Frequently Asked Questions About Robotic Prostatectomy

Robotic prostate surgery, also known as robot-assisted radical prostatectomy, is a minimally invasive approach to remove the whole prostate gland, to treat cancer. The robotic system provides the surgeon magnified vision and enhanced dexterity of ‘keyhole’ instruments. The robotic approach has led to reduced recovery times and fewer complications compared to open surgery or pure ‘keyhole’ / laparoscopic surgery as shown here.

During robotic prostate surgery, the surgeon controls the robotic arms from a surgeon side cart or console.

This console translates the surgeon’s hand movements into precise and dextrous movements inside the body. A high-definition camera provides a magnified 3D view of the surgical area, allowing for improved accuracy.

The docked patient side cart (see below) will allow the surgeon to control surgical instruments through a less than 1 cm skin incision. The vision cart is for the bed side staff to observe and assist in surgery.

The main benefits of robotic prostate surgery include:

• Smaller incisions and less scarring

• Reduced blood loss and need for transfusion

• Shorter hospital stays

• Faster recovery times

• Lower risk of urinary incontinence and erectile dysfunction

Candidates for robotic prostate surgery typically include men diagnosed with stage of localized or non-metastatic prostate cancer. Your doctor will evaluate factors such as the stage of cancer, your overall health, and any prior surgeries to determine if you are a good candidate.

As with any surgical procedure, robotic prostate surgery carries some risks. These can include:

• Infection at the incision sites

• Blood clots in the legs (DVT = deep vein thrombosis) or the lungs (PE = pulmonary embolism).

• Urinary incontinence

• Erectile dysfunction

• Damage to surrounding tissues or organs such ass bowel, vessels and large nerves.

Your surgeon will discuss these risks with you in detail prior to the procedure.

Recovery from robotic prostate surgery typically takes about 2-4 weeks. Many patients can resume light activities within a week and return to normal activities, including work, within a month. Full recovery can take longer depending on individual circumstances.

Most patients experience mild to moderate pain after robotic prostate surgery, which can be managed with prescription or over-the-counter pain medications. Since the procedure is minimally invasive, many patients report less pain compared to traditional open surgery.

Robotic prostate surgery is highly effective for treating localized prostate cancer. Long-term outcomes show that patients who undergo this procedure have similar survival rates to those who undergo traditional open surgery, with the significant benefit of quicker recovery, quicker return home and fewer side effects over all.

Most patients undergoing robotic prostate surgery stay in the hospital for 1-2 days. The minimally invasive nature of the surgery generally allows for quicker discharge compared to traditional open surgery.

Yes, follow-up care is important after robotic prostate surgery. Your doctor will monitor your recovery, review pathology reports, and ensure that cancer has been successfully treated based on your PSA values. Regular follow-up visits will also assess the urinary continence and sexual function over time.

The cost of robotic prostate surgery varies depending on the hospital and the country it is performed in. It may also depend on whether you have insurance coverage or are paying out of pocket. We recommend discussing costs with your healthcare provider and the hospital, to understand the expenses.

Most insurance plans cover robotic prostate surgery if it is deemed medically necessary for the treatment of prostate cancer. Ensure to check with your insurance provider to confirm the details of your coverage.

A nerve-sparing prostatectomy is a surgical procedure to remove the prostate gland while preserving the delicate nerves that control erectile function. This approach aims to treat prostate cancer while minimizing the risk of erectile dysfunction after surgery.

Candidates for nerve-sparing prostatectomy are typically men diagnosed with localized prostate cancer, meaning the cancer has not spread beyond the capsule or lining of the prostate. The surgeon will evaluate whether the cancer is close to the nerves before deciding if nerve-sparing surgery is possible on the side in questions.

The main benefits of nerve-sparing prostatectomy include:

• Preservation of erectile function, improving post-surgery sexual health

• Effective removal of prostate cancer when performed by an experienced surgeon

• Potential for quicker recovery of urinary continence

While the goal of a nerve-sparing prostatectomy is to preserve sexual function, there are some risks, including:

• Erectile dysfunction (though less likely than with non-nerve-sparing procedures)

• Urinary incontinence

• Standard surgical risks such as bleeding, infection, or damage to surrounding tissues

   

Your surgeon will discuss the specific risks with you, depending on your condition.

As described above in Robotic prostate surgery, the entire prostate gland and minimal surrounding tissues are removed. A nerve-sparing prostatectomy carefully preserves these nerves that run closely to the prostate, allowing for better post-operative sexual function while still aiming to effectively treat prostate cancer.

