Robotic Radical Prostatectomy London — Mr Denosshan Sri, Prostate Cancer Surgeon
Surgical procedure · Prostate cancer · Nerve-sparing

Robotic-Assisted Radical Prostatectomy

The surgical removal of the prostate for prostate cancer — performed with nerve-sparing robotic technique, pre-operative pelvic floor preparation, and a structured survivorship programme from day one.

Book a Consultation Prostate cancer overview →
1 dayMedian hospital
stay
>80%Continent
(all patients)
>90%Continent
(nerve-sparing)
6 wksexpectation - Dry at night &
safety pad by day
2–4 wksReturn to normal
activity
The procedure

What is a robotic radical prostatectomy?

Robotic-assisted radical prostatectomy (RARP) is the surgical removal of the entire prostate gland and seminal vesicles for clinically localised or locally advanced prostate cancer. Robotic surgery is now the dominant technique — offering greater precision than open or conventional laparoscopic approaches, with particular advantages for nerve preservation and accurate reconstruction of the bladder-urethra join.

The procedure is performed using the da Vinci system through six small keyhole incisions. The surgeon operates at a console with three-dimensional magnified vision and wristed instruments delivering precision beyond the unassisted hand. The prostate is dissected from surrounding structures, the bladder neck is rejoined to the urethra, and a catheter remains in place for approximately one week while the anastomosis heals.

The principal goals are complete cancer removal with negative surgical margins, while preserving the structures responsible for urinary continence and — where oncologically safe — erectile function. For localised prostate cancer, robotic surgery and radiotherapy offer equivalent cancer control; the choice between them is personal, and discussed openly at consultation. NICE guidance (NG131) sets out the current UK recommended pathway.

Nerve-sparing prostatectomy
The neurovascular bundles running alongside the prostate are responsible for erectile function. Nerve-sparing technique preserves these structures where oncologically safe.
Whether nerve-sparing is possible depends on the MRI appearance, biopsy result, and PSA. Where cancer is close to the nerve bundle, removing it safely must take priority.
Robotic precision allows nerve-sparing surgery more reliably than open approaches — magnification and wristed instruments enable careful dissection in a confined anatomical space.
Structured penile rehabilitation starting early post-operatively significantly improves long-term erectile function recovery where nerve-sparing was performed.
Continence outcomes

What to expect with urinary control

Temporary urinary leakage following catheter removal is expected and normal. The rate and completeness of recovery depend on age, baseline function, and surgical technique. The key target to aim for at 6 weeks is to be dry at night and using a single safety pad during the day. Meeting this milestone places you ahead of the curve in terms of continence recovery.

Pelvic floor exercises — starting before surgery and restarting the moment the catheter is removed — are the single most impactful thing a patient can do to influence their recovery.

All patients — continent or minimal leak at 1 year>80%
Personal series. Does not bother the patient.
Nerve-sparing patients — continent or minimal leak at 1 year>90%
Personal series. Bilateral nerve-sparing performed.
Recovery week by week

Timeline

Before op
Pelvic floor training begins
4–6 weeks of daily exercises before surgery. Referral to specialist pelvic floor physiotherapist arranged.
Day of op
Surgery and early recovery
Mobile the same day. Eating and drinking within hours. Median discharge within 24 hours.
Week 1
Catheter removal
Catheter removed at clinic at 7 - 10 days. Pelvic floor exercises restart immediately. Leakage expected. Tadalafil started to help with penile rehabilitation.
Weeks 2–4
Returning to normal
Desk work by 2–3 weeks. Driving when safe. Leakage improving week by week.
6 weeks
Key milestone
Expectation: dry at night, single safety pad during day. First PSA check. Referral for vacuum pump.
3–12 months
Ongoing improvement
Continence and erectile function continue improving. Regular PSA monitoring.
The most important thing you can do before surgery

Pelvic floor preparation — start before your operation

Pre-operative pelvic floor training is one of the most evidence-based and impactful things a patient can do before prostatectomy. Patients who begin exercises before surgery recover continence significantly faster than those who start only after the catheter comes out. By training the pelvic floor beforehand, you develop the neuromuscular control you will depend on the moment the catheter is removed.

Mr Sri refers all prostatectomy patients for specialist pelvic floor physiotherapy before their operation. Exercises should begin at least four to six weeks before the planned surgery date.

1
Find the correct muscles
Tighten the muscles used to stop urine mid-flow. Do not engage thighs, buttocks, or abdomen. Correct technique is essential — exercising the wrong muscles provides no benefit.
2
Begin 4–6 weeks before surgery
A consistent daily programme — ideally supervised initially by a specialist physiotherapist — builds the baseline strength needed for recovery.
3
Restart immediately after catheter removal
The window immediately after catheter removal is the most critical. Exercises restart the same day — this is non-negotiable.
4
Continue throughout the first year
Pelvic floor exercises remain beneficial at every stage of recovery, and even years later for persistent leakage.
Life after surgery

Survivorship — the long view

The goal of treatment is not just cancer control — it is getting back to living well. Mr Sri's approach places equal emphasis on excellent oncological outcomes and quality of life in the years following surgery.

