If you are considering robotic prostate surgery, you may naturally want to know how often complications occur. The operation is generally safe, but like any major surgery, it still carries some risks.
BAUS registry data from 2016–2019 recorded Clavien–Dindo grade III or higher complications in 1.3% of robotic prostatectomy cases for which complication grading was known (336 of 26,974). The recorded transfusion rate was 0.2%. These figures are useful national benchmarks, but they should be interpreted alongside the completeness and definitions of the registry data.
What Is Meant by a Complication After Robotic Prostate Surgery?
A complication is an unexpected medical or surgical problem that happens during or after your operation. It can be something minor, such as a urinary infection, or a more serious problem that needs further treatment.
The Clavien–Dindo system is commonly used to show how serious a complication is. In the Clavien–Dindo system, grade III complications require surgical, endoscopic or radiological intervention, while grades IV and V represent still more severe outcomes.
It is also important to separate perioperative complications from expected functional outcomes after prostatectomy. Problems such as urinary incontinence and erectile dysfunction can have a major effect on quality of life, but they are usually reported separately from short-term Clavien–Dindo surgical complication rates. This is why a low ‘major complication rate’ does not mean there are no important recovery or functional effects to consider.
What Do UK Robotic Prostatectomy Complication Rates Show?
BAUS data also show that serious complications were uncommon. The national summary reported a 0.3% conversion rate, but this figure was not broken down separately for robotic and laparoscopic procedures, so it should not be interpreted as a robotic-specific conversion rate.
| UK BAUS prostatectomy measures, 2016–2019 | Reported rate |
| Robotic operations in registry | 29,645 |
| Robotic known Clavien–Dindo Grade III+ complications | 1.3% |
| Robotic known blood transfusion rate | 0.2% |
| Overall conversion rate – surgical approaches not reported separately | 0.3% |
| Robotic median hospital stay | 1 day |
These figures are useful because they reflect national UK practice rather than one specialist surgeon’s results. However, if you’re considering prostatectomy, it’s important to understand that the 1.3% figure only covers serious complications. You may still experience temporary urinary leakage, catheter-related problems, constipation or erectile dysfunction, which are not necessarily classed as major surgical complications.
Evidence Note
BAUS recorded 29,645 robotic prostatectomies between 2016 and 2019. Grade III or higher complications were documented in 1.3% of robotic cases with known complication grading, and the known transfusion rate was 0.2%. Because outcome data were not available for every operation, these percentages should be understood as registry benchmarks rather than exact predictions of an individual patient’s risk.
What Is the Overall Complication Rate in Larger Studies?
International studies that track both minor and major complications tend to report higher overall rates. If you’re considering robotic prostatectomy, you should know that a contemporary NSQIP study of 11,811 patients reported complications in 6.1%. A separate study of 3,317 patients reported a 9.8% overall complication rate; in that series, most complications were minor and 81.3% occurred within the first 30 days after surgery.
| Published robotic prostatectomy cohort | Patients | Overall complication rate |
| Contemporary NSQIP analysis | 11,811 | 6.1% |
| Detailed tertiary-centre series | 3,317 | 9.8% |
| UK BAUS 2018, all prostatectomy approaches | National registry data | 6.9% reported postoperative complication rate |
The 2018 BAUS report states that 8,865 entries recorded postoperative-event status and reports a 6.9% complication rate; the denominator printed alongside that percentage in the source is internally inconsistent, so the percentage is best treated as the published BAUS rate rather than recalculated here.
How Common Is Significant Bleeding or Blood Transfusion?
Robotic prostatectomy has generally been associated with lower blood loss and lower transfusion requirements than open prostatectomy. BAUS national data recorded a transfusion rate of 0.2% after robotic prostatectomy, compared with 1.5% after open surgery between 2016 and 2019, while the 2018 audit reported an even lower robotic rate of 0.08%.
| BAUS measure | Robotic | Open |
| Transfusion rate, 2016–2019 | 0.2% | 1.5% |
| Transfusion rate, 2018 alone | 0.08% | 0.78% |
Severe bleeding after surgery can still occur, although it is uncommon and may occasionally require a transfusion, radiological treatment or another operation. UCLH describes severe blood loss requiring transfusion or further surgery as a rare complication, occurring in fewer than 1 in 50 patients, while your individual risk may also depend on your medicines, clotting conditions and the complexity of your surgery.
