Robotic prostate surgery in Rome: when it is indicated

Robotic radical prostatectomy

Short answer. Robotic radical prostatectomy is the removal of the whole prostate with the Da Vinci Xi robot. It is one of the treatments for localised prostate cancer: it is decided after biopsy, MRI and staging, comparing it with radiotherapy and, for low-risk cancers, with active surveillance. The best-known consequences are urinary leakage (urinary incontinence) and difficulty with erections (erectile dysfunction). In Rome Dr. Calarco performs it at San Carlo di Nancy Hospital.

With the same Da Vinci Xi robotic system Dr. Calarco also treats kidney cancer (partial or radical nephrectomy) and bladder cancer (radical cystectomy): see Urologic oncology.

Who it may suit

Usually when the cancer is confined to the prostate and, in selected cases, when it is locally advanced. The decision takes into account:

PSA value, how aggressive the cancer is on biopsy (ISUP/Gleason grade) and stage;
result of the multiparametric MRI and of the staging tests;
age, general health and life expectancy;
the person’s preferences on side effects and recovery time.

The alternatives

active surveillance: in low-risk cancers treatment is deferred and PSA, MRI and any repeat biopsies are monitored;
watchful waiting: in elderly people or those with other major illnesses, treatment is given only if symptoms appear;
radiotherapy, with or without hormone therapy, and in selected cases brachytherapy;
other options to be discussed case by case.

The guidelines recommend discussing the options with the patient and, when possible, in a multidisciplinary team with a urologist, radiation oncologist and oncologist.

The pathway, step by step

First urology visit and review of the tests already done.
Diagnosis: PSA, multiparametric MRI, targeted prostate biopsy.
Staging with the tests indicated according to risk (for example CT, bone scan or PET).
Discussion of the options and shared choice of treatment.
Pre-operative tests and anaesthetic assessment.
Operation with the Da Vinci Xi robot.
Hospital stay and catheter removal (see “How it is performed”).
Final histology report and PSA checks in the following months.

How it is performed

The operation is performed under general anaesthesia with the Da Vinci Xi robotic system, through a few small incisions on the abdomen. The whole prostate and the seminal vesicles are removed and, when indicated by the risk of the cancer, the lymph nodes of the pelvis; the bladder is then reconnected to the urethra. The removed tissue is sent for histological examination.

At the end a catheter is placed, which allows the join between bladder and urethra to heal: the catheter generally stays in for about 7 days; the hospital stay is usually 3 days.

Continence after the operation

In the first weeks after the catheter is removed, urinary leakage is common, especially on effort. In most cases continence recovers over the following months; pelvic floor exercises and rehabilitation help. In a minority the leakage persists, and dedicated treatments exist. In Dr. Calarco’s experience, cases of persistent incontinence are in the lower range of the worldwide average. Individual risk is assessed at the visit.

Erections and the nerve-sparing technique

When the characteristics of the cancer allow it, the aim is to spare the nerve bundles that run beside the prostate and are needed for erections (nerve-sparing technique). Recovery depends mainly on age, erectile function before the operation and whether the nerves can be preserved; it can take many months and sometimes needs supportive treatment. Further reading: Nerve-sparing prostatectomy.

After radical prostatectomy there is no longer any emission of seminal fluid (anejaculation), while the sensation of orgasm is usually preserved.

Possible side effects and risks

urinary leakage (urinary incontinence), especially in the first months; rarely persistent;
difficulty with erections (erectile dysfunction), with variable recovery;
absence of ejaculation (anejaculation), always present after the operation;
bleeding, which rarely may require a transfusion;
urinary tract or wound infections;
collection of lymph in the pelvis (lymphocele), if lymph nodes are removed;
later on: narrowing of the scar between bladder and urethra;
rarely: venous thrombosis, injury to nearby organs or the need to convert the operation to open surgery;
risks related to general anaesthesia.

Risks and alternatives are discussed at the visit and set out in the informed consent.

Useful questions to ask the surgeon

What is the risk of my cancer and what alternatives do I have?
In my case, is it possible to preserve the nerve bundles?
What can I expect for continence and erections, given my data?
How long is the hospital stay and when is the catheter removed?
How will follow-up after the operation be organised?

Where it is performed

Dr. Alessandro Calarco directs the Robotic and Minimally Invasive Urology Unit (UOC) at San Carlo di Nancy Hospital (Via Aurelia 275, Rome), where he performs robotic radical prostatectomy with the Da Vinci Xi system, privately, under agreement with insurers or through the Italian National Health Service (SSN). He has been a specialist in Urology since 2013 and has personally performed more than 3,000 complex surgical procedures. Visits are also held at Nostra Signora della Mercede Clinic and the practice at Viale Aventino 38. Bookings: +39 366 6856844.

Frequently asked questions

When is robotic prostatectomy indicated?

Usually for localised prostate cancer and, in selected cases, locally advanced cancer, in patients whose general health and life expectancy are compatible with the operation. The decision takes into account PSA, tumour grade, MRI and age.

Does the robot give better results than traditional surgery?

The available studies indicate cancer and functional outcomes similar to those of open surgery, with less blood loss and a shorter hospital stay with the robot. The experience of the team matters a great deal.

How long do the hospital stay and the catheter last?

The hospital stay is usually 3 days; the catheter generally stays in for about 7 days. Exact timing depends on recovery and is given before the operation.

Will there be incontinence or erection problems after the operation?

There may be, especially in the first months: they are the best-known consequences of the operation. In most cases continence recovers over the following months; recovery of erections depends on age, function before the operation and whether the nerve bundles can be preserved. Individual risk is assessed at the visit.

Can I ask for a second opinion?

Yes. A review visit can take place in person or, over long distances, also online, by arrangement with the secretary's office. It is useful to have all clinical documentation to hand (PSA, biopsy, MRI, any PET).

Where is it performed in Rome?

At San Carlo di Nancy Hospital, Via Aurelia 275, Rome, privately, under agreement with insurers or through the Italian National Health Service (SSN). To book a visit: +39 366 6856844.

Sources

EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer, current edition.
Yaxley JW, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016.
Coughlin GD, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncology. 2018.

Author and review: Dr. Alessandro Calarco, urologist, Director of the Unit of Robotic and Minimally Invasive Urology at San Carlo di Nancy Hospital · ORCID 0000-0001-6893-2179 · Last updated: 30 October 2026. For information only: this content does not replace a medical consultation. Any test or treatment is decided only after a visit.

Robotic prostate surgery in Rome: indications, pathway, recovery