What percentage of patients undergoing DaVinci (robot-assisted surgical system) procedures with an experienced surgeon experience post-operative urinary incontinence and erectile dysfunction (ED)?

Post-Operative Incontinence and Erectile Dysfunction Rates After Robot-Assisted (DaVinci) Prostatectomy

For robot-assisted radical prostatectomy performed by experienced surgeons, expect approximately 12-16% of patients to have persistent urinary incontinence at 12 months, and 47-87% to experience erectile dysfunction depending on age, preoperative function, and nerve-sparing technique. 1, 2, 3

Urinary Incontinence Outcomes

Short-Term Expectations

• Most men are incontinent immediately after catheter removal, which is expected and normal 4
• Continence gradually improves over the first 12 months post-surgery 4, 1

Long-Term Incontinence Rates

• 12-16% of patients report persistent urinary incontinence at 12 months requiring protective pads 1, 3
• In real-world observational data (not clinical trials), 15% of patients used at least one pad daily at 24 months after excluding those with baseline incontinence 3
• Total incontinence (complete lack of control) is rare, affecting approximately 3.6% of patients 4
• Stress urinary incontinence is the most common type post-operatively 1

Special Incontinence Considerations

• Climacturia (orgasm-associated incontinence) occurs in 20-93% of men, with most studies reporting rates around 30% 4, 1
• Sexual arousal incontinence affects a similar proportion of patients 4

Erectile Dysfunction Outcomes

Overall ED Rates

• 47% of patients experience moderate to severe erectile dysfunction at 12 months in robotic prostatectomy series 2
• In population-based studies, 87% of patients without baseline ED reported erectile dysfunction at 24 months after radical prostatectomy 3

Age-Dependent Recovery

Age is the single most important predictor of erectile function recovery 4, 1:

• Men younger than 60 years with bilateral nerve-sparing: 76% recover full erections 4
• Men older than 65 years with unilateral nerve-sparing: Only 7.5% recover potency 4

Nerve-Sparing Impact

• Bilateral neurovascular bundle preservation is the only surgical factor consistently associated with better erectile function at 24 months 3
• Preoperative erectile function strongly influences post-operative outcomes 4, 1
• Maximal erectile function recovery can take 1-2 years 1

Risk Factors for Worse Outcomes

Incontinence Risk Factors

• Advanced patient age 4, 1, 2
• Larger prostate size 4, 1
• Shorter membranous urethral length on MRI 4, 1
• Prior TURP (transurethral resection) 4, 1
• Presence of erectile dysfunction is an independent predictor of incontinence (OR 1.88), suggesting a common anatomic pathway 2

Erectile Dysfunction Risk Factors

• Older age at surgery 4, 1
• Poor preoperative erectile function 4, 1
• Lack of bilateral nerve-sparing technique 3

Important Clinical Caveats

Surgical approach (open vs. robotic) does not significantly impact continence rates at 12 months, though Retzius-sparing techniques may show earlier continence recovery 4

Real-world outcomes are consistently worse than clinical trial data, emphasizing the importance of setting realistic patient expectations based on population-based studies rather than highly selected trial participants 3

The co-occurrence of ED and incontinence is common: Among patients with ED after surgery, 45% are also incontinent, compared to only 27% of those without ED 2