How Common Are Urinary Tract Infections?
A urinary catheter usually stays in place for several days after robotic prostatectomy while the bladder-to-urethra join heals, but it can increase UTI risk. In a large US NSQIP analysis of 12,123 robotic prostatectomies performed between 2009 and 2012, UTI occurred in 1.77% of patients within 30 days.
Blood-stained urine, bladder spasms and some catheter leakage can be normal during recovery. However, cloudy or strong-smelling urine, burning, fever or feeling unwell should prompt medical advice, as an infection may require antibiotics.
How Common Are Wound Infections?
Wound infection is a recognised complication after radical prostatectomy, although it is generally uncommon. Because published infection rates vary according to surgical approach, patient characteristics and how infection is defined, an overall prostatectomy rate should not be interpreted as a robotic-specific risk.
You should contact your clinical team if a wound becomes increasingly red, hot, painful, swollen or starts producing pus. Mild bruising or discomfort can be normal, but your wound should improve as you recover.
How Common Are Blood Clots After Robotic Prostatectomy?
Major pelvic surgery temporarily increases the risk of venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), but symptomatic blood clots after robotic prostatectomy are relatively uncommon. In a study of 12,123 robotic prostatectomy patients, DVT occurred in 0.67% and pulmonary embolism in 0.45% within 30 days.
| 30-Day Complications in a 2009 | 2012 US NSQIP Robotic Prostatectomy Cohort |
| Urinary tract infection | 1.77% |
| Deep vein thrombosis | 0.67% |
| Pulmonary embolism | 0.45% |
| Pneumonia | 0.27% |
| Heart attack | 0.12% |
| Stroke | 0.01% |
These figures show that symptomatic blood clots and other major medical complications were uncommon in this cohort. However, they remain clinically important, and these percentages should be treated as population estimates rather than a prediction of your individual risk.
What Is a Urinary Anastomotic Leak?
After your prostate is removed, your bladder is reconnected to your urethra through a new join called the vesicourethral anastomosis. Occasionally, urine can leak before this join fully heals; small leaks may only require your catheter to stay in longer, while more significant leaks may need drainage or further treatment.
Reported rates of anastomotic leakage vary between studies and depend partly on how a leak is defined and detected.
What Are Lymphoceles and How Often Do They Occur?
A lymphocele can develop when pelvic lymph nodes are removed during prostatectomy, so this risk mainly applies to men who also have pelvic lymph-node dissection. In a systematic review of robot-assisted prostatectomy with extended lymph-node dissection, symptomatic lymphoceles requiring intervention occurred in about 2.2% of patients.
Your risk depends on whether lymph-node dissection is performed and how extensive it is. A 2026 review of 7,316 patients found that creating a peritoneal flap can reduce the risk of lymphocele formation.
How Common Are Bladder-Neck or Urethral Narrowing Problems?
Scar tissue can sometimes develop where your bladder joins the urethra or within the urethra, causing a weaker stream or difficulty emptying your bladder. UCLH classifies bladder scarring and urethral narrowing as occasional complications, and significant narrowing may require an endoscopic procedure.
Temporary urinary changes can occur after catheter removal, but you should contact your surgeon if your stream becomes progressively weaker or you have difficulty emptying your bladder.
How Often Does Bowel or Rectal Injury Occur?
The rectum lies directly behind the prostate, so rectal injury is a recognised but rare complication. UCLH classifies rectal injury after robotic prostatectomy as rare, occurring in fewer than 1 in 50 patients. If it occurs, additional repair may be required and, in some cases, a temporary colostomy may be necessary.
Previous pelvic surgery, radiotherapy or significant scar tissue can make prostatectomy more technically complex. Your surgeon will review your previous treatment and imaging when assessing your individual surgical risk.