PSA monitoring
PSA should become undetectable after prostatectomy. Regular monitoring - frequency depending on stage of disease — detects any sign of recurrence early. A rising PSA does not necessarily mean spread; early detection opens the window for salvage radiotherapy or other interventions. All patients are followed through a structured PSA surveillance programme.
Continence recovery
Most patients achieve good continence within the first year. Those with persistent leakage beyond 12 months are assessed for further interventions — where necessary, surgical options including a male sling or artificial urinary sphincter. These are discussed openly from the outset. Pelvic floor resources from Prostate Cancer UK →
Erectile function
Erectile recovery after nerve-sparing prostatectomy is gradual — typically 6–18 months. Structured penile rehabilitation from the early post-operative period significantly improves long-term outcomes. Mr Sri works with specialist andrology colleagues for this aspect of care. Honest discussion of realistic expectations takes place at consultation and at each follow-up.
What happens during surgery

The operation — step by step

1
Pre-operative assessment
Anaesthetic review, blood tests, any additional staging imaging. Pelvic floor physiotherapy referral made. Informed consent obtained.
2
General anaesthetic and robot setup
Da Vinci robot docked via five small port incisions in the lower abdomen. Patient positioned head-down so bowel falls away from the pelvis.
3
Prostate dissection and nerve-sparing
The prostate is carefully dissected from the bladder, urethra, and — where oncologically safe — the neurovascular bundles. The seminal vesicles are removed with the specimen.
4
Anastomosis — rejoining bladder to urethra
Bladder neck sutured to urethra with absorbable sutures. Catheter placed through the join, which heals over approximately one week.
5
Recovery and discharge
Mobile on the day of surgery. Median discharge within 24 hours. Pathology results reviewed at the first post-operative appointment.
Common questions

Frequently asked questions

Full information on the prostate cancer page.

In most cases there is time to consider your options fully — a few weeks to understand the alternatives and seek a second opinion will not compromise your outcome. Mr Sri will advise clearly if there is any clinical reason to act with greater urgency. Rushing a decision of this magnitude is never recommended when it can be avoided.

No. The majority of patients achieve social continence within the first year. At 6 weeks, the realistic expectation is dry at night and a single pad during the day for security. Pelvic floor exercises before and after surgery are the most important factor influencing recovery speed. Persistent leakage beyond 12 months is assessed for further interventions.

A PSA rise after prostatectomy — biochemical recurrence — does not necessarily mean the cancer has spread. Management depends on the timing, rate of rise, and pathological features. Options include active surveillance, salvage radiotherapy to the prostate bed, and systemic treatment. All decisions are made through the MDT with full patient involvement.

Both offer equivalent cancer control in most risk categories. Surgery's primary risks relate to urinary continence and erectile function; radiotherapy's primary risks relate to bowel and bladder irritation and long term erectile dysfunction. The right choice depends on your cancer characteristics, general health, and personal priorities. Mr Sri discusses both openly and refers directly to clinical oncology colleagues where radiotherapy is preferred. NICE NG131 sets out the current decision framework.

Related pages

Further information

Condition overview
Prostate cancer — staging, treatment pathway, and all options
Prostate cancer →
All procedures
Full range of urological procedures offered by Mr Sri
Treatments →
Prostate Cancer UK
Surgery for prostate cancer — comprehensive patient guide from the UK's leading charity
PCUK surgery guide →
Mr Denosshan Sri
MA Cantab  |  MB BChir  |  FRCS Urol  |  Consultant Urological Surgeon
Mr Sri performs over 200 robotic procedures annually at St George's University Hospital, where he leads the RCS-accredited robotic surgical fellowship. He is Principal Investigator of the ELLIPSE trial (RARP vs RARP with lymph node dissection for high-risk prostate cancer). His prostatectomy practice emphasises nerve-sparing technique, pre-operative pelvic floor preparation, and structured post-operative survivorship follow-up.
Full profile → Patient reviews →

Clinic locations

Spire Healthcare
St Anthony's Hospital, Cheam
801 London Road, Cheam, Surrey SM3 9DW
Tel: 020 8337 6691
Book at Spire →
Nuffield Health
Parkside Hospital, Wimbledon
53 Parkside, Wimbledon SW19 5NX
Tel: 020 8971 8000
Book at Nuffield →
HCA Healthcare UK
Princess Grace Hospital, Marylebone
18 Devonshire Street, London W1G 7AF
Tel: 020 379 77248
Book at HCA →

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