Understanding the Side Effects of Robotic Prostatectomy: An Honest Guide for Patients

Written by Mr Neil Haldar, Consultant Urological Surgeon. GMC 3683914. Last reviewed: [May 2026].

If you are reading this, you or someone close to you has likely been diagnosed with prostate cancer and is considering robot-assisted radical prostatectomy. One of the first questions patients ask me in clinic is what the robotic prostatectomy side effects are, honestly. This article is my attempt to answer that question openly — covering urinary incontinence, erectile dysfunction, and the less common complications you should be aware of, as well as the rehabilitation that meaningfully improves recovery.

Robotic prostatectomy is a remarkably sophisticated operation, and in my own practice — having started the da Vinci robotic surgery programme at Buckinghamshire Healthcare NHS Trust — I have seen how it has transformed outcomes for men with localised prostate cancer. But no operation is without consequences, and you deserve a clear-eyed account before you make your decision.

What is robotic prostatectomy?

Robot-assisted radical prostatectomy is an operation to remove the prostate gland, along with the seminal vesicles and sometimes nearby lymph nodes, to treat prostate cancer. The “robotic” part refers to the da Vinci surgical system, which allows me to operate through a handful of small keyhole incisions using miniaturised instruments with articulating wrists. The precision and magnified 3D vision it offers are genuinely extraordinary — but the operation still involves removing an organ that sits between your bladder and your erectile nerves, and that has implications.

The two side effects that matter most to the vast majority of men are urinary incontinence and erectile dysfunction. I will cover these in detail, along with the less common complications you should also be aware of.

Urinary incontinence: what to expect

The short version: most men will leak urine in the weeks after their catheter is removed, and most men will recover. A meaningful minority, however, will have some ongoing leakage in the long term.

In the first few weeks, nearly everyone experiences some degree of urinary leakage. This is normal. The muscle responsible for continence (the external urethral sphincter) has been working in partnership with the prostate for your whole adult life, and once the prostate is removed, it needs time to take on the full job.

By twelve months, around four out of five men are pad-free or using only a small security pad. Put another way, about one in five men still report using at least one pad a day at the twelve-month mark in the best published series.

In the longer term, continence continues to improve slowly for some men out to two or even three years after surgery. A large study published in European Urology found that among men still incontinent at twelve months, around 30% achieved good urinary function by 24 months, and almost 60% by 48 months. So even if recovery feels slow, it is worth persevering.

What affects recovery? Age is the single biggest factor. Pad-free rates at twelve months are around 86% for men under 55, but closer to 50% for men aged 75 and over. Other important factors include the severity of leakage in the early weeks and — crucially — whether you engage with pelvic floor physiotherapy.

Erectile dysfunction: the harder conversation

Sexual function after prostatectomy is the side effect patients find hardest to discuss, and I am going to be direct with you.

Immediately after surgery, virtually no man has spontaneous erections adequate for intercourse. The nerves that control erections (the neurovascular bundles) run along either side of the prostate, and even when I am able to preserve them meticulously — what we call nerve-sparing — they undergo a period of “shock” called neuropraxia that typically lasts months, not weeks.

By twelve months, somewhere between 30% and 70% of men who had good erectile function before surgery will have recovered erections adequate for intercourse, often with the help of a tablet such as sildenafil (Viagra) or tadalafil (Cialis). The huge range reflects the importance of three factors:

• Your erectile function before surgery. This is the strongest predictor. Men with excellent preoperative function recover best.
• Whether nerve-sparing is possible. Bilateral (both sides) nerve-sparing gives the best chance of recovery. In some cancers, however, sparing the nerves would compromise cancer control, and in that situation, the cancer takes priority.
• Your age. Younger men recover more completely and more quickly.

In the longer term, recovery can continue for two to four years, though most of the gains occur in the first 18 months. Interestingly, a large American study (CEASAR, published in JAMA in 2024) found that by ten years after diagnosis, sexual function scores were broadly similar across all prostate cancer treatments — including active surveillance, radiotherapy, and surgery — because natural age-related decline closes the gap.

Other complications you should know about

Robotic prostatectomy is generally very safe. The overall complication rate is around 9%, and the large majority of those complications are minor and self-limiting. Still, a complete picture requires honesty about the less common possibilities:

• Blood loss and transfusion. Blood loss averages around 150 ml (well under a teacup), and transfusion is needed in less than 2% of cases — significantly lower than with traditional open surgery.
• Lymphocele. A collection of lymphatic fluid in the pelvis occurs in around 3% of men who have lymph node dissection. Most resolve without treatment; occasionally, drainage is required.
• Urinary leak from the join. The join between the bladder and the urethra (the anastomosis) leaks in about 2% of cases. This usually means keeping the catheter in a little longer.
• Hernia. Robotic surgery is associated with fewer hernias than open surgery, though there is a small risk of a hernia at one of the keyhole port sites.
• Hospital stay. Most men go home the day after surgery. Most of my private patients are home within 24 to 36 hours.
• Pain. Pain is typically mild and well-controlled with simple analgesia. Robotic surgery is associated with significantly lower pain scores than open surgery.

