The preferred surgical approach for most patients is a robotic-assisted laparoscopic prostatectomy, also called a "robotic prostatectomy." This is a form of laparoscopic surgery, meaning use of small incisions and a camera guiding instruments in the abdomen, rather than a larger incision. Robotic surgery involves use of more dexterous and precise instruments compared with traditional laparoscopic surgery, and has been a tremendously useful tool in reducing the invasiveness of radical prostatectomy. The main objective advantages of robotic surgery include decreased risk of bleeding and requiring a blood transfusion, which expedites the healing process and resumption of normal activities.
Prostate surgery, including robotic prostatectomy, requires the patient to undergo general anesthesia and requires an overnight hospital stay. When patients are released to go home, they have a catheter in place for 7-10 days. It is removed when they return to the hospital for a post-operative examination about a week after surgery.
The most frequent side effects of prostate surgery are erectile dysfunction (ED) and urinary incontinence. We provide counseling regarding medical and surgical options for treatment of ED, including oral and injectable medication, vacuum erection devices, urethral suppositories, or even penile prosthesis placement. The extent and duration of ED varies by patient depending on cancer risk, extent of surgery, age and preoperative function, thus we individualize counseling and therapies to the individual patients. Incontinence is generally "stress incontinence", or leakage with coughing, sneezing, laughing or lifting. This is managed by behavioral counseling, physical therapy (e.g. Kegel exercises), and additional treatment when necessary. Patients generally require pads in their underwear for a period of time after surgery, but most ultimately regain urinary control.