RARP
A robotic radical prostatectomy is a minimally invasive surgery used to treat prostate cancer by removing the entire prostate gland and the surrounding tissues. This procedure uses the da Vinci® Surgical System, which allows your surgeon to operate with high precision through small "keyhole" incisions.
1. Before Surgery: Preparation
Preparation is key to a smooth recovery. Your surgical team will provide specific instructions, but generally, you should:
Pelvic Floor Exercises (Kegels): Start these several weeks before surgery. Strengthening these muscles helps you regain bladder control faster after the operation.
Medication Review: Inform your doctor of all medications. You may need to stop blood thinners (like aspirin or warfarin) about 7–10 days before the procedure.
Fasting: Do not eat or drink anything after midnight the night before your surgery.
Bowel Prep: Some surgeons may require a clear liquid diet or a mild laxative the day before surgery.
| Action Item | Why It Matters | Timeline |
|---|
| Kegel Exercises | Strengthens the pelvic floor to help regain urinary continence. | Start 4–6 weeks before surgery. |
| Blood Thinners | Reduces the risk of excessive bleeding during surgery. | Stop 7–10 days before (as directed). |
| Physical Activity | Improves cardiovascular health for anesthesia safety. | Daily walking until day of surgery. |
| Fasting (NPO) | Prevents aspiration during general anesthesia. | Nothing by mouth after midnight. |
2. During the Procedure
The surgery typically takes 2 to 3 hours under general anesthesia.
The Robot: Your surgeon sits at a console and controls the robotic arms, which hold specialized instruments and a 3D high-definition camera.
Incisions: 5 or 6 small incisions (about 1–2 cm) are made in the abdomen.
The Goal: The prostate and seminal vesicles are removed. The bladder is then reattached to the urethra (the tube you urinate through).
Catheter Placement: A urinary catheter (Foley catheter) is inserted to allow the new connection between the bladder and urethra to heal.
| Feature | Detail |
|---|
| Anesthesia | General Anesthesia (you will be fully asleep). |
| Incision Type | 5–6 small "keyhole" incisions (1–2 cm each). |
| Duration | Approximately 2 to 4 hours. |
| Drainage | A small abdominal drain may be placed (removed before discharge). |
3. Post-Operative: In the Hospital
Most patients stay in the hospital for one night.
Walking: You will be encouraged to get out of bed and walk within a few hours of surgery. This prevents blood clots and helps your bowels wake up.
Pain Management: You may feel "gas pain" in your shoulders or abdomen from the carbon dioxide used during surgery. Walking is the best remedy for this.
Diet: You will start with sips of water and gradually move to solid food as tolerated.
| Milestone | Goal | Expected Sensation |
|---|
| Mobility | Walk in the hallway within 4–6 hours. | Mild dizziness is normal initially. |
| Pain Control | Use of non-opioid medications primarily. | Shoulder pain (due to CO2 gas) is common. |
| Catheter | A Foley catheter will be in place. | Occasional bladder spasms or "urgency." |
4. Recovery at Home
Full recovery usually takes 4 to 6 weeks.
Activity Restrictions
Walking: Continue walking daily, gradually increasing your distance.
Lifting: Do not lift anything heavier than 10 lbs (about 4.5 kg) for 6 weeks.
Driving: Do not drive for at least 2 weeks or while taking narcotic pain medications.
Stairs: Climbing stairs is generally safe immediately after discharge.
Catheter Care
The catheter stays in for 7 to 10 days.
You will be given a "leg bag" for daytime use and a larger "night bag" for sleeping.
Keep the area where the tube enters the penis clean with mild soap and water.
