Robotic prostatectomy is a well-established, safe operation, but like any major surgery it carries risks. Understanding them in advance helps you make an informed decision, prepare properly and recognise when to seek help. Your surgeon should discuss these risks with you as part of consent, using figures that reflect their own experience where possible.
Effects that are common and usually improve
Urinary leakage
Leakage of urine is very common after the catheter is removed. Most men see steady improvement over weeks to months, and the majority regain good control within a year. A smaller number have ongoing leakage that needs further help, such as specialist physiotherapy or, occasionally, a further procedure. Our step-by-step pelvic floor guide explains exercises that help.
Erection changes
Erections are commonly affected after surgery, even when the nerves are spared, because the nerves need time to recover. Recovery can take many months and may not be complete. Age, erectile function before surgery and whether nerves could be spared all affect the outcome. Our article on regaining erectile function explains the treatments available.
Dry orgasm and infertility
After a prostatectomy, no semen is produced, so orgasm is dry and natural fertility is lost. This is an expected effect rather than a complication. Men who may want children in future should discuss sperm banking before surgery.
Less common complications
- Bleeding: blood loss is usually low with robotic surgery, and transfusion is rarely needed.
- Infection: of the wounds, urine or chest, usually treated with antibiotics.
- Blood clots: in the legs or lungs. Compression stockings, early walking and sometimes blood-thinning injections reduce this risk.
- Lymphocele: a collection of fluid in the pelvis after lymph node removal.
- Hernia: at one of the incision sites, sometimes months later.
- Anastomotic leak: urine leaking from the join between the bladder and urethra, usually managed by leaving the catheter in for longer.
- Narrowing at the join: scar tissue can narrow the join, causing a weak flow, and may need a small procedure.
- Penile shortening: some men notice a change in length.
Rare complications
- injury to the bowel, bladder, ureter, blood vessels or nerves
- problems related to the head-down position, such as swelling of the face or, very rarely, pressure on the eyes or nerves
- the need to convert to open surgery
- serious heart or lung problems related to the anaesthetic
How teams reduce risks
Surgical teams use a range of measures:
- careful assessment of fitness before surgery
- detailed planning using MRI. Our article on how MRI helps plan your prostatectomy explains this.
- techniques to protect nerves and continence structures
- infection prevention, including antibiotics
- measures to prevent blood clots
- early mobilisation and enhanced recovery programmes
- clear advice on warning signs after discharge
The role of experience
Studies consistently show that outcomes tend to improve with a surgeon's experience, particularly for continence and erections. It is reasonable to ask how many robotic prostatectomies your surgeon performs and what their own results are. Our article on why surgeon experience matters explains why.
When to seek help after surgery
Contact your team urgently if you have:
- a fever or feel very unwell
- increasing abdominal pain or swelling
- a catheter that stops draining
- calf pain, chest pain or breathlessness
- heavy bleeding
Putting risks in context
Most men recover well from robotic prostatectomy, and serious complications are uncommon. The risks need to be weighed against the benefits of treating the cancer and the risks of other treatments. Prostate Cancer UK and the British Association of Urological Surgeons publish detailed information.
Professor Prokar Dasgupta discusses risks openly as part of every consultation at The London Clinic. Please contact the clinic to arrange a consultation.