If you are having robotic radical prostatectomy, you may be wondering what happens to the urethra that runs through your prostate. During the operation, your surgeon separates the prostate from the bladder and divides the urethra just below the gland so the prostate can be removed. The section of urethra inside the prostate is removed with it, while the remaining urethra is preserved as carefully as possible.
Your surgeon then reconnects your bladder to the remaining urethra, creating a new join called a vesicourethral anastomosis. A temporary catheter stays in place while this connection heals. Although some urine leakage is common when the catheter is removed, how the urethra, sphincter and surrounding structures are preserved can influence how quickly you regain urinary control.
Where Is Your Urethra in Relation to the Prostate?
Your urethra carries urine from your bladder to the outside of your body. In men, it passes directly through the prostate before continuing through the penis, with this section known as the prostatic urethra.
Below the prostate, the urethra lies close to your external urinary sphincter, which is important for controlling urine. During prostate surgery, your surgeon therefore aims to preserve as much healthy urethra and sphincter function as safely possible, as these structures can affect your continence recovery.
Why Does the Urethra Need to Be Divided?
Your prostate surrounds part of your urethra, so when your entire prostate is removed, the section running through the gland also needs to be divided. Your surgeon separates the prostate from your bladder and then divides the urethra below the prostate so the gland can be completely removed.
This temporarily leaves a gap between your bladder and the remaining urethra. Your surgeon then reconnects the bladder directly to the urethra, restoring the normal route for urine. This division and reconstruction are planned parts of the operation, not complications.
Exactly Which Part of the Urethra Is Removed?
You do not normally lose your entire urethra during robotic prostatectomy. The section that runs through your prostate, called the prostatic urethra, is removed with the gland, while the urethra further down towards your penis remains in place.
Your surgeon aims to divide the urethra close to the bottom of your prostate while preserving as much healthy urethral length and sphincter function as safely possible. However, the amount that can be preserved depends on your anatomy and the location of your cancer, so removing the tumour completely remains the priority.
What Happens After the Prostate Has Been Removed?
Once your prostate has been removed, your bladder and remaining urethra are temporarily separated. Your surgeon brings your bladder down and carefully stitches it directly to the urethra, creating a new continuous urinary passage.
As this connection heals, urine can once again travel from your bladder through your urethra and out through your penis as usual. The reconstruction is internal, so you will not have a new external opening or normally notice the change once you have recovered.
What Happens to the Urinary Tract During Prostatectomy
| Stage | What happens |
| Before prostate removal | The urethra passes from the bladder through the prostate and continues towards the penis |
| During prostate removal | The prostate is separated from the bladder at the bladder neck, and the urethra is divided below the prostate so the gland can be removed |
| Prostatic urethra | The section of urethra running through the prostate is removed with the gland |
| Remaining urethra | The urethra below the prostate is preserved as carefully as cancer clearance allows |
| Bladder reconstruction | The bladder is brought down towards the remaining urethra |
| New connection | The bladder and urethra are stitched together to form a vesicourethral anastomosis |
| Catheter placement | A temporary catheter is passed through the new connection to drain urine while it heals |
| After healing | Urine can again pass from the bladder through the urethra and out normally |
What Is a Vesicourethral Anastomosis?
A vesicourethral anastomosis is the medical term for the new connection your surgeon creates between your bladder and remaining urethra after your prostate has been removed. Your surgeon uses stitches to bring the two structures together so they can heal into a continuous urinary passage.
The aim is to make the connection well aligned, watertight and free from unnecessary tension, helping it heal properly. A temporary urinary catheter is usually placed through the new join to support healing during the early recovery period.
Why Does the New Join Need to Be Watertight?
Your kidneys continue producing urine after surgery, so your new bladder-to-urethra connection needs to contain urine while the tissues heal. Your surgeon aims to create a secure, watertight seal so urine can pass through the catheter rather than leaking into the surrounding pelvis.
A small amount of leakage can occasionally occur, and your catheter may be left in for longer if your team feels the connection needs more time to heal. The bladder and urethra also need to be brought together without excessive tension, making careful alignment and stitching an important part of the operation.
Why Do You Need a Catheter After Surgery?
A urinary catheter is a soft tube that passes through your penis and urethra into your bladder. It allows urine to drain continuously into a bag while the new bladder-to-urethra connection heals, so you do not need to pass urine normally during this early stage.
