Objective To compare perioperative index and postoperative urinary function following radical resection for middle and low rectal cancer between robotic and laparoscopic surgery. Methods Clinicopathological data of 313 patients with radical surgery for middle and low rectal cancer at our department from September 2015 to October 2018 were analyzed retrospectively. Propensity score matching analysis (1∶1, caliper value=0.01) between robotic surgery group and laparoscopic surgery group was performed based on gender, age, body mass index, American Society of Anesthesiology score, and tumor staging. Two surgical approaches were studied for safety in radical treatment of middle and low rectal cancer and the effect on urinary function, which was assessed using the International Prostate Symptom Score (IPSS) preope-ratively and 1, 3, and 6 months after surgery. Results The matched sample of 101 cases in two groups using propensity score was included. There was no statistical difference in the outcome of radical resection between two groups. However, significant differences were found in operative time, intraoperative blood loss, time to first flatus and postoperative hospital stay (P<0.001). IPSS of robotic surgery group was significantly lower than that of laparoscopic group 1 month after surgery(P<0.001). IPSS of patients older than 60 with low rectal cancer in robotic surgery group was lower than that in laparoscopic surgery group 1 month postoperatively(P=0.027), and no significant difference in IPSS 3 and 6 months after surgery was present between two groups. Conclusions The efficacy of robotic radical surgery was same as laparoscopic surgery for middle and low rectal cancer. The radical surgery of patients with rectal cancer in robotic approach had urinary function less impaired and short-term rehabilitation better compared to that in laparoscopic approach, especially for patients older than 60 with low rectal cancer.