Home » Prostate Cancer diagnosis and treatments » Radical Prostatectomy – a patient guide to preparation and rehabilitation

This guide takes you through the most commonly performed radical prostatectomy treatment in the UK, using the Da Vinci robot-assisted procedure.

Radical prostatectomy (RP) is a journey that starts weeks in advance of the actual procedure and continues for many months afterwards. This guide takes you through what you can expect and tips to help you. It is written from a patient perspective, and is necessarily not a universal experience, since we are all different and react differently.

So here is a step-by-step experience.

1. The waiting time between deciding to have the radical prostatectomy procedure and it actually happening varies between weeks and months, depending on your local waiting lists and your suitability for surgery.
After your consultation, your surgeon will submit your procedure to the hospital scheduling team with a priority marker. The actual date you receive will depend on the resources available and your priority. This varies between health providers, but it is likely that you will get a couple of weeks notice before your procedure. Check with your surgeon at the consultation for the procedure in your area.

At some point you will be scheduled for a pre-operative assessment to determine your suitability for surgery, any complications or concerns regarding existing other conditions and your general fitness, height and weight. This allows your anaesthetist to assess you. (In some extreme cases, it may be that you cannot be safely anaesthetised, so other treatment options will have to be considered.)

2. Use the time before surgery to prepare your body. Now is the time to start Kegel exercises, 3 times per day. Use the Squeezy App or similar if you don’t have the discipline to do it without prompting. Try also and get some general exercise to improve your overall fitness.
One week before surgery cut out all alcohol, tea, coffee and caffeine from your diet.
If you are sexually active, use this time with your partner to make some lasting memories, sex after surgery will be different for both of you.

3. Measure your penis, flaccid and erect. During your rehab, it is useful to know the baseline you are trying to get back to, and memory is not always reliable! You should measure length, girth and firmness when erect and write it down. Use the International Index of Erectile Function to get a realistic score. This will help your physiotherapist to assess you post-op.

4. Post-operation your abdomen will be swollen and sore. Take loose fitting or elasticated waistband trousers and underwear with you to wear when you leave. The robotic procedure can be almost pain-free, so only paracetamol may be required for pain control. If you need cocodamol as stronger pain relief you will also need a laxative since it causes constipation. You will have a catheter inserted during the operation which will stay for anything between 2 and 8 weeks, depending on the surgeon’s view of your healing capacity. Before discharge, you should be given enough catheter supplies to last a couple of weeks.

Make sure you have:

  • Supplies for your catheter, including incontinence pads, leg bags and night bags.
  • Contact telephone number to order more supplies. (Due to the disconnected nature of the NHS, this may be handled by the discharging hospital request, or through your GP surgery contract. Ask.)
  • if you need help with the catheter management, your District Nurse service contact phone number.
  • The contact details of your Urology Nurse Specialist in case there are post-operative problems.
  • A clip remover for the incision clips closing the robot wounds.
  • You may be given  lots of information from Prostate Cancer UK, which will take time to read.
  • It helps to have someone with you during discharge to take notes, because you will still be fuzzy from the anaesthetic.

Ensure the catheter leg bag is sized for your height. Some wear on the thigh, some on the calf, you should be shown how to do this.

5. Managing your catheter at home takes a bit of getting used to, especially sleeping with your night bag attached. Under-bedsheet incontinence pads may be useful in case of accidents.

Depending on your surgeon’s advice, you should get an appointment to go for a Trial Without Catheter (TWOC) within a couple of weeks. Sometimes your surgeon will require a cystogram prior to the TWOC to make sure you have healed properly before catheter removal. You should only take light exercise during this time (walking) and no Kegels. You will have been told not to undertake any heavy lifting for 3 months because some of your muscles have been severed during the operation. Make sure your employer is aware of this when you return to work.
The catheter is going to be uncomfortable, and you will be tired as the day progresses so naps are ok.
The biggest complication of a catheter is Urinary Tract Infection (UTI). You need to be scrupulously clean when handing the catheter. It is worth bathing your penis area in different washing water than the rest of you, ie use washing water to only wash your penis and catheter.

Urine is alkaline, and very quickly the catheter will be colonised by natural bacteria that can build up to a blockage. It helps to lower the pH of your urine slightly, by drinking Cranberry juice and taking Vitamin C supplements. If your catheter blocks, call your Nurse Specialist, or go to A&E and request the on-call urologist see you.
Some blood clots and slight bleeding is normal and should not cause concern. Heavy bleeding of course requires immediate medical attention.

About 10 days after radical prostatectomy surgery, you will need to have the clips that closed the robot incisions removed. Your GP Practise Nurse can do this, you will need to arrange the appointment.

6. The Trial Without Catheter procedure is when you should have your catheter removed. This process may take a few hours because you need to be able to demonstrate that you can pee properly. One of the complications that can occur is constriction of the bladder neck that can prevent you from peeing properly. You will be assessed for this and given plenty of fluids to fill your bladder repeatedly. Take a book.

7. Once the catheter has been removed, you can start your Kegel exercises again, gently at first. These are aimed at restoring your continence, which can take many weeks. During this time you will need incontinence pads. Your GP may supply these or you can buy your own.

After about a week, you should aim to do your Kegels at full intensity. These will also help with erectile problems. if you can, get NHS physiotherapy support otherwise consider private physio if you can afford it.

8. As soon as possible, you should get an appointment with your Nurse Specialist and get prescribed or obtain a Vacuum Erection Device, discussed elsewhere on this site, plus Sildenafil or Tadalafil as appropriate to maintain your penile health until spontaneous erections return ( if your surgery was able to complete with nerve-sparing, otherwise you will need different treatment).

9. Some six weeks or so after your surgery, you should get a histology report. This is where your removed prostate has been checked in a lab to make sure all the cancer was contained within. If there is a positive margin in this, then it is likely that there are cancer Prostate cells outside of the gland, and you will require further treatment, perhaps using radiotherapy.

You will also get another PSA test. This should show immeasurable quantities of PSA ( less than 0.2 is usually the threshold. More than this means you still have prostate cells somewhere, which may or may not be malignant.). Research is currently favouring aspirin to ‘mop-up’ stray cancer cells that could metastasise , discuss this with your clinician. It may also help to check for any nutritional deficiencies, especially Vitamin B12, which can be treated with over the counter supplements.

10. You have now started on your rehab journey from your radical prostatectomy, hopefully short, but in reality it takes time and effort so don’t expect too much too soon. For more detailed information, search this site for specifics on incontinence and erectile dysfunction specifics.