The catheter also helps support the new join while it heals. A small balloon inside your bladder keeps the catheter in place, and you will usually go home with it still fitted. Your nursing team will show you how to care for it, empty the drainage bag and recognise any problems.
How Long Does the Catheter Stay In?
Your catheter will usually stay in for around 7–10 days after robotic radical prostatectomy, although the exact timing can vary between hospitals and depending on how your operation has gone. Some centres may leave it in for around 10–14 days or occasionally longer.
Having the catheter for longer does not necessarily mean that something has gone wrong. Your surgeon may want to give your bladder-to-urethra connection more time to heal, depending on your anatomy, the reconstruction performed and what was seen during your operation. Follow the timing advised by your own surgical team rather than comparing your recovery with someone else’s.
What Happens When the Catheter Is Removed?
Once your surgeon is happy that the new bladder-to-urethra connection has healed, your catheter can be removed. It is normal to notice some urinary changes at first.
- Passing urine: You may be asked to pass urine so your team can check that your bladder is emptying properly.
- Urinary leakage: Some leakage is common when the catheter first comes out.
- Urgency: You may feel a stronger or more frequent need to pass urine during early recovery.
- Continence pads: Taking pads to your catheter-removal appointment can help you feel more prepared.
These symptoms often improve as swelling settles and your urinary-control muscles recover. Your surgical team can advise you if any symptoms are more severe or persistent than expected.
Why Might You Leak Urine After the Catheter Comes Out?
Your prostate normally forms part of the support around your bladder, urethra and urinary sphincter. After it is removed, your external sphincter and pelvic-floor muscles have to provide more of the control that prevents urine leakage, while swelling and temporary weakness can make this harder at first.
You may notice leakage when you stand, walk, cough, sneeze or change position, particularly soon after your catheter is removed. Recovery varies from person to person, and some men regain control quickly while others need pads for several months, but early leakage does not mean that your bladder-to-urethra connection has failed.
Which Part of the Urinary Tract Controls Continence After Surgery?
Your external urinary sphincter, which surrounds the membranous urethra, plays an important role in controlling urine after your prostate has been removed. It acts like a muscular valve, helping keep your urethra closed until you are ready to pass urine, while your pelvic-floor muscles provide additional support.
This is why your surgeon takes particular care around the lower end of your prostate when dividing the urethra. Preserving as much healthy urethral length and sphincter function as safely possible can support continence recovery, although your age, urinary function before surgery and individual anatomy also influence the outcome.
Why Does Urethral Length Matter?
The amount of membranous urethra that remains below your prostate can influence how quickly you regain urinary control after surgery. Studies have linked greater preserved urethral length with a better chance of earlier continence recovery, and your preoperative MRI can help your surgeon assess your individual anatomy.
However, preserving more urethra is not the only consideration. If your cancer is close to the prostate apex, your surgeon may need to remove more tissue to achieve appropriate cancer clearance. Your anatomy and the location of your tumour therefore both influence how much urethral length can safely be preserved.
Does Preserving the Bladder Neck Help?
When your cancer location and anatomy allow, your surgeon may preserve part of the bladder neck during prostate removal. Evidence suggests that bladder-neck preservation can improve continence recovery in appropriately selected patients, although suitability depends on your anatomy and cancer location.
However, preservation is not always suitable, particularly if your cancer is close to the base of your prostate or the area has been altered by previous procedures. Your surgeon also needs to ensure the bladder neck fits properly with the remaining urethra when creating the new connection, so the reconstruction can be tailored to your anatomy.
Evidence Note
A 2025 systematic review and meta-analysis of 30 studies involving 11,239 patients found that a longer membranous urethra measured on MRI was associated with a greater probability of urinary continence at 12 months after radical prostatectomy. Current European guidance therefore recommends preserving as much urethral length as is oncologically safe when planning surgery.
A 2026 UCL and UCLH study of 459 patients also reported better early continence with complete urethral preservation, with continence rates of 77% compared with 67% at three to six months. At 12 months, rates were similar at 83% and 80%. However, this was a retrospective single-centre study involving a single high-volume surgeon, so the findings should not be treated as a guarantee of individual recovery.
How Do Pelvic-Floor Exercises Help?
Pelvic-floor exercises strengthen the muscles that support your bladder and help control your urethra. Learning the correct technique before your operation can help you feel prepared for recovery. After surgery, pelvic-floor muscle training can support earlier continence recovery, particularly during the first few months.