Recovery time after a nerve-sparing prostatectomy varies, but most patients can return to light activities in 2-4 weeks. Full recovery, including urinary continence and erectile function, can take several months. Patients often see improvement in sexual function in weeks with both sides of nerves are spared in a unique retrograde fashion.

While nerve-sparing prostatectomy reduces the risk of erectile dysfunction compared to non-nerve-sparing surgeries, it’s still possible to experience temporary or permanent erectile issues. Many men recover partial or full erectile function over time, particularly with the help of medications or other treatments.

Urinary continence typically returns more quickly after a nerve-sparing prostatectomy than after traditional robotic prostate removal surgeries. However, some men may experience temporary urinary incontinence, which generally improves over time with pelvic floor exercises and rehabilitation.

In some cases, the surgeon may be able to spare both nerve bundles, leading to a greater likelihood of preserving erectile function. However, if the cancer is too close to one or both bundles, the surgeon may need to remove them to ensure all cancer is excised.

The success of nerve-sparing prostatectomy in preserving erectile function depends on factors such as the patient’s age, overall health, and the skill of the surgeon.

Younger men and those with good pre-surgery erectile function have higher success rates, with many regaining full function as soon as 3 months post-surgery.

Follow-up care after a nerve-sparing prostatectomy involves regular visits to your doctor to monitor recovery and ensure cancer has been completely removed. Post-surgery care may also include:

• Erectile function rehabilitation (e.g., medications like sildenafil/tadalafil or vacuum erection devices)

• Pelvic floor exercises to improve urinary continence

• Blood tests (PSA levels) to monitor for any signs of cancer recurrence

Most patients stay in the hospital for 1-2 days after a nerve-sparing prostatectomy. You will be monitored closely to ensure that you are healing properly, can urinate on your own, and are comfortable managing pain before being discharged.

Yes, nerve-sparing prostatectomy is generally covered by insurance if it is deemed medically necessary for the treatment of prostate cancer. It’s advisable to check with your insurance provider for details on coverage and any associated costs.

Aquablation is a minimally invasive procedure that deploys a slender endoscopic camera into the natural water pipe / urethra.

A water jet or aquabeam is guided by robotic technology and the surgeon’s image planning with a simultaneous transrectal ultrasound probe. The water jet ablates excessive prostate tissue at the prostatic urethra.

It is typically used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.

During Aquablation, a surgeon uses the high-velocity water jet or aquabeam to remove the excess prostate tissue that is blocking urine flow at the prostatic urethra. The procedure is performed with the aid of robotic technology to ensure a precise plan and minimize damage to surrounding tissues, particularly at the apex of the prostate (see below). The prostate apex is the where the functioning components of ejaculation, the erectile nerves and sphincter muscle for continence all converge. The advantage of Aquablation is it allows surgeons to minimise heat at the prostate apex.

Patients with symptomatic benign prostatic hyperplasia (BPH), of a range of sizes of their prostate gland. These patients usually have not responded to medication or other treatments to improve their urinary flow, and will be good candidates for Aquablation.

The benefits of Aquablation include:

• Minimal invasiveness with no incisions on the tummy

• Precise, image guided and reproducible ablation of prostate tissue

• Reduced risk of sexual dysfunction compared to other treatments

• Short hospital stay and recovery

• Improved urinary flow and quality of life

While Aquablation is generally safe, potential risks include:

• Temporary bleeding or blood in the urine as uses minimal energy

• Infection

• Urinary incontinence and erectile/ejaculatory dysfunction.

• In rare cases, damage to surrounding organs such as bladder and rectum

   

Your doctor will discuss these risks with you before the procedure.

The Aquablation procedure typically takes about 40 to 60 minutes, however it is dependent on the size of the prostate gland, the amount of tissue to be ablated and keeping the remaining prostate free of bleeding. Most of the procedure time is spent preparing the robotic system and mapping the prostate.

Recovery from Aquablation is generally quicker than traditional open or robotic surgery. Most patients can return to normal activities within a few days to a week, with full recovery in about 2-4 weeks. You may experience temporary irritative urinary symptoms such as urgency or frequency, which usually resolve over time. The heat free nature of Aquablation means intermittent blood in the urine can be expected during the recovery period.

