If your cancer is too close to the nerves, your surgeon may need to remove more tissue on one or both sides so the cancer can be removed safely. This can affect your ability to have natural erections after surgery.
If one nerve bundle is preserved, you may still recover some erections. If neither nerve bundle can be preserved, spontaneous erections are much less likely to return, but treatments may still help you achieve an erection. You can also usually still enjoy sexual sensation and orgasm, although you will no longer ejaculate semen.
What Does It Mean If the Nerves Cannot Be Spared?
If your cancer is too close to the nerves, your surgeon may need to remove some or all of the nerve bundle on that side. This is done to make sure your cancer is removed safely.
This can happen on one or both sides. Preserving functional nerve tissue may improve your chance of erectile recovery, although your age, erectile function before surgery and other health factors also matter.
Why Would Your Surgeon Need to Remove the Nerves?
Your surgeon may need to remove some or all of the nerves if your cancer is very close to them. This helps reduce the risk of leaving cancer behind.
Your surgeon will use your MRI, biopsy and other results to decide how much tissue is safest to remove. Treating your cancer safely always comes first.
How Does Your Surgeon Decide Whether the Nerves Can Be Saved?
Your surgeon looks at several factors to decide how much nerve tissue can be safely preserved during surgery. The aim is to protect your erectile function where possible without compromising cancer treatment.
- MRI Findings: Your MRI helps show where the cancer is and how close it appears to be to the nerves.
- Biopsy Results: Your biopsy provides information about the location and aggressiveness of your cancer.
- PSA and Cancer Stage: Your PSA and stage help your surgeon assess the risk of cancer extending beyond the prostate.
- Findings During Surgery: Your surgeon may change the nerve-sparing plan if what they find during the operation suggests that more tissue needs to be removed.
You may have more nerve tissue preserved on one side than the other depending on your cancer. Your surgeon will always balance nerve preservation with the need to remove the cancer safely.
Can the Nerves Be Removed on Only One Side?
Yes. Your surgeon may preserve the nerves on one side while removing some or all of them on the other, depending on where your cancer is.
This means you may still have a chance of recovering erections if some nerve tissue is preserved. Your recovery will also depend on your erections before surgery and other factors.
How Does Your Surgeon Balance Cancer Removal and Nerve Sparing?
Your surgeon aims to remove the cancer safely while preserving the nerves where this can be done without increasing concern about cancer extending beyond the prostate.
If your cancer is very close to a nerve bundle, more tissue may need to be removed on that side. The amount of nerve tissue preserved can therefore be different on each side depending on your individual cancer findings.
What Happens to Erections Immediately After Surgery?
Erectile difficulties are common soon after surgery, even when nerve sparing is possible. Preserved nerves can be temporarily affected by surgical handling and may take months or longer to recover.
If some nerve tissue or both nerve bundles are removed, natural erections may be less likely to return. Your doctor can discuss treatments with you to help you achieve erections during recovery.
Evidence Note
Nerve preservation is an important predictor of erectile-function recovery after radical prostatectomy, but it is not the only factor. Your erectile function before surgery, age and the extent of nerve preservation also influence recovery.
Current European prostate cancer guidance recommends nerve-sparing surgery when the estimated risk of cancer extending beyond the prostate is low on that particular side. This means that if preserving the nerves could make it harder to remove the cancer safely, using a wider approach may be an appropriate part of the planned operation rather than a sign that surgery has gone wrong.
What Happens If One Nerve Bundle Is Spared?
If your surgeon can preserve one nerve bundle, you may still have a chance of recovering natural erections. Your age and erections before surgery can affect your recovery.
Recovery can take time, so early difficulties do not mean you will not improve. Your doctor can also offer treatments to support your erections while you recover.
What Happens If Both Nerve Bundles Are Removed?
If both neurovascular bundles need to be removed, spontaneous erections are much less likely to return because the cavernous nerve pathways involved in triggering an erection have been removed.
But this does not mean you cannot have an erection or enjoy sex. Your doctor can discuss treatments such as vacuum devices, injections or implants to help you.
Will Removing the Nerves Affect Sexual Sensation?
Not usually. The cavernous nerves mainly control the erectile response rather than normal skin sensation, so penile touch sensation is generally preserved. You can still feel touch and sexual stimulation.