How Common Are Heart, Lung and Anaesthetic Complications?
Robotic prostatectomy is performed under general anaesthesia and usually takes several hours. In the 2009–2012 NSQIP robotic-prostatectomy cohort of 12,123 patients, pneumonia occurred in 0.27%, myocardial infarction in 0.12% and stroke in 0.01% within 30 days.
Your individual risk depends on your overall health, particularly any heart or lung conditions. A pre-operative assessment allows your anaesthetic team to review your medical history, medicines and test results and plan your care safely.
When Should You Seek Medical Help After Robotic Prostate Surgery?
After discharge, some discomfort, mild blood staining in the urine and temporary catheter-related symptoms can occur, but you should know which changes need prompt assessment. Contact your urology team, GP or other service named in your discharge instructions if your catheter stops draining, leaks significantly or falls out, if you pass blood clots, or if your urine becomes cloudy, dark, very red or strong-smelling. You should also seek advice if a wound becomes increasingly red, swollen or painful, if you develop a temperature above 38°C, persistent nausea or vomiting, ongoing abdominal cramps, or new pain or swelling in a calf.
Sudden chest pain, severe shortness of breath, coughing up blood, collapse or other symptoms suggesting a serious blood clot or medical emergency need immediate emergency assessment. Your own hospital may give you more specific instructions, so follow the contact plan provided at discharge. These warning signs do not mean a complication is definitely present, but they should not be ignored while you are recovering at home.
UK Guidance Note
Current UCLH patient information classifies several complications after robotic prostatectomy by frequency. Bladder scarring and severe urinary leakage are listed as occasional, while severe blood loss, rectal injury, anaesthetic problems and serious heart or circulation complications are classified as rare. These categories describe one NHS centre’s patient information and should not replace your surgeon’s personalised risk assessment.
How Often Are Patients Readmitted After Prostate Surgery?
Hospital readmission is another useful measure of postoperative safety, although it should not be treated as the same as a complication rate. The National Prostate Cancer Audit reported that 12% of men in England and 17% in Wales undergoing radical prostatectomy had an emergency readmission within 90 days, with rates varying between surgical centres.
| National Prostate Cancer Audit measure | England | Wales |
| Emergency readmission within 90 days of radical prostatectomy | 12% | 17% |
| GU complication requiring procedure/surgery within 2 years | 6% | 8% |
These figures apply to radical prostatectomy overall, not robotic surgery alone, so they should not be presented as robotic-specific rates. Readmission may result from treatable problems such as infection, bleeding, catheter difficulties or urinary retention.
What Do UK Data Show About Longer-Term Urinary Complications?
Some complications can develop months after surgery. The National Prostate Cancer Audit found that around 6% of men in England and 8% in Wales experienced at least one genitourinary complication requiring a procedural or surgical intervention within two years of radical prostatectomy.
Long-term urinary incontinence is separate from acute complications. UCLH estimates that around 1 in 20 men may have severe leakage at one year, so you should consider immediate risks separately from longer-term outcomes.
Who Has a Higher Risk of Complications?
Your risk of complications after robotic prostate surgery depends on your health, previous treatment and the complexity of your operation. Some factors may increase your individual risk.
- Age and general health: Older age and existing medical conditions may increase some surgical risks.
- Body weight: A higher BMI may make surgery and recovery more complex.
- Previous treatment: Pelvic surgery or radiotherapy can increase technical difficulty.
- Lymph-node dissection: Removing pelvic lymph nodes can increase the risk of problems such as lymphocele.
These factors do not mean you will develop complications. Your surgeon can assess your individual risk before surgery and explain what it means for your recovery.
What Should You Ask Your Surgeon About Their Complication Rate?
When considering robotic prostate surgery, you should ask about your surgeon’s audited complication rates and what they include. Ask about risks such as bleeding, infection, readmission, urinary leakage and lymphocele.
You should also discuss your personal risk factors, including your health, medicines and previous treatment. Ask what specialist support is available if complications occur after surgery.
