Side Effects of Robotic Prostatectomy

What to expect, honestly

These are the effects recognised after a radical prostatectomy in UK practice, grouped by how often they happen and described plainly. Some are certain, some are common and usually temporary, and others are uncommon or rare. Mr Sridhar will go through the ones that matter for your case before you decide.

Effects that happen for everyone

• A dry orgasm. Because the prostate and the glands that produce semen are removed, orgasm no longer releases fluid. The sensation of orgasm usually remains.
• Loss of natural fertility. Natural conception is no longer possible after surgery, so it is worth discussing sperm banking beforehand if this matters to you.
• A temporary catheter. A catheter is needed for a short time after surgery while the join between the bladder and the urethra heals.

Common in the early stages

• A period of urinary leakage. Most men leak at first once the catheter is removed, from a few drops when coughing or lifting to more noticeable leakage. For the majority this improves over the following weeks and months, helped by pelvic-floor exercises.
• Changes to erections. A decline in erectile function is common, because the nerves that control erections run right beside the prostate. It is more likely if a nerve-sparing approach is not possible because of where the cancer sits. Rehabilitation starts early and there are effective treatments to help.
• A slight shortening of the penis. A minor change in length can occur as the urethra is rejoined to the bladder.
• Short-term symptoms. Bruising or discomfort around the small wounds, temporary bladder spasms, shoulder-tip discomfort from the gas used in keyhole surgery, and a few days of sluggish bowels are all common and settle.

Less common

• A narrowing at the new join (bladder-neck contracture). Scar tissue can narrow the join between the bladder and the urethra and weaken the stream; a minor procedure can widen it.
• Longer-term leakage. A small proportion of men have leakage that persists beyond a year and may need a further procedure, such as a sling or an artificial sphincter.
• Leakage of urine at orgasm (climacturia), or discomfort at orgasm (orgasmodynia).
• A hernia at one of the keyhole sites, or in the groin, sometimes appearing months later.
• A collection of lymph fluid (lymphocele) where lymph nodes have been removed, which can cause bloating or leg swelling.
• Bleeding that occasionally needs a transfusion or a return to theatre.

Rare

• Injury to the rectum during surgery, which is rare and may need repair.
• A blood clot in the leg or lung, despite the preventative measures taken around your operation.
• Serious medical or anaesthetic events, as with any major operation under general anaesthetic.

Protecting your function

The techniques Mr Sridhar uses are chosen to reduce these risks wherever it is safe to do so. Nerve-sparing surgery, NeuroSAFE and the Retzius-sparing approach all work to protect the nerves and the structures that control continence and erections while the cancer is fully removed. None of them is a guarantee, and which are appropriate depends on your anatomy and the position of the cancer. You can read more about how these techniques work on the robotic prostatectomy overview, and rehabilitation begins early as part of your recovery.