faster, but staying active helps you learn what works for you. Emptying your bladder before sex and keeping a towel nearby help with leaks at climax. Talk openly with your partner; closeness and pleasure do not depend on erections alone.
Waiting for the PSA
The days before each PSA test can bring back the fear you felt at diagnosis. Many men check the online portal the minute results appear and feel shaky until they see the number.
What helpsKnow the date of the test and when you will hear about it. Ask your team ahead of time how an undetectable result looks on the report, often written as less than 0.1 ng/mL or a smaller number on an ultrasensitive test. A support group or another man who has been through it can help.
How well it works
Success means the cancer is removed with clear edges, the PSA becomes undetectable, and over the following year you regain control of your bladder and as much sexual function as possible.
- The pathology report
The lab reports the grade group (Gleason score), the stage (whether the cancer stayed inside the prostate or grew outside it or into the seminal vesicles), the margins (whether cancer touched the cut edge), and the lymph nodes. A positive margin does not always mean cancer was left behind, but it is watched more closely.
- PSA after surgery
The PSA should become undetectable within about 6 to 12 weeks. A PSA that later rises to 0.2 ng/mL or higher, confirmed on a second test, is the usual definition of cancer coming back (biochemical recurrence).
- If the PSA rises
A rising PSA is usually found years before any symptoms. Radiation to the area where the prostate was, sometimes with hormone therapy, can still cure many men. Large trials support giving radiation early when the PSA starts to rise, rather than to every man right after surgery.
- Urinary control
Most men improve steadily over 3 to 12 months. By one year, most men use no pad or one light safety pad. Men who still have bothersome leakage after a year have good options, such as a male sling or an artificial urinary sphincter.
- Sexual function
Recovery of erections is slow, often 1 to 2 years. Your age, your erections before surgery, and how much nerve tissue was kept matter most. Pills, a vacuum device, injections or a penile implant can help if natural erections do not come back.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Leakage with coughing, standing or lifting is expected after the catheter comes out and improves over months with pelvic floor exercises.
Erections weaken or stop after surgery, at least for a while. Recovery depends on age, erections before surgery and nerve sparing, and can take 1 to 2 years or more. Treatments help most men have sex again.
With the prostate and seminal vesicles removed and the vas tubes cut, orgasm still happens but no fluid comes out. You cannot father a child naturally. This is permanent.
Shoulder-tip pain and bloating from the carbon dioxide gas are common for 1 to 3 days and settle on their own.
Cramps and sudden urges while the catheter is in are common and usually stop once it is removed.
Some men leak a little urine at climax (climacturia) or notice orgasm feels different. Leaks at climax often improve over the first year. Some men notice the penis looks a little shorter.
Less common
Urine can seep through the join while it heals. It usually seals on its own if the catheter stays in a little longer.
After lymph node removal, fluid can collect in the pelvis. Most are small and harmless. A large one can cause pain, leg swelling or infection and may need to be drained.
A bulge in the groin (inguinal hernia) is more likely in the first 1 to 2 years after prostate removal. It can be repaired if it bothers you.
Scar tissue can narrow the connection between bladder and urethra (bladder neck contracture), causing a weak stream months later. It is usually treated with a short scope procedure.
Urine infections and wound infections are uncommon and are treated with antibiotics.
Clots in the leg veins (deep vein thrombosis) or lungs (pulmonary embolism) are uncommon. Walking, leg sleeves and blood thinner shots lower the risk.
Rare
The rectum lies right behind the prostate. A small tear is rare and is usually repaired during surgery. An abnormal channel between bowel and urinary tract (fistula) is very rare.
Blood loss is usually low with robotic surgery, and a blood transfusion is rarely needed.
The ureters, the obturator nerve and the large pelvic blood vessels lie close to the work area. Injury is rare and is usually repaired right away.
Very rarely, the surgeon needs to switch to an open operation for safety.
Pressure injury to nerves in the arms or legs, eye injury, or swelling of the airway are very rare. The team pads and positions you carefully to prevent them.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- No urine draining into the bag for more than 1 to 2 hours, especially with lower belly pain or fullness. Check the tubing for kinks first, then call right away.
- The catheter falls out or slips partway out. Call your surgeon right away, and do not let anyone put in a new one without speaking to your surgeon first.
- Thick blood or clots in the urine that do not clear after resting and drinking more, or that block the catheter.