Clinical Tip
When a surgeon quotes a complication rate, ask what the number includes. A Grade III+ complication rate, an “all complications” rate, a 30-day readmission rate and a one-year urinary-incontinence rate measure very different outcomes. Ask for figures that are audited and relevant to your own operation and risk factors.
Myth vs Fact
| Myth | Fact |
| Robotic prostate surgery has one fixed complication rate. | No. Rates change depending on definitions, follow-up and patient characteristics. |
| A 1.3% serious-complication rate means only 1.3% of patients have any problem after surgery. | No. The BAUS figure covers Grade III+ complications, not every minor or functional problem. |
| Urinary incontinence is the same as a surgical urine leak. | No. Anastomotic leakage and postoperative urinary-control problems are different outcomes. |
| Every patient undergoing robotic prostatectomy is at risk of lymphocele. | The risk mainly relates to patients who also undergo pelvic lymph-node dissection. |
| Robotic surgery eliminates the risk of blood clots or bleeding. | No. These risks are relatively uncommon but still recognised. |
| National averages tell you exactly what your personal risk will be. | No. Health, previous treatment and surgical complexity can alter individual risk. |
Key Takeaways
- There is no single complication rate for robotic prostatectomy because studies count different events and use different follow-up periods.
- BAUS 2016–2019 data recorded Grade III or higher complications in 1.3% of robotic cases with known complication grading.
- A contemporary 11,811-patient NSQIP study reported any postoperative complication in 6.1%.
- Blood transfusion is uncommon after robotic prostatectomy; BAUS reported a 0.2% known transfusion rate.
- Infection, blood clots, urinary anastomotic leakage, lymphocele and urinary narrowing are recognised complications, but individual risks vary.
- Urinary incontinence and erectile dysfunction are important functional outcomes and should be considered separately from short-term surgical-complication statistics.
- Your personal risk depends on factors such as general health, previous pelvic treatment, BMI, operative complexity and whether lymph-node dissection is required.
Frequently Asked Questions
1. What is the complication rate for robotic prostate surgery?
There is no single complication rate because studies count different events and use different follow-up periods. BAUS data recorded Grade III or higher complications in 1.3% of robotic cases with known complication grading, while two larger published robotic cohorts discussed in this article reported overall complication rates of 6.1% and 9.8%.
2. How common is bleeding after robotic prostate surgery?
Significant bleeding is uncommon, with UK BAUS data reporting a blood transfusion rate of around 0.2% after robotic prostatectomy. Your individual risk depends on your health, medicines and the complexity of surgery.
3. How common are urinary tract infections after robotic prostate surgery?
In a large US NSQIP study of 12,123 robotic prostatectomies performed between 2009 and 2012, UTI occurred in 1.77% of patients within 30 days. A urinary catheter can also contribute to infection risk during early recovery.
4. What is the risk of blood clots after robotic prostate surgery?
Blood clots are relatively uncommon. In a large 2009–2012 US NSQIP robotic-prostatectomy cohort, DVT occurred in 0.67% and pulmonary embolism in 0.45% within 30 days.
5. What is a urinary anastomotic leak?
A urinary anastomotic leak occurs when urine leaks from the new bladder-to-urethra connection before it has fully healed. Small leaks may only require your catheter to remain in place for longer.
6. How common are lymphoceles after robotic prostate surgery?
A lymphocele is a collection of lymphatic fluid that can occur after pelvic lymph-node removal. In a systematic review of robot-assisted prostatectomy with extended pelvic lymph-node dissection, symptomatic lymphoceles requiring intervention occurred in about 2.2% of patients.
7. Can robotic prostate surgery cause urinary narrowing?
Yes, scar tissue can occasionally narrow the urethra or bladder-neck area after surgery. This may cause a weaker urine stream or difficulty emptying your bladder and can sometimes require further treatment.
8. How common is bowel or rectal injury?
Bowel or rectal injury is a rare complication of prostatectomy. Previous pelvic surgery, radiotherapy or significant scar tissue can make surgery more technically complex, so your surgeon will consider your previous treatment and individual surgical risk.