Most patients report only mild discomfort after Aquablation, such as a burning sensation during urination, which typically subsides within a few days. Over-the-counter pain relief may be recommended by your doctor if needed, as well as consuming more water.

Aquablation has been shown to be highly effective in reducing urinary symptoms caused by BPH, with most patients experiencing significant improvements in urine flow and bladder emptying. It specifically has a lower risk of ejaculatory dysfunction compared to other surgical options.

Most patients undergoing Aquablation are required to stay in the hospital for 1-2 days for observation with a urinary catheter. This allows time to monitor for any complications and ensure that you can urinate normally, when the catheter is removed and before being discharged.

Follow-up care after Aquablation includes regular visits to your doctor to monitor your recovery and ensure that your urinary symptoms have improved. Your doctor will check for any post-procedural complications, and in some cases, perform tests to measure urine flow and bladder function (known as uroflowmetry.)

Aquablation is generally covered by insurance, if it is deemed medically necessary for treating benign prostatic hyperplasia (BPH). Coverage may vary depending on your provider, so it’s recommended to check with your insurance company to confirm your benefits.

Compared to traditional treatments for BPH (such as TURP/transurethral resection of the prostate, open surgery or laser therapy), Aquablation offers a lower risk of sexual side effects, such as erectile dysfunction and retrograde ejaculation. It is also minimally invasive through the natural opening of the urethra (see abvove). This requires a shorter hospital stay, and is also highly effective for patients with larger prostates.

A transperineal prostate biopsy is a procedure where a small sample of tissues are taken from the prostate gland through the skin of the perineum (the area between the scrotum and anus). It is performed to diagnose or rule out prostate cancer.

A transperineal prostate biopsy is typically performed if there are signs of prostate cancer, such as an elevated PSA (Prostate-Specific Antigen) level, abnormal findings during a digital rectal exam (DRE) or area of concern on a magnetic resonance imaging (MRI) scan. The procedure allows doctors to collect prostate tissue for examination to determine if cancerous cells are present.

In a transperineal biopsy, tissue samples are collected through the perineum, which reduces the risk of infection compared to a transrectal biopsy, where samples are taken through the rectum. The transperineal approach allows for better access to all areas of the prostate and is particularly useful for targeting hard-to-reach areas.

The benefits of a transperineal prostate biopsy include:

• Lower risk of infection and re-admission compared to the transrectal approach

• More precise sampling of all areas of the prostate, including anterior sections

• Reduced chance of false negatives

• Suitable for patients with previous infections or issues with the transrectal method

Your doctor may ask you to:

• Avoid certain medications, such as blood thinners, before the procedure.

• Take antibiotics to reduce the risk of infection.

• Arrive with an empty bladder, or you may be asked to empty it before the biopsy.

Your doctor will provide specific instructions on how to prepare based on your medical history.

A transperineal prostate biopsy is typically performed under local or general anaesthesia, so you shouldn’t feel any pain during the procedure. A local anaesthesia allows this to be performed in the office, without being unconscious. This may be uncomfortable as the transrectal ultrasound probe and tiny needle injection of anaesthesia will be felt.

After the procedure, you may experience some discomfort, swelling, or mild pain in the perineal area, which can be managed with over-the-counter pain relief.

During the procedure:

• You will lie on your back with your legs elevated or spread apart.

• The doctor will numb the area with a local anaesthetic or use general anesthesia.

• A needle is inserted through the perineum, guided by transrectal ultrasound probe, to collect tissue samples from different areas of the prostate.

• The procedure typically takes about 20-30 minutes.

Most patients recover quickly after a transperineal prostate biopsy. You can usually return to light activities the next day. Some common side effects include mild discomfort, blood in the urine or semen, and swelling, which should subside within a few days.

While generally safe, a transperineal prostate biopsy does carry some risks, including:

• Mild discomfort or pain in the perineal area

• Blood in the urine or semen (which usually resolves on its own)

• Difficulty urinating, rarely requiring temporary insertion of a bladder cathter.

• Infection (although the risk is lower than with a transrectal biopsy)

  
  

Your doctor will discuss these risks with you in more detail before the procedure.

After the procedure:

• You may experience some discomfort or bruising in the perineum.

• It’s common to see small amounts of blood in your urine, stool, or semen for up to a week.

• Avoid heavy lifting, strenuous activities, or sexual intercourse for a few days to allow healing.

• Follow your doctor’s advice for post-procedure care, and watch for any signs of infection, such as fever or worsening pain.