- Swelling, pain or warmth in one calf or thigh. Call 911 for sudden shortness of breath or chest pain.
- Belly pain that keeps getting worse, a swollen belly, repeated vomiting, or no gas or bowel movement for 3 days.
- Redness spreading from a cut, pus, or a wound that opens.
- After the catheter is out: you cannot pass urine at all, or you have new pain and swelling in the lower belly, groin or leg.
Questions to ask your surgeon
- How many robotic prostatectomies do you do each year, and what are your results for leakage and erections?
- Based on my MRI and biopsy, can you spare the nerves on one or both sides?
- Will you remove my lymph nodes, and why or why not?
- Do you use a Retzius-sparing approach or other steps to help urinary control?
- How long will I have the catheter, and will I have a drain?
- Should I see a pelvic floor physical therapist before surgery?
- What is your plan for erection recovery, and when does it start?
- Should I bank sperm before surgery?
- When will I get my pathology results, and when is my first PSA test?
- What findings would make you recommend radiation after surgery?
- Will I need blood thinner shots after I go home?
- When can I drive, return to work, and lift things?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Seminal vesicles
- Two small glands behind the prostate that make much of the fluid in semen. They are removed with the prostate.
- Urethra
- The tube that carries urine from the bladder out through the penis.
- Urinary sphincter
- A ring of muscle around the urethra just below the prostate that holds urine in.
- Bladder neck
- The bottom opening of the bladder, where it joins the prostate.
- Anastomosis
- The new join between the bladder neck and the urethra, sewn during surgery.
- Neurovascular bundles
- Thin sheets of nerves and blood vessels along the sides of the prostate that control erections.
- Nerve sparing
- Peeling the erection nerves off the prostate and leaving them in the body.
- Foley catheter
- A soft tube passed through the penis into the bladder, held in by a small water balloon, to drain urine.
- PSA (prostate-specific antigen)
- A protein made by prostate tissue and measured with a blood test. After the prostate is removed, it should be undetectable.
- Grade group (Gleason score)
- A 1 to 5 scale of how aggressive cancer cells look under the microscope. Grade group 1 is the least aggressive.
- Surgical margin
- The cut edge of the removed prostate. A positive margin means cancer cells touch that edge.
- Pelvic lymph node dissection
- Removal of the lymph nodes along the pelvic blood vessels to check for cancer spread.
- Lymphocele
- A pocket of lymph fluid that can collect in the pelvis after lymph nodes are removed.
- Kegel exercises
- Squeezing and relaxing the pelvic floor muscles to strengthen urinary control.
- Climacturia
- Leaking a small amount of urine at orgasm, common in the first year after prostate removal.
Common questions
Is robotic surgery better than open surgery?
In experienced hands, cancer control, urinary control and erections are similar after both. Robotic surgery usually means less blood loss, less pain early on, and a shorter hospital stay. The experience of your surgeon matters more than the tool.
Does the robot do the operation?
Your surgeon does the operation. The robot holds the camera and instruments and moves them only as your surgeon's hands move the controls at the console. It cannot act on its own.
Will I still be able to have an orgasm?
Yes. Most men can still reach orgasm, even without a full erection, because orgasm uses different nerves from erections. It will be dry, with no semen, and it may feel different at first.
How long will I leak urine?
Most men leak at first, then improve steadily over weeks to months. Many are dry or close to dry by 3 to 6 months, and most reach their final level by about a year. Daily pelvic floor exercises and physical therapy help, and good treatments exist if leakage still bothers you after a year.
Will I need radiation or hormone therapy afterward?
Most men need nothing more. Radiation may be advised if the pathology report shows high-risk features or if the PSA does not fall to undetectable or later rises. Your surgeon will go over the report with you.
Will my penis be shorter?
Some men notice the penis looks a little shorter after surgery. This seems to come from changes in the tissues as they heal and from months without regular erections. A penile recovery plan, such as using a vacuum device, may help limit this.
When will I know if the cancer is gone?
The pathology report in about 1 to 2 weeks and your first PSA at 6 to 12 weeks give the first answers. Regular PSA tests over the next years confirm it.
Sources this page draws on
- American Urological Association and American Society for Radiation Oncology, Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022)
- American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)
- American Urological Association, Erectile Dysfunction: AUA Guideline (2018)
- European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
- New England Journal of Medicine, ProtecT trial: Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer (2023)
- American Cancer Society, Surgery for Prostate Cancer
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.