Radical prostatectomy: an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Radical prostatectomy in one minute
What it is: surgery to remove the whole prostate and the seminal vesicles, usually for prostate cancer.
Who it is for: men with cancer confined to the prostate, after discussion of all options.
Main risks: incontinence, erection problems, bleeding, infection, injury to nearby organs (rare).
Usually: robot-assisted keyhole under general anaesthetic, 2–4 hours, 1–2 nights in hospital, home with a catheter.
On this page: What is a radical prostatectomy? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is a radical prostatectomy?
A radical prostatectomy removes the prostate and seminal vesicles, and sometimes nearby lymph nodes. It is one of several treatments for prostate cancer, alongside radiotherapy and active surveillance.
Most are done by robot-assisted keyhole surgery: the surgeon controls instruments through small ports from a console. Open surgery is also used.
The surgeon:
- frees the prostate from the bladder and rectum
- may spare the nerves for erections where it is safe
- removes the prostate
- joins the bladder neck to the urethra over a catheter (the anastomosis)
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- prostate cancer confined to the prostate
- some locally advanced cancers, as part of combined treatment
The decision is made with your urology and cancer team (multidisciplinary team), who will talk through all the options, including radiotherapy and surveillance, and the risks with you.
When is it done?
Most operations are planned; some are urgent. Before it, you usually have:
- MRI and biopsy results and a team review
- blood tests and an ECG
- a review of medicines, especially blood thinners, as per centre protocol
- pelvic floor exercise advice
- a chance to ask questions and give consent
Step by step
1. Getting ready
Team brief and WHO checklist first, including the side and site marking. The anaesthetic team and ODP give a general anaesthetic (with a steep head-down position, often for several hours, as per centre protocol) and place lines as needed; antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning, pressure areas, the diathermy plate, warming, and that the camera stack (and robot, if used) works. The scrub practitioner sets up the keyhole trolley and an open set in case of conversion, and does the first count. The patient is secured for the steep head-down tilt, and pressure areas and eyes are protected.
2. Access
Usually five or six small port cuts across the abdomen for robot-assisted or keyhole surgery; occasionally one lower midline cut for open surgery.
3. Removing the prostate
- A. Prostate exposed. The prostate is reached and freed from the bladder.
- B. Nerve sparing. Nerves for erections are preserved where safe.
- C. Prostate removed. The prostate and seminal vesicles are removed in a bag.
- D. Anastomosis. The bladder is joined to the urethra over a catheter.
Lymph nodes may also be removed, per surgeon. The specimen is retrieved through an enlarged port cut.
4. Finishing
The specimen is removed, a drain may be placed, per surgeon, and ports closed. Final counts are confirmed, the specimen labelled and checked, and the patient goes to recovery with a catheter and a full handover.
Recovery and aftercare
- First day: up and walking; drinking and eating.
- Going home: often 1–2 days, with a catheter.
- Catheter: usually removed after 1–2 weeks.
- Continence: leakage is common at first and improves with pelvic floor exercises.
- Erections: recovery can take months; support is available.
- Follow-up: PSA blood tests to check for cancer.
Call 999 if you have chest pain, sudden breathlessness or collapse. Contact your team urgently if you cannot pass urine, pass large clots, have a high temperature or shivering, or have severe pain.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- urinary incontinence, usually improving
- erection problems
- bleeding
- infection
- leak from the join
- injury to the bowel or ureter (rare)
- blood clots in the legs or lungs
- hernia at a port site
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- robotic system or laparoscopic stack, per centre, with drapes and instruments per device and operator
- ports, sizes per device and operator, and an entry needle or open-entry kit, per surgeon
- laparoscopic graspers, scissors, dissectors and suction-irrigation
- energy device, per surgeon
- clips and sutures for the anastomosis, per surgeon
- retrieval bag
- catheter and drain, per surgeon
- steep head-down positioning and pressure care
Procedural steps
- Team brief, WHO sign in; anaesthesia; lines
- Positioning, secured for head-down tilt; prep and drape; count
- Ports; robot docked if used
- Prostate freed; nerves spared if safe; prostate removed
- Anastomosis over catheter; specimen in bag
- Undock; specimen out; closure; counts; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
- Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
- Specimens. Label every specimen with site and side, and check it with the scrub practitioner before it leaves theatre.
- Head-down tilt. Check the patient is secured and pressure areas protected before tilting.
- Robot emergency undock. Know your role in an emergency undock, as per centre protocol.
FAQ
Will I be incontinent?
Leakage is common at first and usually improves over weeks to months.
Is the robot doing the surgery?
No; the surgeon controls every movement from the console.
How long will I have a catheter?
Usually 1–2 weeks.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- NICE. Prostate cancer: diagnosis and management (NG131). nice.org.uk/guidance/ng131
- NHS. Treatment for prostate cancer. nhs.uk/conditions/prostate-cancer/treatment
- StatPearls (NCBI Bookshelf), search: radical prostatectomy. ncbi.nlm.nih.gov/books
- British Association of Urological Surgeons. Patient information leaflets. baus.org.uk
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