Biopsy results are typically available within 7 to 10 days. Your doctor will schedule a follow-up appointment to discuss the findings. If cancerous cells are detected, the results will also indicate the ‘gleason’ grade and stage of the cancer, helping your doctor recommend the most appropriate treatment.

Alternative options to a transperineal prostate biopsy include:

• Transrectal ultrasound-guided biopsy (TRUS biopsy), where tissue is taken through the rectum. This has a higher risk of infection and hospital re-admission.

• MRI-fusion with ultrasound-guided biopsy, which uses magnetic resonance image findings, overlaid to the ultrasound to target suspicious areas in the prostate.

  
  

Your doctor will recommend the best biopsy method based on your specific condition.

Yes, a transperineal prostate biopsy is generally covered by insurance if it is medically necessary for diagnosing prostate cancer. It’s a good idea to confirm coverage with your insurance provider before the procedure.

Yes, a transperineal prostate biopsy is considered highly accurate for diagnosing prostate cancer. It allows doctors to sample tissue from all parts of the prostate, including areas that may be difficult to reach with other biopsy methods, leading to a more thorough examination.

Flexible cystourethroscopy is a minimally invasive procedure that allows a doctor to examine the inside of the bladder and urethra using a thin, flexible tube with a camera at the tip called a cystoscope. It is commonly used to diagnose and evaluate urinary tract problems.

You might need a flexible cystourethroscopy if you’re experiencing symptoms like blood in the urine (hematuria), frequent urinary tract infections (UTIs), difficulty urinating, or pain during urination. The procedure helps diagnose conditions such as bladder cancer, urinary stones, or strictures in the urethra.

During a flexible cystourethroscopy, the doctor will insert the cystoscope through the urethra and into the bladder. A sterile solution may be used to fill the bladder, making it easier to visualize the inside. The procedure is usually done under local anaesthesia, and patients typically remain awake but may feel slight discomfort.

The procedure usually takes about 5 to 10 minutes. In some cases, additional time may be needed if the doctor needs to take biopsies or remove small stones.

The benefits of flexible cystourethroscopy include:

• Minimally invasive approach with no need for incisions

• Quick and effective way to diagnose urinary tract issues

• Ability to perform minor procedures, such as removing stones or taking biopsies, during the examination

• Tolerable in an office setting and minimal recovery time

During the procedure, you may feel a mild burning sensation when the cystoscope is inserted, and some pressure when the bladder is filled with fluid. While generally not painful, slight discomfort is common. The procedure is quick, and most patients can resume their regular activities shortly afterward.

Flexible cystourethroscopy is considered a safe procedure, but there are some potential risks, including:

• Mild discomfort or burning sensation during urination after the procedure

• Blood in the urine (usually temporary)

• Risk of infection, though antibiotics may be prescribed to prevent this

• Rarely, injury to the urethra or bladder

Your doctor will explain these risks in more detail before the procedure.

There is usually minimal preparation required for flexible cystourethroscopy. You may be asked to empty your bladder before the procedure. In some cases, antibiotics may be prescribed to prevent infection, and you should inform your doctor if you have any known allergies or are taking blood-thinning medications.

The recovery time is generally very short. Most patients experience mild symptoms, such as a burning sensation during urination or a small amount of blood in the urine, which typically resolves within a day or two. You can usually resume normal activities immediately after the procedure.

Most patients experience mild discomfort or a burning sensation during urination for a day or two following the procedure. This is normal and can be alleviated by drinking plenty of water to flush out the urinary tract. Over-the-counter pain relief may also be recommended by your doctor.

Flexible cystourethroscopy is usually performed as an outpatient procedure, meaning you can go home the same day. The entire process, including preparation and recovery, typically lasts less than an hour, and you can resume most activities right after the procedure.

Yes, flexible cystourethroscopy is commonly used to detect or rule out bladder cancer. It allows the doctor to visually inspect the inside of the bladder and take biopsies if any abnormal tissue is found. This helps in early detection and diagnosis of bladder cancer.

Yes, flexible cystourethroscopy is usually covered by insurance if it is deemed medically necessary. Coverage may vary depending on your insurance provider and plan, so it’s advisable to check with your insurance company beforehand to confirm your benefits.

If any abnormalities are found during flexible cystourethroscopy, such as suspicious tissue or stones, your doctor may take a biopsy for further testing or remove small stones during the procedure. Follow-up treatments or tests may be scheduled based on the findings.