Preparing for Robotic Prostatectomy Melbourne — Before, During & After Surgery

A diagnosis of localised prostate cancer is rarely an emergency — and that is good news. It gives you the time to understand your options, optimise your fitness, choose the right surgeon, and walk into theatre fully prepared. For most men, the chosen curative treatment is robotic radical prostatectomy performed with the da Vinci surgical system.

This guide explains exactly what to expect before, during and after robotic prostatectomy in Melbourne with Dr Brendan Dias — including the different surgical approaches such as standard anterior, nerve-sparing and Retzius-sparing robotic prostatectomy.

Robotic Prostatectomy Melbourne — Why the Robot?

Robotic radical prostatectomy uses the da Vinci platform to remove the entire prostate and seminal vesicles through four to five small (8–12 mm) keyhole incisions. Compared with traditional open surgery, the robotic approach offers:

• 10× magnification and 3D high-definition vision for precise dissection around delicate nerves
• Wristed instruments that allow fine, tremor-free movement inside the pelvis
• Minimal blood loss — transfusion is rare
• Shorter hospital stay — typically 1–2 nights
• Faster return to normal activities than open surgery
• Equivalent or better functional outcomes for continence and erectile function

Different Approaches to Robotic Prostatectomy

Not all robotic prostatectomies are performed the same way. Dr Dias tailors the approach to your tumour characteristics, anatomy and personal priorities.

Standard (Anterior) Robotic Prostatectomy

The most widely performed technique worldwide. The bladder is dropped from the anterior abdominal wall and the prostate is approached through the space of Retzius. Excellent oncological outcomes and a robust procedure for almost any tumour configuration. Continence typically returns over 3–12 months.

Retzius-Sparing Robotic Prostatectomy

An advanced posterior approach via the pouch of Douglas that preserves the puboprostatic ligaments, endopelvic fascia and anterior bladder support — the anatomy responsible for early continence. Most men in published Retzius-sparing series are pad-free within 1–4 weeks of catheter removal, with equivalent cancer control when performed by an experienced robotic surgeon.

Nerve-Sparing Technique

The neurovascular bundles running on either side of the prostate carry the nerves responsible for erections. Where your cancer allows, Dr Dias preserves these bundles unilaterally or bilaterally, maximising the chance of erectile function recovery. The decision is guided by your MRI, PSA and biopsy histology.

Before Surgery — Preparing in the Weeks Leading Up

1. Consultation and Decision-Making

Your first appointment with Dr Dias is a detailed discussion of your biopsy, PSA trend, MRI, PSMA PET (if performed) and overall health. Together you will decide between active surveillance, robotic prostatectomy and radiation therapy — and, if surgery is chosen, which technique is best for your cancer and lifestyle. See our full guide to prostate cancer in Melbourne for background reading.

2. Pelvic Floor Exercises (Start ASAP)

Beginning pelvic floor (Kegel) exercises 4–6 weeks before surgery significantly improves continence recovery. Aim for 3 sets of 10 contractions daily. A specialist men's health physiotherapist can confirm you are activating the correct muscles — Dr Dias's rooms can recommend local Melbourne physios.

3. General Fitness, Weight and Smoking

• Walk 30–45 minutes daily and continue any regular cardio
• Modest weight loss in overweight men reduces operative risk and improves continence outcomes
• Stop smoking at least 4 weeks before surgery — this reduces anaesthetic, wound and cardiopulmonary complications
• Limit alcohol in the week before surgery

4. Medication Review

Bring a full list of medications and supplements to your pre-admission appointment. Blood thinners (aspirin, clopidogrel, warfarin, apixaban, rivaroxaban), diabetes medications (metformin, SGLT2 inhibitors) and some herbal supplements need to be paused or adjusted. Dr Dias and your anaesthetist will give you a written plan.

5. Pre-Admission Clinic, Bloods and Imaging

You will have blood tests, ECG and an anaesthetic assessment 1–2 weeks before surgery. Final-stage imaging (such as a PSMA PET scan) is reviewed to confirm there is no extra-prostatic disease.

