Prostate Removal Side Effects After Radical Prostatectomy

When men hear that the prostate will be removed because of cancer, one of their first questions is often, “What will life be like afterward?”

Radical prostatectomy can be an effective treatment for selected localized and locally advanced prostate cancers, but the prostate lies beside structures involved in bladder control, erections and ejaculation. This is why surgery can affect urinary and sexual function.

What Does “Prostate Removal” Mean?

For prostate cancer, prostate removal usually means a radical prostatectomy.

During this operation, the surgeon removes the prostate gland and seminal vesicles. Pelvic lymph nodes may also be removed when appropriate.

The procedure may be performed using an open, laparoscopic or robot-assisted approach.

The goal is cancer control while preserving surrounding structures whenever this can be done safely.

What Are the Main Side Effects of Radical Prostatectomy?

Urinary Incontinence After Prostate Removal

Urinary leakage is very common immediately after the urinary catheter is removed.

The urinary sphincter and surrounding pelvic structures need time to recover after surgery. In many men, continence improves gradually over the following weeks and months.

The most typical problem is stress urinary incontinence, where urine leaks during activities that increase pressure in the abdomen, such as:

• coughing
• sneezing
• laughing
• standing up
• lifting
• exercise

Some men also experience urgency or a sudden strong need to urinate.

Is urinary incontinence permanent?

Not usually.

Many men regain good urinary control over time. However, a smaller proportion continues to require pads or further treatment long term.

Published continence rates vary considerably because studies use different definitions of continence. This is one reason why a single percentage should not be presented as though it applies to every patient.

Can Pelvic Floor Exercises Help?

Pelvic-floor muscle training is commonly used before and after radical prostatectomy to help men regain urinary control.

The important point is to learn the correct muscles and technique. Simply squeezing harder or doing excessive repetitions is not necessarily better.

A pelvic-floor physiotherapist can be particularly useful when leakage continues or when a man is unsure whether he is activating the correct muscles.

If significant incontinence persists despite conservative treatment, a urologist may discuss additional options such as a male sling or artificial urinary sphincter in selected men.

Erectile Dysfunction After Radical Prostatectomy

Erectile dysfunction is another major concern following prostate removal.

The nerves involved in erections run in neurovascular bundles very close to the sides of the prostate.

When cancer location allows, the surgeon may use a nerve-sparing technique in an attempt to preserve one or both bundles.

However, nerve preservation must never take priority over adequate cancer removal. If cancer is very close to or involves the neurovascular structures, part or all of a nerve bundle may need to be removed.

Who has the best chance of erection recovery?

Recovery tends to be more favorable in men who:

• are younger
• had strong erections before surgery
• do not have severe vascular disease or poorly controlled diabetes
• can have both neurovascular bundles safely preserved
• are treated by an experienced surgical team

Recovery can take many months and sometimes one to two years or longer.

How Is Erectile Dysfunction Treated After Surgery?

Treatment depends on residual nerve function, vascular health, patient preference and the time since surgery.

Options may include:

• PDE5 inhibitor medicines such as sildenafil or tadalafil
• vacuum erection devices
• intraurethral medication in selected men
• penile injections
• penile prosthesis when other treatments are unsuccessful or unsuitable

PDE5 inhibitors work better when enough erectile nerve function remains, so they are not equally effective for every man.

Urologists may begin erectile-function treatment relatively early after surgery, although there is no single rehabilitation protocol proven to restore spontaneous erections in every patient.

What Happens to Ejaculation?

After radical prostatectomy, ejaculation changes permanently.

The prostate and seminal vesicles normally produce most of the fluid in semen. Because these structures are removed and the reproductive tract is interrupted, semen can no longer exit during orgasm.

A man may still experience orgasm, but it is a dry orgasm.

This does not necessarily mean that sexual pleasure disappears. Some men describe orgasm as similar to before surgery, while others describe it as less intense or simply different.

Can Orgasm Become Painful?

Some men report discomfort or pain during orgasm after radical prostatectomy, sometimes called dysorgasmia.

This is less common than erectile dysfunction or dry ejaculation and may improve over time.