| Activity | Recommendation | Restrictions |
|---|
| Hygiene | Showering is okay after 48 hours. | No baths or swimming for 4 weeks. |
| Lifting | Max 10 lbs (a gallon of milk). | Avoid heavy lifting for 6 full weeks. |
| Driving | Once off narcotics and able to brake suddenly. | Usually 1–2 weeks post-op. |
| Catheter Care | Keep the tube clean and secured to your leg. | Do not pull or attempt to remove yourself. |
Managing Side Effects
| Side Effect | What to Expect |
|---|
| Incontinence | Most men leak urine after the catheter is removed. Use pads and continue your Kegel exercises. Most regain control within 3–6 months. |
| Erectile Dysfunction | It can take 6 to 24 months for erections to return. Your doctor may prescribe medications (like Cialis or Viagra) to help with "penile rehabilitation." |
| Swelling | Some bruising or swelling in the scrotum and penis is normal and resolves in 1–2 weeks. |
| Function | Expected Timeline | Management |
|---|
| Continence | 3 to 12 months for full control. | Use pads; continue daily Kegels. |
| Erectile Function | 6 to 24 months (if nerves were spared). | Penile rehab (meds/pumps) as prescribed. |
| PSA Monitoring | First test at 6–12 weeks. | Goal is "Undetectable" (<0.1 ng/mL). |
5. When to Call Your Doctor
Contact your surgical team immediately if you experience:
| Symptom | Potential Concern |
|---|
| No urine output from catheter | Catheter blockage (Emergency). |
| Fever > 101°F (38.3°C) | Possible infection (UTI or surgical site). |
| Calf pain or swelling | Possible blood clot (DVT). |
| Severe nausea/vomiting | Post-operative ileus (bowels not waking up). |
6. Dietary Guidelines & Bowel Health
After surgery, your digestive system slows down due to anesthesia and the procedure itself. Preventing constipation is vital because straining to have a bowel movement can put pressure on the internal surgical site (the connection between the bladder and urethra).
| Phase | Recommended Diet | Foods to Avoid |
|---|
| Days 1–3 | Clear liquids, broth, gelatin, and light crackers. | Heavy meats, fried foods, and large meals. |
| Days 4–7 | Soft foods like yogurt, oatmeal, and cooked vegetables. | Spicy foods and carbonated drinks (gas-producing). |
| Long-term | High-fiber diet (fruits, vegetables, whole grains). | Excessive caffeine and alcohol (bladder irritants). |
7. Understanding Your Catheter
The Foley catheter is a temporary but essential part of your healing. It allows the new connection between the bladder and urethra to heal without being stretched by a full bladder.
| Catheter Component | Management Tip |
|---|
| Drainage Bag | Keep the bag lower than your bladder at all times to prevent backflow. |
| StatLock (Securing Device) | Ensure the tube is taped or strapped to your thigh to prevent pulling. |
| Cleaning | Clean the tip of the penis and the tube twice daily with mild soap and water. |
| Fluid Color | It is normal for urine to look pink or "rosé" colored if you are active. |
8. Summary Checklist for the First Week
Use this table to track your daily progress and ensure you are meeting your recovery goals.
| Task | Mon | Tue | Wed | Thu | Fri | Sat | Sun |
|---|
| Walked 3+ times today? | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Drank 2L of water? | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Took stool softener? | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Incision sites look clean? | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Catheter draining well? | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
9. Frequently Asked Questions (FAQs)
Navigating life after surgery often brings up practical questions. Use the tables below for quick reference on when you can return to your normal routine.
Travel & Daily Life
| Question | Answer |
|---|
| When can I travel? | Short car trips are fine. Avoid long flights or drives (>2 hours) for 4 weeks to prevent blood clots. |
| When can I return to work? | 2–3 weeks for desk jobs; 6–8 weeks for jobs requiring heavy labor or long hours on your feet. |
| Can I climb stairs? | Yes, you can climb stairs immediately, but take them slowly and use the handrail. |
Exercise & Physical Activity
| Activity | Timeline | Recommendation |
|---|
| Walking | Day 1 | Start with hallway laps; progress to 30 mins daily by week 2. |
| Golf/Tennis | 6 Weeks | The twisting motion can pull on internal sutures. Wait for clearance. |
| Swimming | 4 Weeks | Ensure all "keyhole" incisions are completely closed and scab-free. |
| Gym/Weightlifting | 6–8 Weeks | Start with 50% of your usual weight and gradually increase. |
| Question | Answer |
|---|
| When can I be intimate? | Most surgeons recommend waiting 4–6 weeks before sexual activity to allow the internal connection to heal. |
| What is Penile Rehab? | It involves using medications (PDE5 inhibitors) or vacuum devices to encourage blood flow during the recovery of the nerves. |
| Will I still climax? | Yes. You will still experience the sensation of orgasm, but it will be a "dry" orgasm since the prostate and vesicles are gone. |
10. Final Checklist for Your First Follow-Up
Bring this completed table to your first appointment (usually 7–10 days post-op) when your catheter is scheduled for removal.
| Information to Report | Your Notes |
|---|
| Daily Pad Count | (How many pads are you using for leaks?) |
| Pain Level (1-10) | (How has your pain been over the last 3 days?) |
| Bowel Movements | (Are they regular and soft?) |
| Questions for the Doctor | (List any new concerns here.) |