Day of Surgery: What Happens Right After
After robotic radical prostatectomy, most patients are transferred to a hospital room within a few hours of surgery. Early mobilization — sitting at the edge of the bed or taking a few assisted steps the same or the following day — helps reduce the risk of blood clots and speeds up the return of bowel function. You will have a urethral catheter and usually a surgical drain, each removed at different points depending on your clinical course.
The First Days in Hospital
Pain in the first few days is usually well controlled with standard analgesics — the robotic approach is often associated with less postoperative pain than open surgery, though this does not mean the absence of discomfort. The length of hospital stay is individualized by your surgeon based on your clinical course, and there is no single "rule" that applies to every patient.
- Mild discomfort around the incision sites, controlled with analgesics
- Gradual return to a normal diet, usually starting with fluids
- Encouragement toward frequent, gentle mobilization within the ward
Living With the Catheter at Home
After discharge, you will keep the urethral catheter for a period determined by your surgeon, based on the healing of the urethrovesical anastomosis. The catheter may cause mild discomfort or a sense of pressure, especially with movement, but should not cause severe pain.
Normal with a catheter
Mild discomfort, minor leakage around the catheter, and slightly blood-tinged urine in the first days.
Needs attention
Significant pain, complete blockage of the catheter, or urine with heavy clots.
Call your doctor immediately
Fever, chills, marked swelling of the scrotum or abdomen, or the catheter falling out completely.
When and How the Catheter Is Removed
The catheter is removed once your surgeon confirms, clinically or with a cystogram, that the anastomosis has healed adequately. The exact timing is individualized and can differ significantly from patient to patient — there is no reason to be concerned if your course differs from someone else's. Removal is quick, performed in the clinic, and does not usually require anaesthesia.
The First Week Without a Catheter
Some degree of urinary leakage immediately after catheter removal is expected and very common — it is not a sign that the surgery failed. Most patients need incontinence pads for the first days to weeks. Gradual improvement is the rule, although the pace varies considerably between patients.
Continence: What Is Normal in the First Weeks
Urinary continence usually improves gradually over the first weeks and months after catheter removal, particularly with regular pelvic floor muscle training. There is no guarantee of full recovery for every patient, and the pace of improvement depends on factors such as age, preoperative continence, and individual anatomy.
- Pelvic floor physiotherapy (Kegel exercises) can start early and often helps speed up improvement
- Pad use gradually decreases for most patients
- Full recovery, when it occurs, can take several months
When Incontinence Needs Further Evaluation
If incontinence remains significant or shows no trend of improvement after several months of consistent pelvic floor physiotherapy, it is worth discussing further evaluation and treatment options with your surgeon. This is neither rare nor something to feel embarrassed about — it is part of the normal follow-up pathway after radical prostatectomy.
Sexual Function and Erections After Surgery
Recovery of erectile function after radical prostatectomy is a gradual process that can take months, even when a nerve-sparing technique was used. No one can guarantee full preservation of erections beforehand — the outcome depends on age, preoperative erectile function, and the degree to which nerve-sparing was oncologically safe in your specific case.
- Early penile rehabilitation with medication (e.g. PDE5 inhibitors) can be discussed with your surgeon even before full natural recovery
- Vacuum erection devices are used by some patients as part of early rehabilitation
- If natural recovery is unsatisfactory after several months, further treatment options exist
Physical Activity: What Is Allowed and When
Guidance on physical activity is individualized by your surgeon, but generally follows a gradual return: gentle walking early on, avoiding strenuous exercise and heavy lifting for a few weeks, and full return to more demanding activities only after your surgeon's clearance at your postoperative visit.
Weeks 1-2
Gentle walking, low-intensity daily activities, avoiding heavy lifting.
Weeks 3-6
Gradual increase in activity for most patients, always according to your surgeon's guidance.
After Week 6
Return to more demanding activities is usually feasible, following assessment at the postoperative visit.
Returning to Work
The time it takes to return to work depends on the nature of your job. Desk-based work often allows an earlier return compared with jobs requiring physical effort or heavy lifting. Discuss the specific timeline with your surgeon based on your own recovery course.
Diet, Hydration, and Bowel Function
Constipation is common in the first weeks, partly due to reduced mobility and analgesics. Adequate hydration, dietary fibre, and gentle mobilization help restore normal bowel function. Avoid straining during bowel movements in the first weeks.
Psychological Adjustment After Diagnosis and Surgery
It is normal to feel anxious about the pathology results, the course of continence and erectile function, or simply about recovery in general. Many patients describe mood fluctuations in the first weeks. Open communication with your surgeon and, where needed, support from a mental health professional or patient support groups can help significantly.
The First PSA Check After Surgery
Your first postoperative PSA check is usually performed a few weeks after surgery, aiming for an undetectable value. This confirms that no active prostate tissue producing PSA remains. Regular follow-up at set intervals continues afterwards, as determined by your surgeon based on the pathology findings.
Milestones at 90 Days: What Has Usually Happened
By 90 days, most patients have noticed a clear improvement in continence compared with the first weeks, have had their first postoperative PSA check, and have returned to most daily activities. Erectile function, when recovering, is usually still at a stage of gradual improvement at this point. This is not a prediction for every patient — simply a general picture of what patients often report at this stage.
When to Contact Your Doctor Immediately
- Fever above 38°C or chills
- Severe or worsening pain not controlled with prescribed analgesics
- Inability to urinate after catheter removal
- Heavy bleeding from the incision or urine with clots blocking the flow
- Swelling, redness, or discharge from the incisions
- Swelling or pain in the calf (a possible sign of a blood clot), or shortness of breath