Robotic prostatectomy.

What it is

Robotic prostatectomy — formally, robot-assisted laparoscopic radical prostatectomy — is the surgical removal of the prostate gland and seminal vesicles to treat prostate cancer. Dr. Ursiny performs it through five small abdominal incisions using the da Vinci robotic platform, operating the instruments from a console at the patient's side. The robot does not act on its own.

For men with localized prostate cancer who choose surgery, the robotic approach is now the most common way the operation is performed. It typically allows for small incisions, minimal blood loss, a short hospital stay, and a relatively quick return to normal activity, with cancer control equivalent to other established surgical techniques.

Who it's for

Robotic prostatectomy is one of two well-established curative treatments for localized prostate cancer (the other being radiation therapy). It is most often chosen by men who:

• Have intermediate- or high-risk localized prostate cancer that warrants definitive treatment
• Are otherwise reasonable surgical candidates with a favorable life expectancy
• Prefer the certainty of a surgical specimen, which yields the most accurate final pathology and risk stratification
• Want to keep radiation in reserve as a future option rather than use it as primary therapy

It is also offered to selected men with low-risk prostate cancer who, after a thorough discussion of active surveillance, prefer to proceed with surgery.

Dr. Ursiny's approach

The operation takes roughly 1.5 to 2.5 hours under general anesthesia, depending on complexity. Once the prostate is removed, the bladder is reconnected to the urethra over a soft catheter that stays in for about a week. Almost all patients go home the same day or the next morning. Three technical points matter most to outcomes:

Nerve-sparing

The nerves that drive erections run in microscopic bundles along either side of the prostate. When the cancer allows, Dr. Ursiny frees these bundles off the prostate before removing it. Whether full, partial, or no nerve-sparing is appropriate is guided by the MRI, the biopsy, the PSA, and what is found during surgery — and is discussed individually beforehand.

Continence and the sphincter

Urinary continence after prostatectomy depends primarily on preserving the external urinary sphincter — the muscle just below the prostate that holds urine back. (Contrary to a common assumption, preserving the bladder neck is not the decisive factor; sphincter preservation is.) Dr. Ursiny's reconstruction is built around protecting and supporting the sphincter and the surrounding structures. Pelvic-floor physical therapy, begun before surgery, helps recovery along.

Pelvic lymph-node dissection

For select intermediate-risk cancers and for high-risk cancers, the standard of care is a bilateral pelvic lymph-node dissection (BPLND) performed during the same operation, for accurate staging. Whether it is indicated — and it often is not for lower-risk disease — is individualized to each patient's cancer.

Why surgeon volume matters

For complex robotic operations, the link between a surgeon's annual volume and patient outcomes is one of the most consistent findings in surgical research. Higher-volume surgeons tend to have:

• Lower rates of positive surgical margins (cancer cells at the edge of the specimen)
• Better urinary continence outcomes
• Better erectile-function outcomes when nerve-sparing is performed
• Fewer complications and shorter operative times

Dr. Ursiny is a deliberately high-volume robotic prostate surgeon, and has been since his training and faculty years at Massachusetts General Hospital.

Recovery at a glance

First week. Home with a catheter for about seven days. Pain is usually controlled without strong opioids. Most men walk the day of surgery and return to desk work within one to two weeks.

Continence. Almost everyone leaks somewhat once the catheter is removed, then improves steadily. Most of Dr. Ursiny's patients are dry by three months. A small percentage have persistent stress urinary incontinence at one year, for which effective salvage options exist.

Erectile function. Recovery is slower and more variable than continence, and depends most on function before surgery, age, and the extent of nerve-sparing. Penile rehabilitation follows an individualized protocol based on shared decision-making, revisited at every follow-up.

Cancer follow-up. The first PSA is checked about two to three months after surgery, then on a schedule based on the final pathology.

Risks worth understanding

Robotic prostatectomy is a major operation. The risks worth understanding include urinary incontinence (usually temporary, occasionally persistent), erectile dysfunction (common in the early months; depends on nerve-sparing), bleeding requiring transfusion (uncommon with the robotic approach), positive surgical margins (lowest in high-volume hands), bladder-neck contracture or urethral stricture (uncommon), lymphocele after node dissection (usually self-resolving), and the general risks of surgery under anesthesia, including blood clots (minimized with early walking and prophylaxis). Dr. Ursiny reviews each of these — what it means, how likely it is in a given case, and how it is prevented and managed — before surgery.

The bigger picture

Surgery is one piece of a larger conversation. Before recommending it, Dr. Ursiny reviews the prostate MRI, the biopsy pathology, the PSA history, family history, overall health, and the patient's priorities — and walks through what active surveillance, radiation, focal therapy, and clinical trials would each look like. Many men leave the first consultation without a decision yet, which is exactly right.

For disease that is node-positive, recurrent after primary treatment, or metastatic, see Advanced Prostate Cancer.

Frequently asked questions

How long is the hospital stay?

Most patients go home the same day or the morning after surgery.

How long is the catheter in?

About seven days. It is removed at a brief office visit.

When can I drive? Return to work? Exercise?

Driving once off opioid pain medication and able to react quickly. Many men prefer not to drive while the catheter is in place (about a week) — that is perfectly reasonable. Desk work in one to two weeks; heavier physical work and full exercise at four to six weeks.

Will I be incontinent?

Some leakage is normal in the early weeks after the catheter comes out. Most of Dr. Ursiny's patients are dry by three months. A small number have longer-lasting stress incontinence, for which there are effective treatment options.

Will I be able to have erections?

Recovery depends most on function before surgery, age, and the extent of nerve-sparing. Penile rehabilitation is individualized and decided together, and revisited at every follow-up.

Can I come in for a second opinion?

Yes — second opinions are welcome. Whether your insurance requires a referral depends on your specific plan, so it's worth a quick call to the office to confirm what yours needs.

How quickly can I be seen?

New cancer consultations are typically scheduled within one to two weeks.

Part of prostate cancer care at this practice — diagnosis, treatment, and long-term management.