DR CHEW-LIN YIP | UROLOGIST

Robotic-assisted radical prostatectomy is an operation to remove the prostate and seminal vesicles for selected patients with prostate cancer. Dr Yip controls fine instruments from a console; the robotic system does not operate independently. 

Suitability depends on the cancer’s Grade Group and stage, PSA, imaging, general health, life expectancy, urinary and sexual function, and personal priorities. Alternatives may include active surveillance, external-beam radiotherapy, whole-gland brachytherapy, hormone therapy or combined treatment.

Before surgery, patients may meet with a prostate cancer nurse, pelvic-floor physiotherapist and sexual-health clinician. These appointments can help with pelvic-floor exercises, catheter care, urinary continence and sexual rehabilitation. Learning the exercises before surgery makes them easier to resume after the catheter is removed. You will also receive individual instructions about medicines, fasting, admission and preparing for recovery at home.

Robotic-assisted radical prostatectomy is performed under general anaesthesia through several small abdominal incisions. The prostate and seminal vesicles are removed and the bladder is reconnected to the urethra. A urinary catheter is placed to drain urine while this new join heals. In some patients, pelvic lymph nodes are also removed; whether this is advised depends on the characteristics and estimated risk of the cancer and will be discussed before surgery.

The nerves involved in erections run close to the outside of the prostate. When it is oncologically appropriate, Dr Yip may be able to preserve one or both nerve bundles. This depends on the location and extent of the cancer and individual anatomy. Cancer control remains the priority, and nerve-sparing cannot guarantee that erectile function will return.

Possible complications include urinary leakage, erectile dysfunction, infertility, shortening or curvature of the penis, bladder-neck narrowing, bleeding, infection, blood clots, lymph-fluid collections, injury to nearby structures and anaesthetic complications. Recovery and long-term effects vary, and no treatment can guarantee cancer control. Dr Yip will discuss the potential benefits, risks and alternatives in the context of your diagnosis and priorities.

After surgery, Dr Yip and the hospital team will manage discomfort, encourage gentle movement and help you begin eating and drinking again. Early mobilisation, breathing exercises and leg exercises are part of recovery. You will be shown how to care for the catheter before discharge. Hospital stay and discharge timing vary according to the operation and your progress.

The catheter supports the new join between the bladder and urethra while it heals and usually remains in place for a period after discharge. You will receive instructions about the drainage bag, hygiene, activity and who to contact if you have concerns. Some bladder irritation, leakage around the catheter or a small amount of blood in the urine can occur early. The catheter should only be removed as arranged by Dr Yip and his team.

Temporary urinary leakage is common after the catheter is removed. The amount and speed of recovery vary. Pelvic-floor exercises are important and are usually resumed after catheter removal; do not perform them while the catheter remains in place unless specifically instructed. A pelvic-floor physiotherapist can check technique and tailor rehabilitation.

Erections are commonly reduced or absent immediately after radical prostatectomy. Recovery may take many months and may not return to the pre-surgery level. Outcomes depend on factors including erectile function before surgery, age, general health, cardiovascular health, smoking, cancer location and whether nerve-sparing is possible. A personalised rehabilitation plan may include oral medicines, vacuum devices, injections or other treatment when appropriate.

After radical prostatectomy, ejaculation no longer occurs because the prostate and seminal vesicles have been removed. Many men can still experience orgasm, although the sensation may be different. Surgery results in infertility; anyone who may wish to have children in future should discuss fertility preservation, including sperm banking, before treatment.

Gentle walking is encouraged, with activity increased gradually as comfort and strength improve. Avoid heavy lifting and strenuous activity during early healing and follow Dr Yip’s advice. Do not drive until you can safely perform an emergency stop, check blind spots and are no longer affected by pain medicine. Return to work depends on recovery and the physical demands of your job.