Urinary Control After Robotic Prostatectomy: How Long Does Leakage Last?

Urine leakage is the side effect men worry about most before prostate surgery, and the one they ask about first afterwards. The reassuring part is that it is usually temporary. The honest part is that it can take months, and a small number of men need extra treatment. This guide explains what is normal and what helps.

Key points

• Some leakage after the catheter is removed is expected. It does not mean the operation has gone wrong.
• Most men improve steadily over the first three months, and most are dry or nearly dry by about a year.
• Pelvic floor exercises, started before surgery if possible, make a real difference.
• If leakage is not improving by six months, there are effective treatments. Please ask rather than put up with it.

Why does leakage happen after prostate surgery?

The prostate sits just above the muscle that closes the urine passage (the sphincter) and just below the bladder. When the prostate is removed, the bladder is joined to the urine passage, and the sphincter and the muscles around it have to do the whole job of holding urine. They are also bruised and stretched from the operation, and the bladder itself may be a little irritable for a while.

So in the first weeks, leakage is mostly stress leakage: a few drops or more when you cough, sneeze, laugh, stand up from a chair, or lift something. Some men also notice a sudden urge to pass urine with a leak before reaching the toilet. This is called urge leakage, and it often settles as the bladder calms down.

A realistic timeline

• Catheter in (usually about one to two weeks): there is no leakage, because the catheter drains the bladder.
• First days after catheter removal: leakage is common, often needing several pads a day, and often worse in the evening when the muscles are tired.
• Weeks 2 to 12: steady improvement for most men. Many go from several pads to one or two.
• Three to twelve months: further gains. Most men are dry or use at most a small protective pad for heavy activity by around one year.

Figures vary between studies and centres, and they depend on your age, the size of your prostate, your weight, how well you controlled urine before surgery, and whether you have had earlier prostate procedures or radiation. Your surgeon can tell you what is likely in your case.

What helps you recover

Pelvic floor exercises

These strengthen the muscles that hold urine. They are the best-supported thing you can do yourself.

• Learn to find the right muscle: it is the one you would use to stop the flow of urine midstream, or to stop passing wind. Do not tighten the buttocks, thighs or stomach, and do not hold your breath.
• Tighten it gently, hold for about five seconds, relax fully, and repeat about ten times. Do this a few times a day.
• Begin before surgery if you can. A trained physiotherapist can check that you are doing them correctly, which matters more than how many you do.
• Tighten the muscle before you cough, sneeze or lift. This simple habit reduces leaks a great deal.

Everyday habits

• Drink normally, mostly in the day. Cutting fluids too much makes urine stronger and the bladder more irritable.
• Cut down on caffeine, fizzy drinks and alcohol for a while, as they can increase urgency.
• Avoid constipation and straining.
• If you are overweight, even modest weight loss helps control.
• Use pads to keep life normal while you recover, and take care of the skin. Needing a pad is not a failure.

When should you ask for help?

Please tell your doctor early if any of these happen:

• You cannot pass urine, or the stream becomes very weak. This may be a narrowing (stricture) at the join, which can usually be treated.
• Burning, fever, cloudy or foul-smelling urine, or blood clots in the urine.
• Leakage that is getting worse instead of better.
• Still using more than one or two pads a day by about six months, or leakage that bothers you at any stage.

If leakage continues

A small number of men continue to have bothersome leakage. The cause should first be understood: stress leakage, an overactive bladder and a narrowing need different treatment. After assessment, options may include supervised pelvic floor therapy, medicines for urgency, and, if stress leakage persists after about six to twelve months, procedures such as a male sling or an artificial urinary sphincter. These work well in suitable men. Deciding when and which is a conversation to have with your surgeon.

Questions to ask before surgery

• How much leakage is typical after your operations, and how many pads a day at three and twelve months?
• Do you advise pelvic floor therapy before surgery, and who should I see?
• Is there something about my prostate or my health that makes leakage more or less likely?
• If leakage continues, what will you offer and when?

To understand your treatment options for prostate cancer, see our guide to prostate cancer by stage and the prostate cancer treatment page. For how robotic surgery fits in, see robotic surgery for urological cancers.

This article is general information. It does not replace advice from your own doctor, who knows your reports and your health.