9. How often are patients readmitted after prostate surgery?
National audit data show that around 12% of men in England and 17% in Wales had an emergency readmission within 90 days after radical prostatectomy. These figures cover all surgical approaches, not robotic surgery alone.
10. Who has a higher risk of complications?
Your risk may be higher with factors such as older age, higher BMI, previous pelvic surgery or radiotherapy, longer surgery and lymph-node dissection. Your surgeon can assess your individual risk based on your health and treatment history.
Final Thoughts: Understanding Your Individual Risk
Robotic prostate surgery is generally safe, but complications can still occur, ranging from minor problems to less common complications requiring further treatment. Your surgeon can explain which complication figures are most relevant to your planned procedure and personal risk.
If you are considering robotic prostate surgery in London and would like specialist advice, you can contact our team to discuss your options and arrange a consultation tailored to your individual needs.
References:
- British Association of Urological Surgeons (BAUS) (2020) BAUS Radical Prostatectomy Registry 2016–2019: National Summary Results. Available at: https://www.baus.org.uk/_userfiles/pages/files/publications/audit/Prostatectomy%202016%20to%202019%20National%20figures.pdf
- British Association of Urological Surgeons (BAUS) (2019) Audit Results Summary – Radical Prostatectomy Dataset: Operations Performed During 2018. Available at: https://www.baus.org.uk/_userfiles/pages/files/publications/audit/Prostatectomy2018finalanalyses.pdf
- National Prostate Cancer Audit (NPCA) (2025) State of the Nation Report: An Audit of the Care Received by Men Diagnosed with Prostate Cancer in England and Wales. London: National Cancer Audit Collaborating Centre, Royal College of Surgeons of England. Available at: https://www.npca.org.uk/wp-content/uploads/2025/01/NPCA-State-of-the-Nation-Report-2024_v2.pdf
- University College London Hospitals NHS Foundation Trust (2026) Robotic prostatectomy. Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/robotic-prostatectomy
- Dindo, D., Demartines, N. and Clavien, P.A. (2004) ‘Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey’, Annals of Surgery, 240(2), pp. 205–213. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC1360123/
- Homer, A., Golijanin, B., Schmitt, P., Bhatt, V., Pareek, G. and Hyams, E.S. (2024) ‘Epidemiology of and risk factors in postoperative complications from robotically assisted laparoscopic radical prostatectomy in contemporary National Surgical Quality Improvement Program data’, Journal of Endourology, 38(3), pp. 270–275. Available at: https://journals.sagepub.com/doi/10.1089/end.2023.0388
- Agarwal, P.K., Sammon, J., Bhandari, A. et al. (2011) ‘Safety profile of robot-assisted radical prostatectomy: A standardized report of complications in 3317 patients’, European Urology, 59(5), pp. 684–698. Available at: https://www.sciencedirect.com/science/article/pii/S030228381100073X
- Dagrosa, L.M., Ingimarsson, J.P., Gorlov, I.P., Higgins, J.H. and Hyams, E.S. (2016) ‘Is age an independent risk factor for medical complications following minimally invasive radical prostatectomy? An evaluation of contemporary American College of Surgeons National Surgical Quality Improvement data’, Journal of Robotic Surgery, 10(4), pp. 343–346. Available at: https://pubmed.ncbi.nlm.nih.gov/27263110/
- Zhong, W., Roberts, M.J., Saad, J. et al. (2020) ‘A systematic review and meta-analysis of pelvic drain insertion after robot-assisted radical prostatectomy’, Journal of Endourology, 34(4), pp. 401–408. Available at: https://journals.sagepub.com/doi/full/10.1089/end.2019.0554
- Yildiz, H., Adhoni, M.Z.U., Byrnes, K., Lamb, B., Lee, D.I. and Shahait, M. (2026) ‘Prevention of lymphoceles using peritoneal flaps during robotic-assisted radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis’, BJUI Compass, 7(3), article e70126. Available at: https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1002/bco2.70126