Your sexual experience may feel different after surgery, especially if you cannot get a natural erection. Your doctor can support you with both the physical and emotional changes.
Can You Still Have an Orgasm If the Nerves Are Removed?
Many men can still experience orgasm even when the erectile nerves cannot be preserved because erection and orgasm are different processes.
Your orgasm may feel different from before, but you can still enjoy sexual pleasure. Some men may also notice discomfort or a small amount of urine during orgasm.
What Happens to Ejaculation and Fertility?
After your prostate is removed, you will no longer ejaculate semen when you have an orgasm. This happens whether or not your nerves are preserved.
If having biological children matters to you, talk to your doctor before surgery. You may be able to store sperm for future fertility treatment.
Will Erectile Dysfunction Tablets Work If the Nerves Are Not Spared?
Medicines such as sildenafil or tadalafil may help you get an erection after surgery, especially if some nerve tissue has been preserved.
If both nerve bundles are removed, these tablets may not work as well. Your specialist can advise you on the most suitable treatment options for you.
Can a Vacuum Pump Help If the Nerves Were Removed?
Yes. A vacuum pump can help you get an erection even if your erectile nerves have been removed.
It works by gently drawing blood into your penis, so it does not rely on your nerves. Your specialist can show you how to use it safely and whether it is right for you.
Can Penile Injections Work Without the Erectile Nerves?
Yes. Penile injections can help you get an erection even if your erectile nerves have not been preserved.
The medicine works directly on the blood vessels in your penis, so it does not rely on your nerves. Your specialist can show you how to use the injections safely and find the right dose for you.
How Can Erections Be Treated If the Nerves Are Not Spared?
| Treatment | Does It Depend on Intact Erectile Nerves? | What It Does |
| PDE5 inhibitor tablets | More dependent on remaining nerve signalling | Enhance the normal erectile response and are generally more effective when some nerve function remains |
| Vacuum erection device | No | Uses negative pressure to draw blood into the penis and can create an erection mechanically |
| Penile injections | No | Medication acts directly on penile blood vessels and smooth muscle to produce an erection |
| Intraurethral treatment | Less dependent on nerve signalling | Delivers erectile medication through the urethra |
| Penile prosthesis | No | Surgically provides a reliable mechanical way to obtain penile rigidity |
The most suitable option depends on how much nerve tissue was preserved, your erections before surgery, other medical conditions, your preferences and how you respond to earlier treatments.
What Is Penile Rehabilitation After Non-Nerve-Sparing Surgery?
Penile rehabilitation is a term used for treatments intended to support erectile and penile health after prostate surgery and help you resume sexual activity. It can include medicines, vacuum devices or injections to help you achieve erections.
If both neurovascular bundles could not be preserved, penile rehabilitation cannot make the removed nerves grow back or guarantee spontaneous erectile recovery. Treatment instead focuses on assisted erections, penile health and maintaining sexual activity where possible.
When Should Erectile Dysfunction Treatment Start After Surgery?
You do not necessarily need to wait for spontaneous erections to return before discussing treatment. Your specialist can advise when it is appropriate to start options such as tablets, a vacuum erection device or injections after your operation.
The most suitable timing and treatment depend on how much nerve tissue was preserved, your erectile function before surgery, your recovery and your individual health.
Research Insight
A systematic review of erectile dysfunction treatment after robot-assisted radical prostatectomy found that PDE5 inhibitor treatment was mainly supported after nerve-sparing surgery. The review also identified vacuum devices, alprostadil-based treatments and penile implants as options used after surgery, including treatments that can be useful when nerve sparing has not been possible.
However, studies of postoperative rehabilitation use different treatments, schedules and definitions of recovery. Current EAU guidance notes that penile rehabilitation itself has not been shown to increase the chance of spontaneous erectile-function recovery after nerve-sparing prostatectomy. This uncertainty is important when discussing rehabilitation after surgery.
Can Your Penis Become Shorter After Non-Nerve-Sparing Surgery?
You may notice changes in penile size or shape after radical prostatectomy, such as shortening, narrowing or curvature. These changes are not unique to non-nerve-sparing surgery, although reduced spontaneous erections may contribute.
A vacuum erection device may help support penile blood flow and may help maintain penile size in some patients. If you notice pain, significant curvature or changes that worry you, speak to your urology team.
