Robotic-assisted laparoscopic prostatectomy (RALP)

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Robot Assisted Laparoscopic Prostatectomy (RALP)

Robot assisted laparoscopic prostatectomy (RALP) is the surgical removal of the prostate to treat prostate cancer. The robot is a state-of-the-art surgical interface system. It includes fine instruments that a Urologist uses to remove the prostate gland through several small incisions (keyhole surgery).

Due to magnified 3D-visualisation of the anatomy, very precise surgery is possible. This results in less blood loss and faster recovery after surgery compared to conventional open surgery. Some studies show that there is a better outcome with regards to post-operative continence and sexual function.

The robot is completely controlled by the surgeon at all times and cannot operate independently.

Before your operation

The operation and outcomes will be explained to you by your Urologist. When you feel comfortable that you understand what is to be done and have had all your questions answered you will be asked to sign a consent form.

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RALP

Blood test / Urine test

A blood test will need to be performed and a urine sample may need to be taken 4-5 days prior to surgery. Your surgeon will give you a form to take to the laboratory to have these tests done.

Avoid constipation

It is important to avoid constipation. Try to establish and maintain a regular, soft bowel habit leading up to your operation. Identify the foods that can help you maintain a regular bowel habit for your post-op period.

Operation day

Robot assisted laparoscopic prostatectomy is an operation performed by making several small cuts in the abdomen between your navel and pubic bone. Ports are placed into these cuts, the robotic camera and instruments are then introduced into the abdomen via these ports. The prostate is removed. The bladder is joined back into the urethra (water pipe) and a catheter is placed to drain the urine. The cut at the navel will be enlarged slightly to remove the prostate.
The procedure takes about 2-3 hours.

Recovery

When the operation is completed, you will go to the recovery room for a short while where you will be cared for until you are ready to be transferred to your room.

You will be in hospital for 1 or occasionally 2 nights following this surgery.

Expected symptoms

After surgery, you may or may not experience some of the following symptoms:

Irritation

A stinging or burning sensation at the tip of the penis where the catheter enters. This is generally due to irritation and may be relieved by increasing fluid intake and ensuring the catheter is well supported.

Feeling of full bladder

A feeling of having a full bladder and low to nil drainage of urine through the catheter. This can be caused by blockage of the catheter tube either by a blood clot or by accidental kinking of the tube. Catheter blockages are easily cleared by the nurse.

Bladder spasms

Bladder spasms can occur due to the bladder trying to expel the catheter because of irritation. Some patients experience bladder spasm. Symptoms may include:

leakage of urine around the catheter
a feeling of wanting to pass urine
lower abdominal pain (short, sharp, grabbing pains)

These are easily treated with medication.

After discharge

You will receive two follow up appointments after your surgery. The first is for the removal of your catheter with the continence nurse and the second with your surgeon six weeks after the operation.

You can do most activities after your operation except heavy lifting, straining, intercourse or strenuous activity which should be avoided for 2-3 weeks after surgery. You will be able to continue with your normal daily routines as you feel able.

Generally when you feel that you could perform an emergency stop without being concerned about abdominal pain (at about 3 weeks), then you can resume driving.

Complications

Following Radical Prostatectomy Patient Information Booklet Pelvic Floor Exercises for Men

Bleeding

It is normal to have some leakage or discharge at the end of your penis/catheter. The discharge may be urine, blood or brown coloured. You should wash the area with soap and water to remove this discharge and reduce any irritation. It is also normal to see blood occasionally in the catheter bag.
Bleeding severe enough to bring you back to the hospital is rare. This risk disappears when healing is complete, 6-8 weeks after surgery. If you notice an increase in bleeding or are unable to pass urine, contact Urology Associates.

Incontinence

Urgency is common. Incontinence, or leakage of urine without control, may occur temporarily. Only very few patients have incontinence which lasts beyond the first few months. If you have any incontinence after your operation, you will be given information and instructions about exercises that you can do to strengthen the pelvic floor muscles.

Urethral stricture

In a small number of cases tightness may develop in the urethra. This may occur either near the tip of the penis or further up the urethra, several months after the operation. You may notice your urinary stream, which was better after the operation, slows down again. Please mention this problem to your Urologist. If detected early and treated with gentle stretching under local anaesthetic most strictures resolve. An operation to cut open the tight area may be required.

Sexual function

A RALP can cause impotence – the inability to have an erection. The likelihood of this occurring depends on a number of factors. At best only 35% of men retain normal erections which may take a year to return after surgery. This does not mean that you cannot continue to have a satisfactory sexual life. With some creativity, men can have orgasms without having an erection. There are also a number of treatments available to help bring back erections. Talk to your Urologist about this if you are experiencing difficulties in this area.