Robotic Prostate Surgery Side Effects: What to Expect

When men consider robotic-assisted radical prostatectomy (RALP), the most persistent concerns rarely focus on the operation itself. Instead, questions center on quality of life afterward: Will I leak urine? Will I ever get an erection again? How long until I feel normal?

Renowned robotic urologic oncologist Dr. David Samadi—Director of Men’s Health at St. Francis Hospital and developer of the SMART (Samadi Modified Advanced Robotic Technique) prostatectomy—counsels patients that understanding post-surgical side effects requires understanding the underlying anatomy. The prostate is nestled deep within the male pelvis, encircled by microscopic nerve networks that control erections and situated adjacent to the external sphincter muscle that governs urinary continence.

Experiencing temporary changes in urinary control or sexual tumescence immediately following surgery is not a sign that something went wrong—it is the body’s expected physiological response to tissue healing and temporary nerve stunning (neuropraxia). With advanced robotic techniques and structured post-operative rehabilitation, functional recovery follows a steady, predictable timeline.

What to Expect:

1. Urinary Incontinence: Mechanisms and Recovery Milestones

During radical prostatectomy, the prostate is excised, requiring the bladder neck to be reconnected directly to the urethra (vesicourethral anastomosis). The internal, involuntary smooth muscle sphincter is removed with the gland, leaving the external, striated voluntary urinary sphincter responsible for maintaining continence.

• The Initial Phase (Weeks 1 to 6): A temporary Foley catheter remains in place for approximately 7 days to allow the new bladder-urethral connection to seal watertight. Once the catheter is removed, most men experience stress urinary incontinence—leakage during sudden physical exertion, coughing, laughing, or standing up quickly.
• The Rehabilitation Phase (Months 2 to 6): Pelvic floor strengthening through targeted Kegel exercises retrains the external sphincter. Most men experience rapid improvements, transitioning from heavier pads to light security shields.
• Long-Term Outcomes: In Dr. Samadi’s clinical experience, the vast majority of patients achieve complete pad-free urinary control within 3 to 12 months post-surgery.

2. Erectile Dysfunction and Sexual Function Recovery

The paired neurovascular bundles that transmit the autonomic electrical impulses necessary for an erection run along the outer posterolateral surface of the prostate.

• The Neuropraxia Window: Even when meticulous bilateral nerve-sparing surgery is completed without severing a single nerve fiber, the microscopic nerves experience temporary traction, swelling, and manipulation. This stunning of the nerves causes a temporary inability to achieve spontaneous erections.
• Slow Axonal Regeneration: Peripheral cavernous nerves regenerate slowly—at roughly 1 millimeter per day. While urinary continence recovers in weeks to months, erectile function recovery is gradual, typically unfolding between 6 and 18 months post-surgery.
• Sensation and Climactic Function: The sensory nerves governing physical touch, pleasure, and orgasmic climax (the pudendal nerve pathway) do not travel through the prostate and remain intact. Men retain the ability to experience orgasms, although they will be “dry orgasms” (anejaculation) because the prostate and seminal vesicles that produce seminal fluid have been removed.

Side Effect Recovery Milestones: What to Expect

How Dr. Samadi’s SMART Technique Minimizes Side Effects

The severity and duration of side effects are tied to surgical volume and technical execution. Dr. Samadi developed the SMART (Samadi Modified Advanced Robotic Technique) procedure with specific modifications designed to mitigate postoperative side effects:

1. Athermal Nerve Dissection: Electrosurgical heat (cautery) can cause thermal spread that burns adjacent cavernous nerve fibers. Dr. Samadi avoids thermal energy near the neurovascular bundles, utilizing cold scissors and surgical clips instead to preserve delicate nerve integrity.
2. Maximum Urethral Length Preservation (MULP): By leaving the dorsal venous complex unstitched until the end of the operation, Dr. Samadi preserves the maximum possible length of the urethral stump and protects the striated sphincter, promoting earlier post-catheter continence.
3. No-Touch Surgeon Control: Dr. Samadi performs every critical step of the operation personally at the robotic console from start to finish, ensuring anatomical dissection is customized to the patient’s specific pelvic contours.

Frequently Asked Questions (FAQ)

Will I have permanent urinary leakage after surgery?

Permanent, severe urinary incontinence is uncommon following robotic prostatectomy in experienced hands. While nearly all men experience initial leakage after the catheter is removed, adherence to pelvic floor retraining and natural sphincter healing results in more than 95% of patients returning to full continence.

What can I do to speed up the recovery of erections?

Penile rehabilitation plays a role in functional recovery. Dr. Samadi frequently recommends low-dose nightly PDE-5 inhibitors (such as tadalafil or sildenafil) to increase oxygenated blood flow to the corporal erectile bodies while stunned nerves regenerate, preventing structural tissue hypoxia and scarring. Vacuum erection devices (VED) are also utilized to maintain penile tissue elasticity.

Does robotic prostatectomy cause changes in penile length?

Some men notice a temporary perception of shortening after surgery, primarily caused by temporary retraction of the urethral sphincter and lack of regular nocturnal erections. As continence is re-established and regular blood flow returns through penile rehabilitation and spontaneous tumescence, natural length is largely preserved.

Conclusion

While temporary urinary leakage and erectile changes are expected parts of the immediate healing curve after robotic prostate surgery, they should not be feared as permanent outcomes. By choosing an experienced, high-volume robotic surgeon who utilizes athermal nerve-sparing techniques and prioritizing post-operative pelvic and penile rehabilitation, men can achieve the primary objective of cancer cure with an undetectable PSA while preserving long-term urinary and sexual vitality.

Consult with Dr. David Samadi

Navigating prostate cancer surgery and understanding what to expect during recovery requires expert surgical evaluation. Dr. David Samadi is a board-certified urologic oncologic surgeon, Director of Men’s Health at St. Francis Hospital, and developer of the SMART robotic technique with thousands of successful surgeries performed.

• Office Locations: 485 Madison Avenue, 21st Floor, New York, NY 10022 & Roslyn, NY
• Clinical Specialization: SMART Robotic Radical Prostatectomy, Nerve-Sparing Dissection, Continence Preservation, and Men’s Health
• Direct Consultation Line: (212) 365-5000
• Case Review Portal:roboticoncology.com