Bowel function: the reassurance

Unlike radiotherapy, which can affect the rectum, robotic prostatectomy does not typically affect bowel function. This is a meaningful advantage for men weighing up surgery versus radiotherapy.

Modern techniques that reduce side effects

Robotic prostatectomy today is not the operation it was fifteen years ago. Several refinements have meaningfully improved functional outcomes:

Nerve-sparing technique has become increasingly sophisticated, with the ability to peel the neurovascular bundles away from the prostate in layers (intrafascial, interfascial, extrafascial) depending on the cancer.

NeuroSAFE is an intraoperative technique in which the pathologist examines the surface of the prostate while you are still asleep on the table. If the margin is clean, the nerves can be preserved; if not, a secondary “shave” can be performed. The NeuroSAFE PROOF trial, published in The Lancet Oncology in 2025, showed that NeuroSAFE-guided surgery produced significantly better erectile function at twelve months, with 39% of men having no or only mild erectile dysfunction compared with 23% having standard surgery.

Retzius-sparing prostatectomy is a technique that approaches the prostate from behind rather than from in front, leaving the supporting structures at the front of the bladder undisturbed. Early continence recovery is faster with this approach, though it is technically demanding and not appropriate for every cancer.

What you can do: rehabilitation matters

This is the part of the conversation I most want patients to engage with, because it is the part you can influence.

Pelvic floor physiotherapy

The evidence here is unambiguous: supervised pelvic floor muscle training works, and unsupervised training does not. Men who see a specialist pelvic floor physiotherapist recover continence significantly faster than those who are simply handed a leaflet. Starting before surgery improves continence at three months; continuing afterwards improves the long-term picture.

A practical protocol looks like this:

• Three daily sessions — lying, sitting, and standing
• 15 repetitions of contractions held for 2–10 seconds, with equal rest
• Progress by one second per week, up to 10–20 seconds
• Learn the “knack” manoeuvre — a deliberate pelvic floor squeeze just before coughing, lifting, or sneezing

I refer all my surgical patients to a specialist pelvic floor physiotherapist, and I consider it an integral part of the operation, not an optional extra.

Penile rehabilitation

The principle here is that the erectile tissue needs regular oxygenation to avoid scarring and shrinkage during the months while the nerves are recovering. The evidence supports starting rehabilitation as soon as the catheter is removed, not waiting to “see what happens.”

A typical programme involves:

• A regular low-dose PDE5 inhibitor (such as tadalafil 5 mg daily, or sildenafil 50–100 mg twice weekly)
• A vacuum erection device used daily
• For some men, intracavernosal injections (small injections into the erectile tissue) added to the regimen

In a published academic rehabilitation programme, combination therapy achieved around 80% assisted erectile function recovery at two years in men with good baseline function — considerably better than any single treatment alone.

When should I worry?

Most side effects follow a predictable trajectory. You should contact my secretary (Emma Stacey, 07841 048975) or your GP promptly if you experience:

• Fever, heavy wound discharge, or increasing pain after discharge
• Inability to pass urine after catheter removal
• A sudden deterioration in continence after a period of improvement
• Blood in the urine that is heavy or clotting

Frequently Asked Questions

The bottom line

Robotic prostatectomy is, for the right man with the right cancer, an excellent operation. Modern techniques have meaningfully reduced both urinary and sexual side effects, and active engagement with rehabilitation can substantially improve your recovery.

But this is a decision that deserves careful thought. The right choice for you depends on your cancer’s features, your age, your baseline function, your priorities, and the realistic alternatives — which may include active surveillance, focal therapy, or radiotherapy. My role in clinic is not to sell you an operation; it is to help you make the best decision for your own circumstances.

If you would like to discuss your case in more detail, my secretary can arrange a consultation at The Chiltern Hospital in Great Missenden, or at other locations in Buckinghamshire and Berkshire.

Mr Neil A Haldar is a Consultant Urological Surgeon and former Urology Cancer Lead at Buckinghamshire Healthcare NHS Trust. He specialises in robotic and laparoscopic surgery, uro-oncology, and paediatric urology, and started the da Vinci robotic prostatectomy surgery programme at Buckinghamshire NHS Trust.

This article is for general information only and does not replace individual medical advice. Every patient’s situation is unique, and treatment decisions should be made in consultation with your own specialist team.