Objective To explore factors for long-term postoperative cognitive dysfunction(POCD) in elderly patients undergoing robot-assisted laparoscopic urological surgery. Methods The clinical data of patients with robot-assisted laparoscopic urological surgery, who were aged ≥65 year were analyzed. The patients’ sex, age, education years, preoperative comorbidities, history of alcohol and smoking history; intraoperative factors included procedure duration, use of drugs, fluid intake and output and so on; postoperative factors included length of stay, postoperative survival rate; follow-up information of the patients’pain, anxiety, depression, and cognitive status were all collected. According to the occurrence of POCD, patients were divided into POCD group and non-POCD group. Multivariable logistic regression was used to determine the risk factors for POCD. Results A total of 252 patients were finally enrolled in this study, 36 patients developed POCD, and the incidence was 14.29%. Multivariate logistic regression showed that the possible risk factors for the development of POCD six months after surgery were intraoperative hypotension ( OR= 4.714，95%CI 1.614-13.767,P=0.005).Conclusions Elderly patients undergoing robotic-assisted laparoscopic urology surgery have long-term cognitive decline after surgery, stable intraoperative blood pressure may have protective effects on brain function.