Persistent pain should be discussed with a urologist rather than simply accepted as a permanent consequence of surgery.

Does Prostate Removal Cause Infertility?

Yes. Radical prostatectomy causes permanent loss of natural fertility through intercourse.

The testicles may continue producing sperm, but sperm and seminal fluid no longer pass through the penis during orgasm.

For men who may want biological children in the future, sperm banking should therefore be discussed before surgery.

Can the Penis Become Shorter?

Some men notice that their penis appears shorter after radical prostatectomy.

Several mechanisms have been proposed, including postoperative anatomical changes, alterations in blood flow, erectile dysfunction and changes where the bladder is reconnected to the urethra.

The exact mechanism is not completely understood.

Research has documented measurable or perceived shortening in some men, while other studies suggest that penile length may recover partly over the following one to two years.

It should therefore be presented as a possible effect, not something that inevitably happens to every patient.

Can Prostate Removal Cause an Inguinal Hernia?

Yes. An inguinal hernia is a recognized complication after radical prostatectomy.

A hernia occurs when tissue protrudes through a weak area in the abdominal or groin wall.

The increase in risk appears particularly relevant during the first years after surgery and has historically been reported more often following open prostatectomy than some minimally invasive approaches.

A groin lump, pressure or discomfort should be evaluated by a clinician.

Other Possible Surgical Complications

Radical prostatectomy is a major operation, so there are also general surgical risks.

These can include:

• bleeding
• infection
• blood clots
• reactions to anesthesia
• urine leak from the surgical connection
• scar tissue or narrowing at the bladder neck or urethral connection
• lymphocele if lymph nodes are removed

Serious complications are less common, but the individual risk depends on age, health, surgical complexity and other factors.

Are Robotic Surgery Side Effects Lower?

Robot-assisted radical prostatectomy is widely used, but “robotic” does not mean that urinary or sexual side effects disappear.

Current evidence suggests that long-term urinary and erectile outcomes are broadly similar between robot-assisted and open radical prostatectomy when appropriate comparisons are made.

The experience of the surgeon and surgical team, patient factors and cancer anatomy can matter more than simply whether the operation uses a robotic platform.

How Long Do Side Effects Last?

There is no single recovery timetable.

Urinary control

Leakage is usually worst immediately after catheter removal and often improves substantially during the first several months. Improvement may continue beyond the first year.

Erections

Erectile recovery tends to be slower. Nerves can require many months to recover even after successful nerve-sparing surgery.

Some men regain erections adequate for intercourse, some require medication or devices, and others have persistent erectile dysfunction.

Dry orgasm and infertility

These are permanent anatomical consequences of radical prostatectomy.

Penile shortening

This may improve partly in some men, although recovery is variable.

What Can You Do Before Surgery?

It is useful to discuss urinary, sexual and fertility issues before the operation rather than waiting until problems appear afterward.

Questions worth discussing with your urologist include:

• Is nerve-sparing surgery safe for my cancer?
• What is my individual likelihood of urinary leakage?
• What is my likelihood of recovering erections?
• Should I start pelvic-floor exercises before surgery?
• When should erectile-function rehabilitation begin?
• Do I need to consider sperm banking?
• How experienced is the surgical team with this procedure?

When Should You Contact Your Doctor After Prostatectomy?

Follow the discharge instructions from your surgical team, because expected recovery differs between patients.

Contact the treating team promptly if you develop problems such as:

• fever or signs of infection
• increasing redness or drainage from an incision
• inability of the catheter to drain
• new severe pain
• significant bleeding or large blood clots
• marked swelling of one leg
• new shortness of breath or chest pain

Longer-term concerns such as persistent urinary leakage, erectile dysfunction, painful orgasm or groin swelling also deserve medical review because treatment options are available.

PSA Follow-Up After Prostate Removal

Side-effect recovery is only one part of follow-up after radical prostatectomy. Cancer monitoring remains essential.

After the prostate has been removed, PSA is expected to fall to an undetectable or very low level. PSA is then checked periodically to look for evidence of recurrence.

You can learn more in my guide to understanding PSA.

If you are still reviewing how prostate cancer is diagnosed and staged, see my guide to prostate tests and evaluation.