Most men regain continence within three to twelve months, but the timeline varies widely

After robotic-assisted prostatectomy (also called da Vinci prostatectomy), temporary urinary incontinence is common—but it is not permanent. Most men experience some leakage in the weeks and months after surgery. The sphincter muscles that control urine need time to heal and regain strength. For roughly 90 percent of men, continence returns substantially within a year. However, the exact timeline depends on age, how much damage occurred during surgery, how strong the sphincter was before surgery, and how consistently you do pelvic floor exercises.

The first few weeks are typically the worst. Many men wear pads or protective garments during this period. By three months, most notice significant improvement. By six months, many are dry or nearly dry. A smaller group takes longer—some men continue to see gradual improvement into the second year after surgery.

Key Takeaways

  • Temporary incontinence after robotic prostatectomy usually improves within three to twelve months as the sphincter heals.
  • Pelvic floor exercises (Kegel exercises) started before surgery and continued after surgery speed recovery and improve outcomes.
  • Age matters: men under 60 typically regain continence faster than men over 70.
  • Persistent incontinence beyond twelve months affects a minority of men and has treatment options including injections, slings, and artificial sphincters.

What happens to the sphincter during and after surgery

The prostate surrounds the urethra—the tube that carries urine. During robotic prostatectomy, the surgeon removes the entire prostate gland, which means cutting through tissue around the urethra and then reconnecting the bladder to the urethra. This process stretches and sometimes damages the external urethral sphincter, the muscle that holds urine in.

In the immediate weeks after surgery, swelling and inflammation make the sphincter weak. The muscle itself is not permanently damaged in most cases—it simply needs time to heal and regain tone. This is why incontinence after prostatectomy is almost always temporary. The sphincter gradually tightens as swelling goes down and scar tissue matures, usually over several months.

Some men also experience urgency incontinence—a sudden urge to urinate followed by leakage—because the bladder is irritated from surgery. This typically improves as the bladder heals, usually within the first few weeks to months.

Timeline: what to expect week by week and month by month

Weeks 1 to 4: Most men have significant leakage and wear pads or adult incontinence garments. The catheter (a tube placed during surgery to drain urine) is usually removed around two weeks after surgery. Once it comes out, many men notice they cannot hold urine at all. This is normal and temporary. Leakage is heaviest during this phase.

Weeks 5 to 12 (months 2 to 3): Leakage usually decreases noticeably. Many men go from heavy leakage to moderate leakage—perhaps a few drops when coughing or straining, or occasional urgency accidents. Some men are already dry or nearly dry by the end of month three. Others still need pads but fewer of them.

Months 4 to 6: Most men see continued improvement. By six months, roughly 70 to 80 percent of men report being dry or having only occasional light leakage. Some still wear a pad as backup but may go through only one or two per day instead of many.

Months 7 to 12: Further gradual improvement continues. By one year, about 90 percent of men are continent or have only minimal leakage. A small percentage continue to improve into the second year.

Age and other factors that affect recovery speed

Age is the strongest predictor of how quickly continence returns. Men under 60 typically regain continence faster—often within three to six months—than men over 70, who may take nine to twelve months or longer. This is because younger men's tissues heal faster and their sphincter muscles are generally stronger before surgery.

Preoperative continence status also matters. Men who had any incontinence before surgery (from benign prostate enlargement, for example) may take longer to recover full continence afterward. Conversely, men who were completely continent before surgery usually recover faster.

How much the surgeon had to manipulate tissue around the sphincter during the operation can affect recovery too, though this is difficult to predict beforehand. Surgeons with more experience performing robotic prostatectomy tend to have better continence outcomes, on average, than those doing fewer procedures.

Nerve-sparing surgery—where the surgeon tries to preserve the nerves that control erection—does not significantly delay continence recovery. Incontinence after prostatectomy is mainly a sphincter issue, not a nerve issue.