Once your surgical team advises you to restart them, regular exercises can support your continence recovery. Technique is more important than simply doing large numbers of contractions, so a specialist physiotherapist or continence professional can help if you are unsure whether you are using the correct muscles.
UK Guidance Note
Current NICE prostate cancer guidance advises that people should be warned before radical treatment about possible changes in urinary function. If troublesome urinary symptoms continue after treatment, patients should have access to specialist continence services, which may include pelvic-floor muscle re-education, bladder retraining and other conservative treatments.
UK catheter-removal practice varies between surgical centres. Many centres remove the catheter approximately 7–10 days after robotic prostatectomy, while others routinely use a 7–14-day period. Your own surgical team’s instructions should therefore take priority over a general timetable.
Can the New Bladder-to-Urethra Join Become Narrow?
Yes, although significant vesicourethral anastomotic narrowing is uncommon after modern robotic prostatectomy. Contemporary reviews suggest that vesicourethral anastomotic narrowing occurs in roughly 1–5% of patients after radical prostatectomy, although rates vary between studies and surgical approaches. Scar tissue can sometimes form around the new bladder-to-urethra connection, making the opening narrower.
You may notice a weaker urine stream or difficulty emptying your bladder. Treatment is available, often using an endoscopic procedure to open the narrowed area, so report any worsening urinary flow to your urology team.
What Urinary Symptoms Should You Report After Surgery?
Some leakage, urgency and frequent urination are common after your catheter is removed while your bladder and sphincter adjust. However, you should contact your medical team if you cannot pass urine, develop a progressively weaker stream, feel unable to empty your bladder or develop fever or signs of infection.
While your catheter is still in place, make sure urine continues to drain into the bag. If drainage stops or you develop significant bladder discomfort, seek advice promptly and tell the clinician that you have recently had prostate surgery.
Does Cutting the Urethra Cause Erectile Problems or Dry Ejaculation?
Cutting and reconnecting your urethra is part of restoring your urinary pathway and is not usually the direct cause of erectile problems or dry ejaculation. Your erections depend mainly on the nerves and blood vessels running alongside your prostate, while your ability to ejaculate changes because your prostate and seminal vesicles are removed and the reproductive pathway is interrupted.
You can still pass urine normally through the reconstructed urethra once it has healed, and you may still experience orgasm without releasing semen. Erectile recovery depends on factors such as your function before surgery, cancer location and whether nerve-sparing surgery is safely possible.
What Should You Ask Your Surgeon About Your Urethra?
Before surgery, ask how the location of your cancer may affect how much healthy urethra can be preserved. You can also ask whether your MRI shows anything about your membranous urethral length, whether bladder-neck preservation is suitable and how your surgeon will create the bladder-to-urethra connection.
It is also worth asking how long your catheter is likely to stay in and what level of urinary leakage you should expect after it is removed. If you have previously had TURP, HoLEP or another prostate procedure, tell your surgeon, as this can affect the anatomy around your bladder neck.
Myth vs Fact
| Myth | Fact |
| Your entire urethra is removed during prostatectomy. | No. The prostatic segment is generally removed with the prostate, while the remaining membranous and penile urethra stay in place. |
| After the prostate is removed, your bladder is no longer connected to the urethra. | Your surgeon reconnects the bladder neck directly to the remaining urethra through a vesicourethral anastomosis. |
| A longer urethra guarantees continence. | No. Greater membranous urethral length is associated with better recovery, but age, baseline function, sphincter preservation and surgical technique also matter. |
| Bladder-neck preservation always improves long-term continence. | No. Bladder-neck preservation can support continence recovery in selected patients, but it is not suitable for everyone. Cancer location, prostate anatomy and previous procedures can affect whether it can be preserved safely. |
| A weak urine stream after surgery should always be ignored as normal recovery. | No. Progressive weakening or difficulty emptying your bladder can indicate narrowing of the new connection and should be assessed. |
Key Takeaways
- During radical prostatectomy, the prostatic urethra is generally removed with the prostate, while the remaining urethra is preserved.
- Your surgeon reconnects your bladder to the remaining urethra through a vesicourethral anastomosis so urine can pass normally again.
- Preserving as much healthy membranous urethral length and sphincter function as cancer clearance allows can support earlier continence recovery.
- A catheter is commonly kept in place for around 7–10 days, although some UK centres use a longer 7–14-day period.
- Temporary leakage is common after catheter removal, while a progressively weaker urine stream, inability to pass urine or a catheter that stops draining should be reported promptly.