6. Practical Preparation at Home

• Stock up on loose, comfortable clothing — tracksuit pants are ideal for the catheter
• Buy a few packs of incontinence pads/pull-up pants for after catheter removal
• Arrange someone to drive you home and stay with you for the first 24–48 hours
• Plan 2–3 weeks off work; longer for manual jobs
• Fast from midnight the night before surgery (clear fluids until 2 hours pre-op)

During Surgery — What Happens in Theatre

1. Anaesthesia and Positioning

You will be put fully to sleep under general anaesthesia by your consultant anaesthetist. You are positioned on the operating table head-down (steep Trendelenburg) so that the bowel falls away from the pelvis, giving Dr Dias a clear view of the prostate.

2. Port Placement

Four to five small keyhole ports (8–12 mm) are placed across the lower abdomen. The abdomen is gently inflated with carbon dioxide, and the da Vinci robotic arms are docked.

3. The Prostatectomy (2–3 hours)

Working from the surgeon console with full 3D vision, Dr Dias removes the prostate and seminal vesicles while protecting the neurovascular bundles where possible. The pelvic lymph nodes may also be removed if your cancer risk profile warrants it. Whether the approach is Retzius-sparing or standard anterior is decided pre-operatively and confirmed intra-operatively.

4. Vesicourethral Anastomosis and Catheter

The bladder is rejoined to the urethra with a watertight running suture. A urinary catheter is left in place to allow the join to heal. A small drain may be left for 24 hours.

Immediately After Surgery

• You wake in recovery and return to the ward — most men are sitting out in a chair the same evening
• Pain is generally mild and managed with paracetamol, anti-inflammatories and short-term opioids if needed
• You will eat and drink the same day and walk the next morning
• Anti-clot injections continue until you are fully mobile, plus compression stockings
• Discharge is usually on day 1 or day 2 with a catheter, leg bag and clear written instructions

Recovery Timeline

Catheter Care at Home

Keep the catheter taped to your inner thigh, drain the leg bag when it is half full, and switch to a larger overnight bag at bedtime. Drink 1.5–2 L of water daily. Some pink-tinged urine is normal. Contact Dr Dias's rooms urgently if the catheter stops draining, you develop fever, or you experience heavy fresh bleeding.

Continence Recovery

Stress leaks (with coughing, standing or exercise) are common after catheter removal and improve week by week. Strategies that genuinely help:

• Pelvic floor exercises 3× daily — quality over quantity
• Avoid heavy lifting for 4–6 weeks
• Cut back caffeine and alcohol initially
• See a men's health physiotherapist if leakage persists at 6 weeks

For the small number of men with persistent incontinence beyond 12 months, surgical options such as a male sling or artificial urinary sphincter are highly effective.

Sexual Recovery and Penile Rehabilitation

With nerve-sparing technique, gradual erectile recovery occurs over 12–24 months. Dr Dias supports a structured penile rehabilitation programme — typically combining a daily low-dose PDE5 inhibitor (e.g. tadalafil), a vacuum erection device and, where needed, intracavernosal injections. Starting early (within 2–4 weeks) gives the best results.

Follow-Up and PSA Monitoring

You will see Dr Dias 2–3 weeks after surgery to review pathology and at 6 weeks to discuss continence and erectile recovery. PSA is then checked every 3 months for 2 years, every 6 months until year 5, then annually. PSA should be undetectable after radical prostatectomy. A rising PSA prompts further imaging and discussion of salvage radiotherapy.

Risks to Be Aware Of

Robotic radical prostatectomy is a major operation. The most common risks include temporary urinary incontinence, erectile dysfunction, dry orgasm, bladder neck contracture, lymphocele (if nodes are removed), small risks of bleeding and infection, and rare risks of bowel or vascular injury. Dr Dias will go through these in detail and provide a written consent.

About Dr Dias and Robotic Prostatectomy in Melbourne

Dr Brendan Dias is a Melbourne-based consultant urologist and robotic surgeon performing robotic prostatectomy across leading Melbourne hospitals. He offers the full suite of techniques — standard anterior, nerve-sparing and Retzius-sparing robotic prostatectomy — and personalises the approach to each man's cancer and lifestyle goals.

For a full overview of prostate cancer management — screening, MRI-targeted transperineal biopsy, active surveillance and treatment — see our prostate cancer treatment hub.

Frequently Asked Questions

Next Steps

If you have been recommended robotic prostatectomy in Melbourne and want a clear, unhurried discussion of your options — including whether Retzius-sparing or standard nerve-sparing technique suits your cancer — book a consultation with Dr Dias. A GP or specialist referral is required to access your Medicare rebate.