Prostatectomy Recovery Timeline: What to Expect Week by Week

Recovery after radical prostatectomy (open, laparoscopic, or robotic) varies by approach, patient factors, and nerve-sparing status. This timeline outlines typical milestones for robotic-assisted laparoscopic prostatectomy (RALP), the most common approach.

Hospital Phase (Days 0–1)

• Day 0 (Surgery): 2–4 hr procedure. PACU 2–4 hrs. Pain controlled with IV → oral multimodal regimen (acetaminophen, gabapentin, limited opioid).
• Day 1: Catheter remains. Clear liquids → regular diet. Ambulate 3–4x. Drain removed if output <50 mL/8hr. Discharge criteria met: pain controlled on PO meds, tolerating diet, ambulating, voiding trial not yet (catheter in place).

Weeks 1–2: Catheter Phase

• Catheter in place (typically 7–10 days post-RALP).
• Pain: Minimal incisional; bladder spasms common (oxybutynin PRN).
• Activity: Walk 5–10 min q2–3h awake. No lifting >10 lbs. No driving while on opioids or catheterized.
• Bowels: Stool softener (docusate) + fiber + hydration. Goal: soft daily BM by day 3.
• Incision care: Dermabond/glue or steri-strips. Shower daily (pat dry). No soaking.
• Follow-up: Day 7–10 for catheter removal (cystogram if surgeon prefers).

Weeks 2–6: Early Continence & Potency Recovery

• Catheter removed: Expect urgency, frequency, stress leakage. Pad use universal initially.
• Pelvic floor PT: Start Kegels immediately post-removal (biofeedback ideal). 3 sets 10 reps, 3x/day.
• Continence trajectory: 0 pads/day at 3 mo: ~70–85%; 12 mo: ~90–95% (surgeon/volume dependent).
• Erectile function: Nerve-sparing status key. Early rehabilitation: PDE5i (daily low-dose), vacuum device, intracavernosal injections per protocol. Recovery 6–24 months.
• Activity progression: Light core at 3 wks, golf 4–6 wks, heavy lifting 6–8 wks.

Weeks 6–12: Functional Restoration

• Most return to desk work by 2–3 wks; physical work 4–6 wks.
• PSA nadir (<0.01 ng/mL) expected by 4–6 wks (confirm surgical cure).
• Penile rehab continues; consider referral to sexual medicine if no spontaneous erections by 3 mo.

Long-Term (3–12+ Months)

• PSA q3–6 mo x 2 yrs, then annually.
• Continence plateau; consider male sling or AUS if persistent SUI >1 yr.
• Erectile function may improve up to 2 yrs with consistent rehab.
• Lifestyle: weight control, exercise, smoking cessation optimize outcomes.

Red Flags – Call Surgeon Immediately

• Fever >101°F, increasing pain, wound drainage
• Inability to urinate after catheter removal
• Heavy bleeding, clot retention
• Calf pain/swelling (DVT)
• Severe rectal pain (rare rectal injury)

Every patient's recovery is unique. Follow your surgeon's specific protocol—this is a general framework.