When can a 48-year-old male, 11 days post-robotic prostatectomy with 50% of the right nerve spared and 100% of the left nerve spared, expect to stop experiencing urinary dribbling?

Timeline for Resolution of Urinary Dribbling After Robotic Prostatectomy

Most men are not continent immediately after catheter removal, but the majority achieve continence (not requiring pads) within 12 months of surgery, with significant improvement typically occurring in the first 3-6 months. 1

Expected Timeline for This Patient

At 11 days post-surgery, urinary dribbling is completely expected and normal. 1 Based on the nerve-sparing status (50% right, 100% left), here's what to anticipate:

Short-term (0-3 months):

• Immediate post-catheter removal: Most men are NOT continent when the catheter is removed 1
• First 3 months: Continence recovery begins, with pelvic floor muscle exercises accelerating improvement 1, 2
• At this 11-day mark, dribbling is universal and should not cause alarm 1

Medium-term (3-6 months):

• Significant improvement occurs during this window 1
• Pelvic floor muscle training shows maximal benefit in achieving earlier continence recovery 1
• Patients showing no improvement by 6 months may be candidates for early intervention 1, 2

Long-term (6-12 months):

• Most men achieve continence by 12 months (defined as not requiring pads or protective devices) 1
• Overall continence rates at one year are similar regardless of whether formal pelvic floor exercises were performed, though exercises hasten the timeline 1, 2

Critical Action Items Now

Immediate initiation of pelvic floor muscle exercises is strongly recommended upon catheter removal (or now if not already started): 1, 2

• These exercises improve time-to-achieving continence compared to no intervention 1
• Should be offered to all patients in the immediate post-operative period 1

Factors Affecting This Patient's Recovery

Nerve-sparing status does NOT significantly affect urinary continence recovery, contrary to common belief: 1

• The bilateral nerve preservation (even partial on right side) primarily impacts erectile function, not continence 1
• Age (48 years) is favorable—younger age is associated with better continence outcomes 1, 2

Red Flags Requiring Earlier Evaluation

Consider earlier urological consultation if: 1, 2

• No improvement by 6 months despite conservative therapy 1, 2
• Severe incontinence (5+ pads per day) at 6 months 1
• Complete lack of any improvement trajectory by 3-6 months 1

Important Counseling Points

Set realistic expectations: 1

• Incontinence is expected in the short-term and is not a complication at 11 days 1
• The definition of "continence" means 0-1 pad per day that is tolerable to the patient 1
• Mild incontinence (1-2 pads/day) may persist beyond 12 months in some men 1

Surgical intervention timing (if needed): 1, 2

• Can be considered as early as 6 months if no improvement with conservative therapy 1, 2
• Artificial urinary sphincter is the gold standard for persistent incontinence 2