Robotic radical prostatectomy removes the whole prostate, usually together with the seminal vesicles and, when needed, nearby lymph nodes. Because it is done through a few small cuts, most men are walking the same evening, go home within two to three days, and return to normal daily activities within a few weeks.
Recovery is not only about the wounds healing. Most men want to know when the catheter comes out, when they will be dry, when erections return and what the first PSA should show. This guide covers each stage. Everyone recovers at a slightly different pace, so use it as a general map and follow the specific advice given to you.
Before surgery: preparing helps recovery
- Start pelvic floor (Kegel) exercises two to four weeks before surgery. Men who learn them beforehand usually regain bladder control sooner.
- Walk daily and stop smoking. Fitness before surgery shortens recovery.
- Review your medicines with your surgeon, especially blood thinners, which usually need to be paused or adjusted.
Related: Robotic Surgery · Prostate Cancer treatment options
In hospital (the first 2 to 3 days)
- You will usually be out of bed and walking on the day of surgery or the next morning. Walking reduces the risk of blood clots and helps the bowels start working.
- Pain is usually mild to moderate and is controlled with tablets. Shoulder-tip pain from the gas used during surgery is common for a day or two.
- You can usually drink the same day and eat normally the next day.
- You go home with a urinary catheter. A small drain, if used, is normally removed before discharge.
- Most men go home after two to three days.
The catheter weeks (week 1 to 2)
The catheter allows the new join between the bladder and the urethra to heal. It usually stays for about 7 to 10 days.
- Keep the catheter secured to your thigh so it does not pull.
- Clean around the tip of the penis twice a day with plain water.
- Drink enough to keep the urine light yellow, about 2 to 2.5 litres a day unless advised otherwise.
- Avoid constipation and straining. A stool softener is often prescribed.
- Slight blood in the urine or a little leakage around the catheter can be normal, especially after walking or a bowel movement.
Do not do pelvic floor exercises while the catheter is in. Restart them the day it is removed.
After the catheter comes out (weeks 2 to 6)
Some leakage of urine is expected at first, especially when standing up, coughing or lifting. This is the most common concern after surgery, and it improves steadily.
- Restart pelvic floor exercises several times a day.
- Use pads as needed. Most men use fewer pads week by week.
- Cut down on tea, coffee, fizzy drinks and alcohol, which irritate the bladder, and avoid drinking large amounts in the evening.
- Walking is encouraged. Avoid heavy lifting (anything more than about 5 kg), the gym and cycling for around 4 to 6 weeks.
- Most men return to desk work in 2 to 3 weeks and to physical work after about 6 weeks.
- Driving is usually fine once the catheter is out and you can brake suddenly without pain, typically after about 2 weeks.
Bladder control: what to expect
Recovery of continence is gradual. Most men are dry, or need at most one light safety pad, within three months, and many improve further up to a year. Recovery tends to be quicker in younger men, in those who did pelvic floor exercises before surgery, and when the nerves and the muscles around the urethra could be preserved.
If leakage is still a problem after six months to a year, effective treatments are available, including physiotherapy-guided pelvic floor training, a male sling or an artificial urinary sphincter.
Track your progress: Urinary leakage questionnaire (ICIQ-UI SF)
Erections and sex
Erections depend on how well they worked before surgery, your age, and whether the nerves alongside the prostate could be spared. Where it is safe for cancer control, a nerve-sparing technique is used, and robotic magnification helps with this.
- Recovery of erections is slow: often 6 to 24 months.
- Penile rehabilitation usually starts a few weeks after surgery, typically with tablets such as tadalafil or sildenafil, and sometimes a vacuum device or injections.
- Orgasm is still possible, but it is "dry": no semen comes out, because the prostate and seminal vesicles have been removed. Natural conception is no longer possible, so discuss sperm banking beforehand if you may want children.
- Sexual activity can usually resume once you feel comfortable, often after about 4 to 6 weeks.
Track your progress: Erectile function score (SHIM)
Your pathology report and first PSA
About one to two weeks after surgery, the final pathology report gives the Gleason score, the stage, whether the surgical margins are clear, and whether any lymph nodes contained cancer. Your surgeon will explain what this means for you.
The first PSA test is done about 6 to 8 weeks after surgery. With the prostate removed, the PSA should fall to an undetectable level (usually below 0.1 ng/mL). After that, PSA is typically checked every 3 months for the first year or two, then less often.
A PSA that does not fall, or that rises again later, does not always mean the cancer has spread. It is assessed carefully, sometimes with a PSMA PET scan, and further treatment such as radiation can be very effective when started early.
Related: Gleason score explained · Follow-up after Prostate Cancer treatment
When to contact the hospital urgently
- Fever above 38 °C, or shivering
- The catheter stops draining, or you cannot pass urine after it has been removed
- Heavy bleeding or large clots in the urine
- Pain, swelling or redness in a calf, or sudden breathlessness or chest pain (possible blood clot)
- Increasing tummy pain or swelling, vomiting, or a wound that becomes red, hot or leaks
Consultation
Dr. Anshuman Singh, Uro-Oncologist & Robotic Surgeon, performs robotic radical prostatectomy and sees patients at the Uro-Oncology OPD, Chandan Hospital (10 AM – 4 PM) and at Uro-Onco Connect, Gomti Nagar (6 – 9 PM), Monday to Friday, and by teleconsultation. Biopsy reports, MRI and PSMA scans can be shared in advance. Book a consultation.
Frequently asked questions
How long does it take to recover from robotic prostatectomy?
Most men go home in two to three days, have the catheter removed after about 7 to 10 days, return to desk work in 2 to 3 weeks and to full activity in about 6 weeks. Bladder control and erections take longer and keep improving for months.
How long is the catheter needed after robotic prostatectomy?
Usually about 7 to 10 days, while the join between the bladder and the urethra heals.
Will I be incontinent after prostate surgery?
Some leakage is common after the catheter is removed, but it improves steadily. Most men are dry, or need at most one light pad, within three months. Pelvic floor exercises speed up recovery.
Will I have erections after robotic prostatectomy?
Many men do, especially when nerve-sparing surgery is possible and erections were good beforehand. Recovery can take 6 to 24 months and is helped by penile rehabilitation with tablets or other treatments.
What should my PSA be after prostatectomy?
About 6 to 8 weeks after surgery the PSA should be undetectable, usually below 0.1 ng/mL. It is then checked regularly, often every 3 months for the first year or two.
When can I drive after robotic prostatectomy?
Usually after about 2 weeks, once the catheter is out and you can brake suddenly without pain.
This article is for general education and does not replace a personal medical consultation.