For men having surgery for prostate cancer, keeping bladder control and sexual function are often the biggest concerns after the cancer itself. A nerve-sparing robotic prostatectomy is designed to address both. Preserving function is not a single step in the operating theatre, though. It begins with careful planning and continues through a structured recovery. This article follows that process from start to finish.
Planning starts with your scans
Before surgery, your MRI scan and biopsy results show where the cancer sits and how close it is to the edge of the prostate. Because the nerves that control erections run along each side of the gland, this information shapes the plan for each side separately.
If the cancer lies well within the prostate on one side, the nerves there can often be preserved. If it is close to the edge or beyond it, removing more tissue on that side may be necessary to treat the cancer completely. Our guide to nerve-sparing techniques explains the anatomy in more detail.
Agreeing the plan with you
Your surgeon should explain what they expect to be possible and why. This is also the moment to talk about what matters most to you. For some men, preserving erections is a high priority; for others, the main concern is the most complete removal of the cancer. Both are reasonable, and the plan should reflect your wishes as well as the clinical findings. Bringing your partner to this conversation can help, since decisions about sexual function often affect you both.
Cancer control always comes first. A good surgeon will be honest if nerve-sparing on one or both sides would increase the risk of leaving cancer behind.
During the operation
Robotic surgery gives the surgeon a magnified 3D view and fine control of the instruments. This makes it possible to separate the prostate from the nerve bundles layer by layer. The surgeon may adjust the plan during the operation, depending on what they see. You will be told afterwards how much nerve-sparing was possible on each side, which helps set expectations for recovery. Our robotic prostatectomy page describes the operation as a whole.
Rehabilitation after surgery
Bladder control
Pelvic floor exercises, ideally started before surgery, help bladder control return. Most men regain control over weeks to months, and a specialist physiotherapist can help if progress is slow.
Erectile function
Even when the nerves are preserved, they need time to recover. Many teams recommend a structured rehabilitation programme, which may include tablets, a vacuum device or, in some cases, injections. The aim is to support healthy blood flow while the nerves heal. Our article on erectile function after surgery explains what to expect and how long recovery can take.
Follow-up
Regular PSA tests check that the cancer has been controlled. Follow-up appointments are also an opportunity to review progress with continence and sexual function and to adjust support. Prostate Cancer UK offers independent advice on living with side effects, including a specialist nurse helpline.
Why experience matters
Nerve-sparing is one of the most demanding parts of the operation, and results are more consistent in experienced hands. Professor Dasgupta has many years of experience in robotic surgery and in the techniques that protect function. Our article on why surgeon experience matters explains this further, and NICE guidance sets out the standards for treatment and follow-up.
Quality of life as a goal
A nerve-sparing robotic prostatectomy aims to treat the cancer effectively while protecting the functions that matter to everyday life. With careful planning, skilled surgery and good rehabilitation, many men return to the life they had before diagnosis.
To discuss whether nerve-sparing surgery may be possible for you, please contact the clinic to arrange a consultation.