Having your prostate removed, a surgery called radical prostatectomy, eliminates the prostate gland and the seminal vesicles attached to it. The operation is most commonly performed to treat prostate cancer. It’s effective at removing the disease, but it changes how your body handles urination, sexual function, and fertility in ways that can take months or even years to fully adjust to. Here’s what to expect.
The First Weeks After Surgery
Most men go home one to two days after a robotic-assisted prostatectomy. You’ll leave the hospital with a urinary catheter in place because the surgeon has reconnected your urethra directly to your bladder, and that connection needs time to heal. In older open surgical techniques, catheters stayed in for two to three weeks. With modern robotic approaches, many surgeons remove them around day seven, though some centers trial removal as early as day two or three. Removing it too soon carries a small risk of needing a catheter placed again (about 13% in one study of very early removal on day two), so most practices favor the one-week mark.
During this period, expect some discomfort around the incision sites, fatigue, and limited physical activity. Most men recover their general physical capacity within several weeks.
Urinary Incontinence and Recovery
Leaking urine is the most common early side effect, and nearly every man experiences some degree of it right after the catheter comes out. Your prostate used to sit around your urethra and played a role in urinary control. Without it, the muscles of your pelvic floor have to do all the work on their own, and they need time to strengthen.
Recovery follows a fairly predictable curve. About 30% of men are fully continent at three months, 58% at six months, and roughly 79% by one year. Over 95% of men regain continence within a few months at experienced surgical centers, though “continence” can mean different things: some men still use a thin liner for occasional minor leaks and consider themselves continent.
The length of your membranous urethra (the segment that runs through your pelvic floor) and your surgeon’s experience are both strong predictors of how quickly you’ll recover. Men with a shorter urethra in that area tend to have a harder time.
Pelvic Floor Exercises Speed Recovery
Structured pelvic floor training, essentially Kegel exercises, makes a measurable difference. In one study comparing men who followed a dedicated rehab program to those who didn’t, the training group regained continence in a median of 44 days versus 76 days for the control group. A typical starting protocol is three sets of 30 contractions per day, alternating between quick one-to-two-second holds and longer six-to-seven-second holds, without clenching your glutes or abs. Starting these exercises before surgery can give you a head start.
Erectile Dysfunction
The nerves that control erections run along both sides of the prostate. Even when a surgeon performs a “nerve-sparing” technique, carefully preserving those nerve bundles, they’re still bruised and swollen from the surgery. Erections don’t just come back overnight.
Among men who had normal erections before a nerve-sparing prostatectomy, about 40 to 50% return to their pre-surgery function within one year. By two years, that figure reaches 30 to 60%, a wide range that reflects how much outcomes depend on the individual surgeon’s skill and how much nerve tissue could realistically be preserved. Men whose cancer had grown close to or into the nerve bundles may not be candidates for nerve-sparing at all, and their recovery rates are significantly lower.
Most men use oral medications (like Viagra or Cialis) during the recovery period to encourage blood flow and help the nerves heal. Some doctors recommend starting these medications early, even before erections return on their own, as part of a “penile rehabilitation” strategy.
Penile Shortening
This side effect surprises many men because it’s rarely discussed before surgery. Between 68% and 71% of men experience some degree of penile shortening after prostatectomy. The average decrease in both flaccid and erect length is around 8 to 9%, and about half of men in one study lost more than one centimeter of stretched length by three months. The likely causes include changes in blood flow, nerve damage, and structural changes from reduced erections during recovery. Early and regular use of a vacuum erection device has been shown to reduce the risk of this length loss compared to doing nothing.
Changes to Orgasm and Ejaculation
Your prostate and seminal vesicles produced most of the fluid in your ejaculate. Without them, you will have “dry” orgasms, meaning you can still climax, but nothing comes out. Your testicles continue to produce sperm, but those cells are simply reabsorbed by your body.
Some men say a dry orgasm feels essentially the same as before. Others report that it feels less intense or less satisfying, and the absence of visible ejaculation can be psychologically significant. A small percentage of men also experience climacturia, which is leaking a small amount of urine at the moment of orgasm. This tends to improve over time as pelvic floor strength returns.
Fertility After Prostate Removal
Natural conception is no longer possible after a radical prostatectomy. Because semen can’t be produced or ejaculated, sperm have no way to leave your body during sex. Your testicles still make sperm, but that doesn’t help without a delivery route.
If fathering children is important to you, the best option is sperm banking before surgery. Frozen semen can later be used for artificial insemination, and about 50% of sperm survive the thawing process. If banking wasn’t done beforehand, sperm can sometimes be extracted directly from testicular tissue and injected into an egg in a lab. The combined success rate of extraction plus fertilization is under 50%, making it a less reliable path.
PSA Monitoring After Surgery
One of the benefits of removing the entire prostate is that your PSA (prostate-specific antigen) level should drop to essentially zero, since the prostate is the main source of PSA. This gives your doctors a very sensitive tool for detecting any cancer that might return. If your PSA rises to 0.2 ng/mL or above on two consecutive blood tests, that’s considered a biochemical recurrence, a signal that some prostate cancer cells may still be present somewhere in your body. Regular PSA blood draws, typically every few months for the first few years, become a routine part of your follow-up care.
Inguinal Hernia Risk
An underappreciated long-term consequence is a higher risk of developing an inguinal hernia, the kind where tissue pushes through a weak spot in your lower abdominal wall near the groin. The surgery disrupts the layers of tissue in that area. A large meta-analysis found that about 12% of men developed a hernia after open prostatectomy, compared to about 3% in men who didn’t have the surgery. Robotic and laparoscopic approaches carry a somewhat lower risk, around 7 to 8%, but it’s still more than double the baseline. This is worth knowing so you can recognize the symptoms early: a bulge in the groin area, especially one that appears when you cough or strain.