Pelvic floor exercises and their role in recovery

Pelvic floor exercises, also called Kegel exercises, strengthen the external urethral sphincter and can speed continence recovery. The exercises involve tightening the muscles you use to stop the flow of urine midstream, holding for a few seconds, then relaxing. Repeating this 10 to 20 times, several times per day, trains the sphincter to work harder.

Starting these exercises before surgery—if you know you are having the procedure—gives you an advantage. Men who do preoperative pelvic floor training often regain continence faster than those who do not. After surgery, continuing the exercises as soon as you are able (usually within a few weeks, once initial pain and swelling subside) helps rebuild sphincter strength.

Some men work with a pelvic floor physical therapist who can teach proper technique and monitor progress. Others do the exercises at home using written or video instructions. Either way, consistency matters more than intensity. Daily practice over months produces better results than sporadic effort.

When to consider treatment for persistent incontinence

If incontinence persists beyond twelve months, or if it is severe enough to significantly affect quality of life before then, several treatments exist. These are not first-line options—most urologists recommend waiting at least a year and doing pelvic floor exercises before pursuing them—but they can help when conservative measures are not enough.

Urethral bulking injections involve injecting material (collagen, calcium hydroxylapatite, or other substances) into the tissue around the urethra to increase pressure and reduce leakage. The procedure takes 15 to 30 minutes and can be done in an office. Results are often noticeable within weeks. The injections may need to be repeated every one to three years as the material gradually absorbs.

Male slings are surgical devices that support the urethra and sphincter, similar to how a hammock supports weight. The procedure takes about 30 minutes and is minimally invasive. Success rates are high for men with mild to moderate incontinence. Recovery is faster than with other surgical options.

Artificial urinary sphincter is a surgically implanted device that mimics the function of the natural sphincter. It is more invasive than slings or injections and is typically reserved for men with severe incontinence or those who have not responded to other treatments. It requires learning to operate the device and occasional maintenance, but it has high success rates.

Managing incontinence while you wait for recovery

During the months after surgery, practical strategies make daily life easier. Adult incontinence pads and protective garments come in many absorbency levels—using the right level for your leakage amount keeps you comfortable without waste. Disposable pads are convenient; reusable cloth pads are more economical and environmentally friendly.

Limiting fluids in the evening can reduce nighttime leakage. Avoiding caffeine and alcohol, which irritate the bladder, may help. Some men find that double-voiding—urinating, waiting a minute, then urinating again—reduces daytime accidents by ensuring the bladder is as empty as possible.

Waterproof mattress covers and absorbent bed pads protect your bed during sleep. Many men find that sleeping on a waterproof pad or using absorbent underwear at night gives them confidence to sleep normally rather than waking frequently to urinate.

Frequently Asked Questions

Can incontinence after prostatectomy be permanent?

Permanent incontinence is rare. About 90 percent of men regain continence within a year. Fewer than 5 percent have persistent incontinence beyond two years. When incontinence does persist, it is usually mild and treatable with the options described above.

Will I be incontinent at night as well as during the day?

Many men experience both daytime and nighttime leakage initially. Nighttime incontinence often improves faster than daytime incontinence because the bladder is fuller and pressure is higher, which helps the healing sphincter hold urine. Some men regain nighttime continence within weeks while still having daytime leakage for months.

Does robotic surgery cause less incontinence than open surgery?

Robotic-assisted prostatectomy and open prostatectomy have similar continence outcomes overall. The advantage of robotic surgery is smaller incisions and faster recovery from the surgery itself, not necessarily faster return of continence. Surgeon experience matters more than the surgical approach.

What if I am still incontinent after six months?

Six months is still early in the recovery process for some men, particularly older men. Continuing pelvic floor exercises and waiting until the one-year mark is reasonable. If incontinence is severe and affecting your life significantly, discuss it with your urologist—they may recommend earlier intervention or referral to a pelvic floor specialist.

Do pelvic floor exercises work if I start them after surgery instead of before?

Yes, they still help. Starting before surgery gives an advantage, but beginning exercises after surgery—once you are cleared by your surgeon, usually a few weeks after the procedure—still speeds recovery. It is never too late to start, though earlier is better.