AKArchan Khandekar, MD

FOR PATIENTS

Surgical Information

General, plain-language guidance on what to expect before and after common urologic cancer surgeries, for patients and families. Available in English and Spanish.

A robotic-assisted radical prostatectomy removes the whole prostate gland to treat prostate cancer. It is done through five or six small incisions on the abdomen, so most patients have less bleeding and pain and stay in the hospital only overnight.

1

Getting ready for surgery

Appointments and tests

  • You will have a pre-operative visit that may include blood tests, a urine test, an ECG, and a meeting with the anesthesia team.
  • Your surgeon will review your imaging and answer questions. Bring a written list of your questions and of everyone who helps care for you at home.
  • This is a good time to arrange time off work and a family member or friend to drive you home and stay with you the first day or two.

Medications

  • Bring a complete, current list of all medicines and supplements, including doses.
  • Blood thinners (for example aspirin, clopidogrel, warfarin, apixaban, rivaroxaban) and anti-inflammatory medicines are usually stopped several days before surgery, but only stop or change any medicine when your surgeon tells you to.
  • Ask specifically about diabetes medicines, blood-pressure medicines, and herbal supplements, some of which are held on the day of surgery.

The day before and the morning of surgery

  • You may be asked to follow a light diet or clear liquids and to do a simple bowel preparation or enema the evening before.
  • Do not eat or drink after the time you are told (often midnight); this keeps anesthesia safe.
  • Shower with the cleanser you are given the night before and the morning of surgery, and do not apply lotions, powders, or deodorant afterward.
  • Arrive at the time you are given. An IV is placed, you meet your team, and the surgery is performed under general anesthesia.
2

In the hospital

Waking up after surgery

  • You will wake up with a urinary (Foley) catheter draining your bladder, an IV for fluids, and sometimes a soft drain near one incision to remove extra fluid.
  • A mild sore throat from the breathing tube and grogginess from anesthesia are normal and pass quickly.
  • You may feel bloated or have shoulder-tip discomfort from the gas used to inflate the abdomen during robotic surgery; this improves with walking over a day or two.

Moving, eating, and going home

  • Nurses will help you get up and walk the same day or the next morning. Walking protects your lungs and circulation and helps your bowels wake up.
  • You will start with liquids and advance your diet as tolerated. Pain is usually well controlled with medication.
  • The drain, if present, is usually removed before you leave. Most patients go home the next day once they are walking, eating, and comfortable.
  • Bring two soft pillows for the ride home to cushion your abdomen from the seatbelt.
3

Living with your catheter (about 1 to 2 weeks)

What the catheter does and how to manage it

  • The catheter stays in for roughly 7 to 14 days to protect the new connection between the bladder and urethra while it heals.
  • You will be shown how to empty the bag, switch between a larger night bag and a smaller leg bag, and always keep the bag below the level of your bladder so urine drains and does not flow back.
  • Secure the catheter to your thigh so it does not pull, and clean gently where it exits the body with mild soap and water each day.
  • Drink plenty of water so urine keeps flowing and clots do not form.

Things that are normal with a catheter

  • A small amount of urine or blood leaking around the catheter, especially with movement or bladder spasms, is common and does not mean the catheter is not working.
  • Bladder spasms feel like a sudden cramp or a strong urge to urinate even though the catheter is draining. They come from the bladder being irritated and usually settle down.
  • Pink or blood-tinged urine that clears as you drink fluids is expected, particularly after activity.

Removing the catheter

  • You will usually be given an antibiotic to start the day before the catheter is removed to help prevent infection.
  • The catheter is taken out at a short office visit; it is quick and generally causes only brief discomfort.
  • Right afterward, expect to urinate frequently and to have some leakage while your bladder and pelvic muscles recover.
4

Recovery at home and follow-up

Activity

  • Walk a little more each day. Do not lift anything heavier than about 10 pounds, do strenuous exercise, or do core or abdominal workouts for about 4 to 6 weeks.
  • Do not drive while the catheter is in place or while taking prescription narcotic pain medicine. Many patients return to desk work in about 2 to 4 weeks.
  • You can shower, but avoid baths, swimming pools, and hot tubs until your team clears you.

Urinary control and pelvic floor

  • Leakage after the catheter is removed is expected and usually improves over weeks to months. Use pads as needed and change them regularly.
  • Pelvic floor (Kegel) exercises strengthen the muscles that control urine and can speed recovery. Your team can teach you the technique.

Bowels, diet, and sexual function

  • Eat a normal, fiber-rich diet and stay hydrated. Constipation is common after surgery and pain medicine; a stool softener helps, and avoid straining.
  • After the prostate is removed you will be dry at climax (no semen); this is expected.
  • Recovery of erections often takes several months and may be supported with medication or devices. Ask your team about a recovery plan.

Follow-up and when to get help

  • You will return to have the catheter removed and to review your pathology results, and you will have PSA blood tests on a schedule to monitor your cancer.
  • Call your team for: fever of 100.4°F (38°C) or higher, a catheter that stops draining or falls out, heavy bleeding or blood clots, a red or draining incision, or no bowel movement for several days.
  • Go to the nearest emergency room for: chest pain or trouble breathing, or pain and swelling in the calf or leg.

This information is general and for educational purposes only. It is not medical advice and does not replace the specific instructions your surgical team gives you. Timelines, medications, and restrictions vary from patient to patient. Always follow the guidance from your own surgeon and care team, and contact them with any questions or concerns.