Having your prostate removed

This leaflet explains the operation to have your prostate and sperm sacs removed. This is sometimes called a ‘radical prostatectomy’. 

We usually recommend this surgery to treat prostate cancer. It may include draining your lymph glands and tying off your sperm-carrying tubes. (Lymph glands act as filters in your body).

The operation usually takes 2 to 3 hours.

We perform this operation using a general anaesthetic. This means you will be asleep throughout. 

We will give you more information about the anaesthetic at your pre-operative assessment appointment.

About robot-assisted surgery

We perform this operation using keyhole (laparoscopic) surgery with robotic assistance. 

Keyhole surgery means a telescope and other instruments are inserted into the body through small cuts instead of one large cut.  

Robot-assisted surgery means the surgeon uses the robot to help perform the procedure. The robot does not operate by itself. It allows the surgeon to make more precise movements and do more complex surgery.

Read our leaflet to learn more about robot-assisted surgery and why a robot is used.

Benefits of this type of surgery 

Keyhole surgery uses only a few small cuts, each about the size of your fingertip.

Because of this, robot-assisted keyhole surgery has lots of benefits compared to traditional ‘open’ surgery. You are likely to return to normal activities sooner after keyhole surgery.

Most patients go home the day after surgery or within 1 to 3 days. 

Other benefits of keyhole surgery include:

  • smaller scars
  • less blood loss
  • lower risk of infection
  • less pain
  • lower risk of wound complications.

What to expect

Before your operation

Before your surgery, you will have the following.

  • An appointment with the surgical doctors. They will explain the procedure and discuss the benefits and risks. 
  • A pre-operative assessment. This may include blood tests, heart checks and other tests. At this assessment, we will give you full instructions on how to prepare in the days leading up to your operation. These include whether to stop your medications, and when to stop food and drink. If you have other relevant medical conditions, you may see a consultant anaesthetist for more detailed checks.

On the day of surgery

On the day of surgery, you should come to our ‘Admissions on the Day’ unit at Kingston hospital. If you have other health problems we may admit you the evening before surgery.

The anaesthetist will see you on the morning of surgery. The surgical team will also see you to obtain your consent for surgery.

After the operation (in hospital)

After surgery, you may spend one night in a high dependency unit, if needed.

You might have:

  • oxygen tubing in your nose (which we usually remove after 1 day)
  • a drip in your arm (which we usually remove after 1 day)
  • a wound drain to remove excess blood and fluid (usually removed after 1 day)
  • a catheter (thin, flexible tube) to drain your bladder (usually removed after 7 to 10 days).

Driving

You will not be able to drive yourself home after this procedure. We advise you to arrange for someone to drive you home and stay with you overnight.

Eating and drinking

We will give you instructions about eating and drinking after your surgery. It is likely we will encourage you to drink and eat as you feel able. 

Pain

You may feel mild pain, swelling or bruising around the surgery cuts. 

You may get shoulder pain, due to the gas we use to inflate your abdomen during surgery. Your abdomen may feel bloated (swollen) or uncomfortable. These symptoms usually settle within a few days.

Getting moving

Our nurses or physiotherapists will help you to get out of bed and move around. If you can, do this first thing on the morning after your surgery. Gentle movement helps reduce complications and will speed up your recovery.

Going home

Most patients go home 1 to 3 days after surgery, depending on their recovery. 

You may have stitches that dissolve (fall out naturally) or wound clips. If you have wound clips, you will need to arrange for your GP practice nurse to remove them 10 to 14 days after surgery. 

Do not drive for 2 to 4 weeks after your operation. Only drive when you are not limited by pain and can react quickly enough to perform an emergency stop.

Recovery at home

You can expect the following while you recover at home.

Pain For most patients, their pain is often at its worst between day 2 and day 4 after the operation. Before you leave hospital, we will discuss appropriate pain relief with you. 
Washing You can shower the day after your operation.
Constipation Patients often feel constipated (unable to poo easily). We will give you medicines (laxatives) to use if you need them.
Tiredness You may feel tired for up to 2 months. This is normal.
Exercise

We recommend gentle walking and light exercise. This will speed up your recovery.

For 3 to 4 weeks, avoid heavy lifting, gym work, running, cycling or swimming.
Check your wounds

Check your wounds for signs of infection, such as redness, swelling, pain or discharge.

Contact your GP, district nurse or hospital team if you have any concerns.

When to seek urgent medical help

Go to your nearest Emergency Department (A&E) if you experience:

  • blood in your urine 1 or 2 weeks after, and the blood does not go away if you drink lots of fluids (6 to 8 glasses of water a day)
  • fevers or sweating
  • vomiting 
  • a feeling of being extremely unwell (you feel something is seriously wrong with your health).

Risks of this operation

Risks during or shortly after surgery

Less common
Fewer than 15 in 300 patients
  • Switch from keyhole to open surgery during the operation. We may do this to control bleeding, repair intestinal injury or because we cannot complete the operation in the keyhole way. There is greater risk of this happening if you are obese or have had previous surgery in the same body area.
  • Significant bleeding caused by injury to blood vessels, liver or spleen. You may need a blood transfusion or further emergency treatment.
  • Complications during or immediately after the operation, such as infection, blood clots, heart problems, stroke, memory problems or kidney problems. These may mean you need to stay in hospital for longer or need extra treatment.
Rare
Fewer than 3 in 300
  • Damage to the large bowel. Injury is usually repaired immediately. May need large cut in tummy and very rarely a stoma (opening for faeces on front of your tummy).

Risks after surgery

All patients
  • No semen produced during orgasm (effectively making you infertile).

Common
More than 15 in 300 patients
  • Erectile dysfunction. High chance, if a nerve-sparing operation is not possible or nerve damage is unavoidable. We usually manage this with a combination of medication and a vacuum assisted pump.
  • Some shortening of your penis.
  • Urinary incontinence (urine leakage). Mild incontinence may continue for a year and require use of urine pads (but not corrective surgery). ​​​​Severe incontinence may be temporary and require use of urine pads, but may need surgery.
Less common
Fewer than 15 in 300 patients
  • Collection of lymph fluid. May need a procedure to drain it.
  • Sluggish bowels. Can lead to tummy pain or constipation.
  • Wound infection. This may need treatment, such as antibiotics.
  • Blood clots. Wearing compression stockings and getting moving early reduces your risk of clots. We may also use blood thinning injections, depending on your treatment and medical history.
  • Hernia caused by the abdominal muscles being weakened by the surgery wound. Tissue, such as bowel, may bulge through. Patients sometimes need surgery to correct this.
  • Narrowing of urethra (water pipe). Can make it hard to wee and may need treatment to correct the condition.
  • Urine leakage (internal). This can settle down after a few days. If it does not, you may need a minor procedure (under general anaesthetic) to insert a tube into your bladder and close the leak. We will remove the tube 3 weeks later (using local anaesthetic).

Follow-up

Catheter

Most patients do not find a catheter too uncomfortable. We will teach you how to look after it before we discharge you home. 

Depending on your recovery, we will arrange a catheter appointment for you 7 to 10 days after your operation. This is called a TWOC appointment (trial without catheter). It will take place at Kingston Hospital.

General

We will offer you:

  • a follow-up appointment 6 weeks after your operation
  • an appointment in our vacuum pump clinic, as needed (see 'Common risks after surgery' and 'More information').
  • a pelvic floor physiotherapy appointment if needed.

More information

British Association of Urological Surgeons on vacuum erection assistance devices

Contact information

Kingston Hospital Urology Department

Telephone:

020 8934 2976

Email: krft.urology@nhs.net