Frequently Asked Questions
1. What happens to the urethra during robotic prostate surgery?
During robotic radical prostatectomy, the section of your urethra that passes through the prostate is removed with the gland. Your surgeon then reconnects your bladder to the remaining urethra so that you can continue to pass urine normally after you recover.
2. Is the entire urethra removed during prostate surgery?
No, your entire urethra is not removed. Only the section running through your prostate is removed, while the remaining urethra is preserved as carefully as possible to support normal urinary function.
3. What is a vesicourethral anastomosis?
A vesicourethral anastomosis is the new connection between your bladder and remaining urethra after your prostate has been removed. Your surgeon creates this join with stitches so that urine can pass from your bladder through your urethra once healing is complete.
4. Why do you need a catheter after robotic prostate surgery?
A catheter drains urine from your bladder while the new bladder-to-urethra connection heals. It also helps protect the join during the early stages of recovery and is usually left in place for around 7–10 days, although the timing can vary.
5. What happens when the catheter is removed?
Once your surgeon is satisfied that the connection has healed sufficiently, the catheter can be removed. You may initially experience urine leakage, urgency or increased frequency, but these symptoms often improve as your urinary control recovers.
6. Why might you leak urine after prostate surgery?
Urinary leakage can occur because your urinary sphincter and pelvic-floor muscles have to take over more of the work previously supported by the prostate. Early leakage is common and often improves over time, although recovery varies between individuals.
7. Does preserving urethral length help urinary continence?
Preserving as much healthy urethral length as safely possible may support earlier recovery of urinary control. However, your surgeon must balance this with cancer clearance, particularly if your tumour is close to the prostate apex.
8. Can the bladder neck be preserved during robotic prostate surgery?
In selected patients, your surgeon may be able to preserve part of the bladder neck if your cancer location and anatomy allow it. This may support earlier continence recovery, but preservation is not appropriate when it could compromise cancer removal.
9. Can the new bladder-to-urethra connection become narrowed?
Yes, scar tissue can occasionally form around the new connection and make the opening narrower. If you develop a progressively weaker urine stream or difficulty emptying your bladder, you should contact your urology team because treatment may be available.
10. Can pelvic-floor exercises help after robotic prostate surgery?
Yes, pelvic-floor exercises can strengthen the muscles that help control your bladder and urethra. Learning the correct technique before surgery can help you restart the exercises appropriately after your catheter is removed and your surgical team advises you to do so.
Final Thoughts: Understanding Your Urethra During Prostate Surgery
During robotic prostate surgery, the section of your urethra that passes through the prostate is removed with the gland, but the remaining urethra is carefully preserved and reconnected to your bladder. This reconstruction allows you to continue passing urine normally once the new connection has healed, although temporary leakage is common while your urinary control recovers.
Your surgeon’s approach to preserving urethral length, the bladder neck and the urinary sphincter can all play a role in your recovery, but your individual anatomy and the location of your cancer are also important. 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:
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer. EAU Guidelines Office, Arnhem, The Netherlands. Available at: https://uroweb.org/guidelines/prostate-cancer
- National Institute for Health and Care Excellence (2019, updated 2021) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: https://www.nice.org.uk/guidance/ng131
- 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
- Negrean, C. et al. (2025) ‘Preoperative magnetic resonance imaging membranous urethral length as a predictor of urinary continence after radical prostatectomy: a systematic review and meta-analysis’, European Urology Focus, 11(4), pp. 648–661. Available at: https://pubmed.ncbi.nlm.nih.gov/40055093/
- Yousaf, A. et al. (2026) ‘Urinary continence after robot-assisted radical prostatectomy with complete urethral preservation’, BJUI Compass, 7(5), e70230. Available at: https://pubmed.ncbi.nlm.nih.gov/42255328/
- Zeng, Y. and Wang, J. (2024) ‘Pelvic floor muscle exercises can effectively improve urinary incontinence after radical prostatectomy: systematic review and meta-analysis based on randomised controlled trials’, Archivos Españoles de Urología, 77(6), pp. 658–665. Available at: https://pubmed.ncbi.nlm.nih.gov/39104234/
- Valovska, M.T., Woodle, T. and Hagedorn, J.C. (2025) ‘Surgical management of vesicourethral anastomotic stenosis’, Investigative and Clinical Urology, 66(5), pp. 383–394. Available at: https://pubmed.ncbi.nlm.nih.gov/40897657/