Since prostate cancer is one of the most common cancers in men, radical prostatectomy—that is, surgery to completely remove the prostate—has become one of the most commonly performed cancer surgeries today. Especially with the advancement of robotic systems (Da Vinci robotic surgery), these procedures can now be performed with much greater precision, control, and tissue preservation.

However, the two issues patients are most curious about after surgery are as follows:

1. Is urinary incontinence permanent?

2. Will erectile function return?

In this article, I will specifically address the issue of urinary incontinence from all angles and provide a comprehensive guide based on my clinical practice, the modern literature, and my experience with robotic surgery. I will answer the common questions asked by the hundreds of patients who visit my outpatient clinic, drawing on scientific evidence.

I explain things to my patients as clearly as possible before surgery:

“Urinary incontinence after prostate surgery may be temporary; in rare cases, it may be permanent, but most patients recover completely.”

Urinary incontinence after radical prostatectomy is actually to be expected because during the surgery:

•the prostate is removed,

•The urinary tract is reconnected to the bladder,

•The muscle structure known as the external sphincter, located just below the prostate, may be partially affected.

This area contains both muscles and nerves, and no matter how careful the surgeon is, this area remains sensitive due to the prostate’s anatomical location.

However, thanks to robotic surgery, the sphincter that controls urinary continence can now be preserved much more effectively, and the rates of permanent incontinence have dropped dramatically compared to the past.

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Postoperative urinary incontinence is not uniform; it varies from patient to patient.

This is the most common type of incontinence we see after prostate surgery.

Urinary incontinence occurs in the following situations:

•Coughing

•Sneezing

•Bending

•Standing

•During the walk

•While exercising

This is caused by a weakening of the external sphincter muscle.

The bladder is overactive. This usually:

•Difficulties with bladder adaptation following surgery

•Damage to the bladder muscle caused by years of prostate obstruction prior to surgery

is caused by.

Both the stress and the compression components are present at the same time.

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My patients ask me this question very often.

I summarize the reasons as follows:

✔ 1. Weakening of the Sphincter Muscle

The muscle responsible for grip may be affected during surgery.

✔ 2. The Bladder’s Adaptation Process to Tissues

It takes time for the bladder to adapt to the newly created connection.

✔ 3. Weak Pelvic Floor Muscles

✔ 4. Tension in Nerve Bundles

✔ Age 5

The recovery process is longer for patients aged 65 and older.

✔ 6. Preoperative prostate size

The larger the prostate, the longer the post-surgery recovery process may take.

✔ 7. Preoperative fatigue of the bladder muscle

A bladder that has been obstructed for a long time is more sensitive.

✔ 8. Preoperative level of continence

If there is slippage before surgery, there may be more after surgery.

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In my practice, the rates of urinary incontinence following robotic surgery are much lower than those following open surgery. The reason for this is:

✔ 1. Image magnified 10–15 times

The sphincter muscle is much more clearly visible.

✔ 2. Minimal blood loss

Tissue plans are better preserved.

✔ 3. The ability to perform nerve-sparing techniques with precision

✔ 4. Minimal trauma

There is less tissue edema, and healing is faster.

✔ 5. Maximizing preservation of urethral length

This is the most critical part of holding your urine.

✔ 6. Reconstruction Techniques

In particular, methods that accelerate healing, such as “anterior suspension stitching.”

For this reason, the rate of permanent incontinence in patients who undergo robotic surgery ranges from 1% to 5%.

(Varies depending on the patient's characteristics.)

In open surgery, this rate used to be 10–20 percent.

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The vast majority of my patients ask:

“Doctor, will my urinary incontinence go away completely?”

My answer is clear:

🟢 80–95% of patients make a full recovery within 1 year.

🟡 Partial incontinence may persist in 5–10% of patients.

🔴 Persistent incontinence may occur in a small group of 1–5%.

The permanent miss rate is even lower in robotic surgery.

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Based on my own experience, let me share a clear overview:

✔ Month 1:

Most patients have significant leakage.

It is normal to use a daily pad.

✔ Month 3:

60% of patients achieve significant improvement in urinary continence.

✔ Month 6:

80% of patients show significant improvement.

✔ Month 12:

90–95% make a full recovery.

