Prostate removal (radical prostatectomy) is major surgery, and its two most common side effects are urinary incontinence and erectile dysfunction (ED). Other possible effects include changes in orgasm, loss of fertility, lymphedema, inguinal hernia and a slight shortening of the penis. Severity and recovery vary a lot from person to person. The encouraging part is that these effects can be managed — with pelvic floor exercises, medication, devices, implants and other treatments — so most men can maintain a good quality of life after surgery.
Facing prostate removal raises understandable worries about life afterward. Knowing the common side effects and the treatments available helps men prepare and recover with realistic expectations.
The most common side effects
The two most common side effects are urinary incontinence and ED. Urinary incontinence — an inability to control the bladder — often shows up as a dribble or leak when sneezing or laughing, a direct result of removing the prostate, which helps control urine. Erectile dysfunction, the inability to achieve a full erection, is a reality for many men afterward, and it can persist whether or not the nerves were spared during surgery.
| Side effect | Notes |
|---|---|
| Urinary incontinence | Leakage; often improves with pelvic floor exercises |
| Erectile dysfunction | Common; may persist even with nerve-sparing |
| Dry orgasm / infertility | No semen ejaculated; seminal vesicles often removed |
| Lymphedema | Leg swelling after lymph-node removal |
| Other | Inguinal hernia; slight penile shortening |
Changes in orgasm and fertility
Beyond incontinence and ED, men may notice changes in orgasm and loss of fertility. Surgery can lead to dry orgasms, where no semen is ejaculated, and because the seminal vesicles are often removed, infertility can result. Lymphedema — swelling in one or both legs — may occur after lymph nodes are removed, due to disrupted lymphatic drainage and fluid build-up. These are less talked about but important to anticipate.
Hernia and penis length
An inguinal hernia is a potential side effect, involving the bulging of fatty tissue or a loop of small intestine through a weak area in the groin, sometimes caused by the strain of surgery. Some men also notice a change in penis length — specifically a shortening — as a possible physical alteration after the procedure. These effects vary and are not universal.
Variability in recovery
Severity and recovery time vary significantly from person to person: some men have mild symptoms while others face more serious consequences. Long-term effects can include ongoing ED and different types of urinary incontinence — stress, overflow, urge and continuous. There may also be cases of pain persisting after surgery. Because outcomes differ so widely, an individual recovery plan is essential.
Managing side effects and life afterward
When facing these effects, open conversations with your healthcare provider are key — they can outline options to treat or manage symptoms, from medication and physical therapy to, in some cases, additional surgery. Urinary incontinence can often be managed with pelvic floor exercises or medication; ED can be treated with medication, vacuum devices or penile implants; and lymphedema with compression garments and physical therapy. Life after prostate removal brings adaptations, with loss of urinary control and erectile function the two prominent quality-of-life issues — but with proper care and management, men can lead fulfilling lives. Staying vigilant about your health and seeking advice promptly for any complications makes recovery smoother.
On ED treatment options, read the broader causes of ED and, for the medicine, what sildenafil is and how it is used. On painful sex, see causes and symptoms of painful sex.
Frequently asked questions
- What are the main side effects of prostate removal?
- Most commonly urinary incontinence and erectile dysfunction, plus possible changes in orgasm, fertility and more.
- Does ED always happen after surgery?
- It is common and can persist even with nerve-sparing surgery, but it can be treated with medication, devices or implants.
- Will I still be fertile?
- Often not, because the seminal vesicles are usually removed and orgasms become dry, leading to infertility.
- Can these effects be managed?
- Yes. Pelvic floor exercises, medication, vacuum devices, implants and physical therapy all help maintain quality of life.
For the full picture of causes and treatments, return to the erectile dysfunction and male sexual health hub.