What Is Robotic Simple Prostatectomy?

A simple prostatectomy removes the inner, obstructing portion of an enlarged prostate (the "adenoma") while leaving the outer "capsule" of the gland in place. It is a treatment for benign prostatic hyperplasia (BPH) — not for prostate cancer — and is reserved for men with very large prostates that are too big to safely treat with TURP, laser enucleation, or water-jet ablation.

The procedure was historically done as an open operation through a 6–8 inch abdominal incision, with a long recovery. Today it can be done robotically using either:

  • Multi-port robot (da Vinci Xi) — 5–6 small incisions
  • Single Port robot (da Vinci SP) — a single 2.5 cm incision, usually in the lower abdomen, through which all four robotic instruments and the camera are introduced

Why Single Port (SP)?

The da Vinci SP uses one incision instead of five, which means less postoperative pain, faster return to normal activity, and a single small scar that is often hidden below the belt line. For appropriately selected patients, SP simple prostatectomy delivers the same durable BPH relief as the open or multi-port versions with a meaningfully gentler recovery.

Who Is a Candidate?

Ideal Candidates

  • Very large prostate — typically over 80 grams, often 100–300+ g
  • Significant BPH symptoms despite medication (Flomax, finasteride, etc.)
  • Recurrent urinary retention or need for a Foley catheter
  • Recurrent UTIs or bladder stones from incomplete emptying
  • Bladder diverticula or kidney effects from chronic obstruction
  • Prefer a single, durable surgical solution over repeat procedures

May Not Be Ideal For

  • Smaller prostates (<80 g) — usually better treated with ThuLEP, Aquablation, or UroLift
  • Known or suspected prostate cancer (a different operation — see robotic prostatectomy)
  • Major prior pelvic surgery that has scarred the operative space
  • Patients who cannot tolerate general anesthesia

How the Procedure Works

SP robotic simple prostatectomy is performed under general anesthesia and usually takes 2–3 hours, depending on prostate size.

The Steps

  • Single incision: a 2.5 cm cut in the lower abdomen, often hidden below the belt line
  • SP port placement: the SP cannula is inserted; four instruments and a flexible 3D camera articulate inside the pelvis through the one port
  • Access to the prostate: the surgeon opens the prostate capsule
  • Enucleation: the obstructing inner adenoma is carefully separated and removed in pieces
  • Hemostasis: the prostate capsule is meticulously closed and any bleeding controlled
  • Closure: a Foley catheter is placed and the single incision is closed with absorbable sutures

At-a-Glance

  • Duration: 2–3 hours
  • Anesthesia: general
  • Incisions: one (2.5 cm)
  • Hospital stay: typically overnight (1 night)
  • Catheter: usually removed at 5–7 days
  • Tissue sent to pathology: yes — to confirm benign disease

Outcomes & Durability

Outcome Result
Symptom improvement (IPSS) ~70–80% reduction
Maximum urinary flow rate (Qmax) Typically doubles or triples
Need for re-operation <3% over 10 years (very durable)
Hospital stay (SP vs open) 1 night vs 3–5 nights
Blood loss (SP vs open) Significantly less
Return to normal activity 2–4 weeks

Simple prostatectomy is one of the most durable BPH procedures because the obstructing tissue is physically removed rather than ablated or held open by an implant. Re-treatment is rare.

Recovery

Days 1–7

  • Overnight in the hospital, home the next day
  • Foley catheter in place to allow the prostate capsule to heal
  • Mild incisional discomfort, controlled with non-narcotic medication
  • Light walking encouraged; no driving while on opioid pain medication

Week 1–2

  • Catheter removed at 5–7 days, usually in clinic with a brief voiding trial
  • Expect some pink-tinged urine for a few weeks — this is normal
  • No heavy lifting (>10 lbs / ~4.5 kg) and no strenuous activity
  • Most patients return to desk work in 1–2 weeks

Weeks 2–6

  • Gradual return to all activity including exercise
  • Resume sexual activity after 4–6 weeks once cleared
  • Follow-up visit to review symptoms and pathology

Risks & Potential Complications

  • Bleeding — uncommon to need transfusion; SP approach significantly reduces blood loss vs open surgery
  • Infection — uncommon; antibiotics given at surgery
  • Bladder neck contracture — narrowing of the bladder outlet that can occur in a small percentage and may need a minor procedure to correct
  • Temporary urine leakage — common after catheter removal, usually improves over weeks with pelvic floor exercises
  • Retrograde ejaculation — most patients will experience "dry orgasm" (semen flows backward into the bladder instead of out); does not affect orgasm sensation
  • Erectile dysfunction — uncommon as a new problem from simple prostatectomy, since the nerves that control erections sit outside the prostate capsule
  • Incidental finding of prostate cancer — the removed tissue is sent to pathology; cancer is rarely identified and usually low-grade, but treatment plans are adjusted if it is

How It Compares to Other BPH Surgeries

Procedure Best for prostate size Incisions Catheter Durability
UroLift 30–80 g (no median lobe) None Often none ~5 yr
Aquablation 30–150 g None (through urethra) 1–2 days Very good
ThuLEP 30–200+ g None (through urethra) 1–2 days Excellent
SP Robotic Simple Prostatectomy Very large (>80 g, especially >150 g) One (2.5 cm) 5–7 days Most durable

For more on choosing among the options, see our BPH procedures comparison guide.

Frequently Asked Questions

Is this surgery for prostate cancer?

No. Simple prostatectomy treats benign prostate enlargement. It removes only the obstructing inner tissue and leaves the prostate capsule in place. It is a different operation from a radical prostatectomy, which is done for prostate cancer.

Why Single Port instead of multi-port?

The SP system uses one 2.5 cm incision instead of five. Patients typically have less postoperative pain, a shorter hospital stay, and a smaller, often hidden scar. The cancer/BPH outcomes are equivalent — SP improves the experience, not the result.

Why not just do TURP?

TURP works well for prostates up to about 80 g but becomes less safe and less complete for very large glands. For prostates over 80–100 g, enucleation procedures (ThuLEP, HoLEP) or simple prostatectomy are recommended. SP simple prostatectomy is often the best fit for the largest prostates.

Will I have ejaculation changes?

Most patients will experience retrograde ejaculation — semen flows backward into the bladder rather than out — after any major BPH surgery, including this one. Orgasm sensation is preserved. This is not a fertility-preserving procedure.

Is the SP robot covered by insurance?

Yes. Simple prostatectomy is a standard, insurance-covered BPH procedure regardless of whether it is done open, multi-port robotic, or single-port robotic. Our office will verify coverage before scheduling.

Lasting Relief for Very Large BPH

If you have a very large prostate that is not getting better with medication — or has caused retention, recurrent infections, or bladder damage — Single Port robotic simple prostatectomy offers durable relief with one small incision and a single overnight stay.

  • ✅ One small incision, often hidden below the belt line
  • ✅ Designed for the largest prostates (>80 g)
  • ✅ Most durable BPH procedure available
  • ✅ Experienced SP surgical team
Schedule Your Consultation

Call 678-344-8900 to speak with our team