What is robotic radical prostatectomy?
Robotic radical prostatectomy is the surgical removal of the entire prostate gland and seminal vesicles using the da Vinci robotic surgical system. It is used to treat prostate cancer that is confined to the prostate (localised) or has spread just beyond it (locally advanced). Surgery is performed through five small incisions (each 5–10mm) in the abdomen, with the surgeon controlling the robotic instruments from a console in the operating theatre.
The da Vinci system provides the surgeon with a 10× magnified, three-dimensional view of the operative field, and instruments with seven degrees of freedom — exceeding the range of the human hand. These features enable precise dissection of the prostate from the bladder, urethra, rectum and neurovascular bundles (the nerve structures responsible for erectile function).
Who is a candidate for robotic prostatectomy?
Robotic prostatectomy is most appropriate for men with:
- Localised prostate cancer (confined to the gland — clinical stage T1 or T2)
- High-risk or locally advanced prostate cancer (T3) where surgery is part of a multimodal plan
- A Gleason score (Grade Group) indicating intermediate or high-risk disease
- A life expectancy of at least 10 years
- Good general health and fitness for general anaesthetic
- A preference for definitive surgical treatment over radiotherapy or surveillance
Surgery is generally not appropriate for men with very low-risk disease (where active surveillance is often preferred) or where cancer has spread to lymph nodes or distant sites. Individual suitability is assessed at consultation, using your PSA, biopsy results, MRI staging, and general health.
How is robotic prostatectomy performed?
The operation follows a structured sequence. At the Wellington Hospital, Mr Ameen performs his operations using the Retzius-sparing posterior approach as standard.
Recovery after robotic prostatectomy
Robotic surgery offers substantially faster recovery than open surgery. The following timeline reflects typical milestones — individual variation is normal.
| Timeframe | What to expect |
|---|---|
| Day 0–1 | Surgery performed. Catheter in situ. Pain managed with oral analgesia. Most patients mobilise within hours. Discharge usually on day 1 or 2. |
| Day 7–10 | Catheter removal in clinic. Many patients with the Retzius-sparing technique experience good early control from this point. Light leakage is expected — pelvic floor exercises begun. |
| Week 2–4 | Driving can typically resume. Light walks comfortable. Avoid strenuous activity and lifting. Fatigue is normal — rest is important. |
| Week 4–6 | Return to desk work for most patients. Six-week post-operative outpatient review with Mr Ameen. First PSA blood test arranged. |
| Month 3 | Majority of patients continent or using minimal pads. Erectile rehabilitation programme in progress. Second PSA check. |
| Month 6–12 | Continence fully established for most men. Erectile function continues to recover — this is a slow nerve regeneration process. PSA should remain undetectable. |
| Year 1+ | Annual PSA monitoring. Erectile function continues to improve for up to 24 months, particularly with early penile rehabilitation. Most men report high satisfaction with their decision at this stage. |
Risks and side effects
All surgery carries risk. The following reflects the risks specific to robotic prostatectomy, consistent with BAUS patient information guidance. These are discussed in detail at your pre-operative consultation.
Very common
Urinary incontinence (temporary)
Most men experience some leakage after catheter removal. With Retzius-sparing technique, the majority regain good control within 3–6 months. Pelvic floor exercises significantly accelerate recovery.
Common
Erectile dysfunction
Depends on nerve preservation. Younger men with bilateral nerve sparing have the best outcomes. Penile rehabilitation (PDE5 inhibitors, vacuum devices) should begin early and is strongly recommended.
Universal
Dry orgasm
Without the seminal vesicles and prostate, ejaculation no longer produces fluid. Orgasmic sensation is preserved in most men. This is a permanent, expected consequence of the operation.
Uncommon
Positive surgical margins
Cancer cells at the edge of the removed specimen. Does not mean cancer spread, but may indicate the need for further treatment (radiotherapy to the prostate bed). Mr Ameen's positive margin rates are benchmarked in the top 25% of European surgeons.
Uncommon (1–3%)
Anastomotic leak
A leak at the join between bladder and urethra. Usually managed conservatively with prolonged catheterisation. Rare with experienced robotic surgeons.
Rare
Bowel, vessel or ureteric injury
Serious injury to adjacent structures occurs in less than 1% of robotic prostatectomy cases. The 3D vision and precision of the robotic system significantly reduce this risk versus open surgery.
Robotic prostatectomy vs other treatments
Surgery is one of three primary treatments for localised prostate cancer. The right choice depends on personal factors that a consultation will clarify — this table provides a starting comparison.
| Factor | Robotic Prostatectomy | Radiotherapy (EBRT + brachytherapy) | Active Surveillance |
|---|---|---|---|
| Cancer control | Excellent (equivalent to RT) | Excellent | Monitoring only — no treatment |
| Hospital stay | 1–2 nights | Day case / outpatient | None |
| Treatment duration | Single operation | 4–7 weeks daily sessions | Ongoing monitoring visits |
| Recovery time | 4–6 weeks to work | 1–2 weeks | None |
| Continence risk | Temporary (common) → resolves | Late bowel/bladder effects | None |
| Erectile function | Risk depends on nerve preservation | Gradual decline over years | Not affected by treatment |
| PSA monitoring | Simple: should be undetectable | Complex: PSA nadir variable | Regular PSA + MRI + biopsy |
| Prostate biopsy required? | Yes (pre-operative) | Yes (pre-operative) | Yes, repeated |
| Suitable for all stages? | Localised and locally advanced | Localised and locally advanced | Low risk only |
Frequently asked questions
The operation itself takes 2.5 to 4 hours. With anaesthetic preparation and recovery room time, you should expect to be away from the ward for approximately 5–6 hours. Complex cases — including large prostates or extensive lymph node dissection — may take longer.
The space of Retzius is the anatomical space in front of the bladder and prostate. In standard robotic prostatectomy this space is entered, which disrupts the anterior puboprostatic ligaments — supportive structures important for urinary control. The Retzius-sparing approach accesses the prostate from behind (posteriorly), preserving these structures and resulting in faster return to continence. Mr Ameen performs this as his standard technique. Clinical data consistently shows higher immediate continence rates with the Retzius-sparing approach.
The majority of men who have surgery for localised prostate cancer do not require further treatment. A detectable or rising PSA after surgery (biochemical recurrence) occurs in roughly 20–30% of cases and may be treated with radiotherapy to the prostate bed — often with excellent long-term results. This is one reason why PSA monitoring after surgery is straightforward: it should be undetectable, so any recurrence is detected early and is highly treatable.
After a successful prostatectomy, PSA should fall to an undetectable level — below 0.1 ng/mL — within 4–6 weeks. Your first test is arranged at 6 weeks, then again at 12 weeks, then every 6 months for two years, then annually thereafter. A PSA above 0.2 ng/mL on two consecutive tests defines biochemical recurrence and triggers further investigation and usually radiotherapy.
Privately, surgery can usually be arranged within 2–4 weeks of a decision to proceed. An initial consultation is available within days. On the NHS, waiting times vary considerably — typically 4–18 weeks from referral through to surgery. Mr Ameen operates at the Wellington Hospital for private patients and at West Hertfordshire Teaching Hospitals for NHS patients. For patients with private health insurance, surgery costs are usually fully covered.
Before surgery you will attend a pre-operative assessment at the hospital — usually 1–2 weeks before your operation date. This includes blood tests, an ECG, blood pressure check, and a review of your medications. A nurse will explain what to expect on the day, including fasting instructions and what to bring. Mr Ameen or a senior member of the team will be available to answer any last questions.