✔ 18th Month:

Even in severe cases, most people recover.

The important thing here is:

How well you use your pelvic floor muscles

Your surgeon’s meticulous attention to tissue preservation during surgery

Your bladder function before surgery

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•Advanced age (70+)

•Obesity

•Diabetes

•Cigarettes

•Prolonged obstruction prior to surgery

•Enlarged prostate

•Open prostatectomy

•Complex surgery

•Having undergone pelvic radiation therapy

•Leaving the catheter in place for a long time

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Now let me explain the most effective post-surgery treatments.

🟣 1. Kegel Exercises (Pelvic Floor Muscle Training)

It's the first step to get started.

However, Kegel exercises done without proper awareness are of no benefit.

At my clinic, I teach patients one-on-one:

•Finding the right muscle

•Extraction time

•Relaxation period

•Number of sets

•Daily review

Recovery is faster in patients who perform Kegel exercises correctly.

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🟣 2. Biofeedback Therapy

Under the guidance of a professional instructor, the pelvic muscles are trained while being viewed on a screen.

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🟣 3. Electrostimulation

We do this to strengthen weak muscles.

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🟣 4. Bladder Training

Bladder capacity is increased, and urgency episodes are reduced.

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🟣 5. Medication Treatments

If there is a jam-type misfire:

•Anticholinergic medications

•Beta-3 agonists

It's very effective.

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🟣 6. Botox Treatment

If urge incontinence is the predominant type, Botox injections into the bladder are quite effective.

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A year has passed, and the abductions continue.

You’re using more than two pads a day, and your quality of life is seriously affected…

In this case, surgical treatments may be considered.

All the modern methods are listed below:

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🔵 1. Male Sling (Male Sling Surgery)

Moderate tension yields excellent results when cutting.

➜ Who is eligible?

•Those who use 1–3 pads a day

•Those with a partially intact sphincter structure

➜ Advantages:

•Not robotic; just a small surgical incision

•High achievement

•Very low risk

•Supports the body’s natural urinary control mechanism

After sling surgery, many patients stop using pads altogether.

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🔵 2. Artificial Urinary Sphincter (AUS)

It is the gold standard surgical procedure for severe hernias.

➜ Who is it for?

•Those who use 4–10 pads a day

•The bladder muscle functions normally

•Can be used in patients who have undergone radiation therapy

➜ Success rate:

Excellent results in 80–90% of cases.

➜ How does it work?

A balloon (capsule) inserted into the penis wraps around the urethra → acts as a muscle → when the patient wants to use the restroom, they press the control button → the system relaxes → urination occurs → then it closes automatically.

It is one of the most successful surgeries in modern urology.

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🔵 3. Bulking Agent Injections

It may be a suitable option for patients with very mild incontinence.

But its durability is limited.

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Some specific techniques I use during surgery:

✔ Maximum preservation of urethral length

✔ Anterior reconstruction

✔ Bilateral nerve protection

✔ Protection of the pelvic fascia

✔ Keeping tissue planes clean with minimal bleeding

✔ An anatomical closure that preserves natural flexibility instead of a tight seam

✔ Rocco stitch technique

These techniques are modern methods recognized in the international literature for increasing urinary continence rates.

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❓ What is the rate of chronic urinary incontinence?

🟢 1–5% in robotic surgery

🟡 5–20% in open surgery

❓ I'm older—will it take longer for me to recover?

Yes, but they still recover from serious illness within 12–18 months.

❓ When should I stop using pads?

It varies from patient to patient, but most people quit within 3–6 months.

❓ Do I need to have surgery again?

Only in the group experiencing 5–10% permanent loss.

❓ Does sexual intercourse increase the risk of abduction?

It may be mild at first, but it will subside over time.

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Urinary incontinence following prostate surgery can be a challenging process for the patient, their family, and the physician. However, thanks to modern robotic surgery, proper patient education, pelvic floor strengthening, and advanced treatment options, it is now possible to:

✔ More than 90% of patients make a full recovery

✔ The likelihood of permanent loss is very low

✔ Advanced surgical solutions fully restore quality of life

I always tell my patients:

“Urinary incontinence is not an inevitable consequence of prostate surgery. With the right surgery and the right treatment, most patients return to complete normalcy.”