Robotic prostatectomy (RARP) is performed through 5–6 small keyhole incisions. Most patients go home on day 1–2, return to light activities within 2 weeks, and resume normal life by 4–6 weeks. Knowing what to expect removes the fear.
You have been diagnosed with prostate cancer and your surgical team has recommended — or you have chosen — robotic radical prostatectomy. The operation involves complete removal of the prostate gland, along with the seminal vesicles, through 5–6 small keyhole incisions using the da Vinci robotic system.
This article is a practical guide to the RARP journey — what happens before, during, and after surgery, and what realistic recovery looks like week by week.
1. What is RARP?
RARP — Robot-Assisted Radical Prostatectomy — is the gold standard surgical treatment for localised prostate cancer. The surgeon operates from a console, controlling robotic arms with 3D magnification and tremor-filtered precision, through ports approximately 8mm in diameter placed in the abdomen.
The operation removes the prostate, seminal vesicles, and a small margin of surrounding tissue. The urethra (urine tube) is then rejoined to the bladder — a connection called the vesicourethral anastomosis. A urinary catheter is left in place while this join heals, typically for 7–10 days.
The robotic platform provides 10x magnification, 3D vision, and articulating instruments that can work in the narrow pelvis with a precision that open surgery cannot match. For prostate surgery specifically — where the goal is to remove all cancer while preserving the nerves for erection and the sphincter mechanism for continence — this precision is critical.
2. Before surgery — preparation
2–4 weeks before: Pre-assessment
Blood tests, ECG, chest X-ray, and anaesthetic review. Any medications that need to be stopped (blood thinners, aspirin, herbal supplements) will be identified. You will be given specific instructions on timing.
1 week before: Pelvic floor exercises
Begin pelvic floor (Kegel) exercises if you have not already. These exercises strengthen the sphincter muscles that control urinary continence. Starting before surgery significantly improves post-operative continence recovery.
Evening before: Bowel preparation
A light bowel prep — typically oral laxative and a liquid diet — may be recommended to clear the large bowel and improve operative field visibility. Your surgical team will provide specific instructions.
Midnight before: Nil by mouth
No food after midnight. You may have clear fluids (water, clear juice, black tea) until 2 hours before your admission time. Your anaesthetist will provide specific guidance.
3. The day of surgery
You will be admitted to hospital on the morning of surgery (typically). After admission and final checks, you will receive a general anaesthetic. The operation takes 2–3 hours in experienced hands. You will wake in recovery and be transferred to the ward, where you will have a urinary catheter in place and possibly a small drain from the pelvis.
Most patients are comfortable on oral analgesia (paracetamol, anti-inflammatories) by the evening. A small amount of blood-stained urine via the catheter is expected. You will be encouraged to sit up and move within hours of surgery — early mobilisation significantly reduces the risk of blood clots.
Hospital stay: Most patients are discharged on day 1 or 2 after surgery. Discharge with the catheter in situ is routine — you will be given full instructions on catheter care before going home.
4. Week-by-week recovery guide
Week 1: Rest and catheter management
Focus on rest, hydration, and catheter care. Short gentle walks inside the house are encouraged from day 2–3. Avoid lifting anything heavier than a kettle. Constipation is common — stool softeners and a high-fibre diet help. Drive only after catheter removal and surgical clearance.
Week 1–2: Catheter removal (7–10 days post-op)
The catheter is removed at the outpatient clinic after a trial without catheter. Most patients pass urine satisfactorily immediately. Some initial urgency and frequency is normal. Pelvic floor exercises should continue aggressively from this point.
Weeks 2–4: Gradual activity increase
Light walks outside can begin. Avoid heavy lifting, vigorous exercise, or activities that strain the abdomen. Most men with desk-based work can return to work at 2–3 weeks. Physical jobs require 4–6 weeks.
Weeks 4–6: Return to normal activities
Driving is usually cleared at 4–6 weeks (varies — depends on catheter removal, pain, and insurance requirements). Exercise (gentle gym, swimming from week 4–6) can resume. Sexual intimacy can gradually resume — discuss timing with your surgical team.
6 weeks: First post-operative PSA
A PSA should be undetectable (<0.1 ng/mL) after complete prostate removal. This is called the nadir PSA. This first check confirms surgical success. Subsequent PSA checks are done at 3 and 6 months, then annually.
5. Managing the urinary catheter at home
Most patients go home with a urinary catheter — a thin tube from the bladder, through the urethra, attached to a leg bag (small, worn during the day) or a night bag (larger, hung from the bed). Catheter management is simpler than most patients expect.
- Keep the bag below bladder level at all times — urine must drain downhill.
- Drink plenty of fluids — aim for 2–2.5 litres daily. Concentrated urine increases irritation and infection risk.
- Change between leg bag and night bag using the connector — never disconnect from the catheter tip itself.
- Some blood in the urine is normal — if heavy bleeding or large clots occur, contact your surgical team.
- Catheter comes out in clinic — do not attempt to remove it yourself.
6. Urinary continence recovery
Urinary leakage after catheter removal is expected and normal. The majority of men achieve good continence (no pads or 1 safety pad) by 3 months. Full continence often continues to improve up to 12 months post-surgery.
Using 2–4 pads per day is normal at this stage. Focus on pelvic floor exercises. Avoid heavy lifting. Caffeine, alcohol, and spicy food worsen urgency.
80–90% of patients are using 0–1 pads at 3–6 months. Improvement continues at 12 months. Pelvic floor physiotherapy accelerates recovery.
Contract your pelvic floor muscles (as if stopping the flow of urine mid-stream) for 10 seconds, then relax for 10 seconds. Repeat 10 times, three times daily. Do these standing, sitting, and lying down. Start before surgery and continue daily for at least 6 months.
7. Erectile function recovery
The nerves responsible for erection run on either side of the prostate. Whether these can be preserved depends on where the cancer is located relative to the nerve bundles — this is the basis of "nerve-sparing" surgery.
Even with successful bilateral nerve-sparing, erectile function recovery takes time — the nerves are stretched during surgery and require 12–24 months to recover fully. Erections during this period are typically weaker than baseline and improve gradually.
- Penile rehabilitation: Using PDE5 inhibitors (sildenafil/tadalafil) regularly — even without an erection — promotes blood flow and nerve recovery. This is called penile rehabilitation and should begin 4–6 weeks after surgery.
- Realistic timeline: Patients with bilateral nerve-sparing in experienced hands typically see meaningful erection recovery by 12–18 months. Younger patients (<65) with good preoperative function have the best outcomes.
- Options if recovery is slow: Vacuum erection devices, intraurethral alprostadil (MUSE), penile injections, or — in selected patients — penile implants. These should be discussed with your surgeon.
- Will you be performing nerve-sparing — on one side or both?
- How many RARPs do you perform per year — and at what institution?
- What is your continence rate at 3 months at your centre?
- When should I start pelvic floor exercises — and should I see a physiotherapist?
- Will I need additional treatment if the PSA is not undetectable after surgery?
- What is the plan if pathology shows positive margins?
This article is for general patient education only. Individual recovery varies significantly based on patient factors, surgical approach, and cancer characteristics. All specific guidance should come from your treating surgical team.