What If Vacuum Devices and Injections Do Not Work for You?
If tablets, vacuum devices or injections do not work well for you, you still have options. Your specialist may discuss a penile implant with you.
An implant can help you get an erection without relying on your nerves. It usually comes after other treatments have been tried, as it requires another operation.
How Can Sexual Changes Affect You Emotionally?
Erectile difficulties after prostate surgery can affect more than your sex life. You may feel frustrated, less confident or worried about intimacy and your relationship, especially if your cancer treatment has gone well but your sexual recovery is harder than expected.
You and your partner may find it helpful to talk openly about these changes. If you are struggling, you do not need to wait. Your doctor can offer support, including counselling or specialist psychosexual advice.
UK Guidance Note
NICE recommends discussing before radical prostate cancer treatment how surgery may affect your sexual experience, erections, ejaculation and fertility. If you develop erectile difficulties afterwards, you should have access to specialist erectile dysfunction services.
PDE5 inhibitor tablets may be offered when suitable. If these do not restore useful erectile function or cannot be used, options can include vacuum devices, intraurethral treatment, penile injections or a penile prosthesis. NICE also recommends giving you and your partner access to healthcare professionals experienced in psychosexual support.
What Should You Ask If Your Surgeon Says the Nerves May Not Be Spared?
Before surgery, ask your surgeon whether the concern is on one side or both, and what your MRI and biopsy show. You can also ask whether some nerve preservation is still possible and how your erections before surgery may affect your recovery.
If you have already had surgery, ask whether both nerve bundles, one bundle or part of a bundle was preserved. You should also ask when your erectile treatment will start and who will support you with it.
Myth vs Fact
| Myth | Fact |
| If the erection nerves cannot be spared, robotic prostate surgery has gone wrong. | Non-nerve-sparing surgery may be necessary when preserving the neurovascular tissue could make it harder to remove the cancer safely. It can be an appropriate planned part of radical prostatectomy. |
| If both nerve bundles are removed, you can never have an erection again. | Spontaneous erections are much less likely, but vacuum devices, penile injections and penile prostheses can create erections without relying on intact cavernous nerve signalling. |
| Removing the erectile nerves means you lose all feeling in your penis. | The cavernous nerves mainly control erection rather than normal skin sensation, so penile touch sensation is usually preserved, although sexual experience can still change. |
| You cannot have an orgasm without an erection. | Orgasm and erection are different processes. Orgasm may still be possible after prostatectomy, although it may feel different and there will be no normal semen ejaculation. |
| Tablets will work equally well whether or not the nerves are preserved. | PDE5 inhibitor tablets generally work better when functioning nerve pathways remain. If both nerve bundles have been removed, vacuum devices or injections may be more useful. |
| Penile rehabilitation can make removed nerves grow back. | Erectile dysfunction treatments can support erections, blood flow and sexual activity, but they cannot regrow neurovascular bundles that were removed during surgery. |
Key Takeaways:
- A surgeon may need to use a non-nerve-sparing approach on one or both sides when preserving the neurovascular bundles could make it harder to remove the cancer safely.
- If one neurovascular bundle is preserved, spontaneous erectile recovery may still be possible; bilateral non-nerve-sparing surgery makes spontaneous erections much less likely.
- Removing the erectile nerve bundles does not usually remove normal penile touch sensation, and many men can still experience orgasm, although sexual experience can change.
- PDE5 inhibitor tablets are generally more useful when some nerve function remains, while vacuum devices and penile injections can work without intact cavernous nerve signalling.
- There is no single penile-rehabilitation programme proven to restore spontaneous erections for every patient, particularly after bilateral non-nerve-sparing surgery.
- Specialist erectile dysfunction and psychosexual support are available, and treatments can help you maintain sexual activity even when spontaneous erections do not recover.
Frequently Asked Questions
1. What Does It Mean If Your Nerves Cannot Be Spared?
If your cancer is too close to the nerves, your surgeon may need to remove some or all of the nerve bundle so the cancer can be removed safely.
2. Why Would Your Surgeon Need to Remove the Nerves?
Your surgeon may need to remove the nerves if your cancer is very close to them or appears likely to have spread towards them. Your MRI, biopsy and other results help guide this decision.
3. Can Your Nerves Be Removed on Only One Side?
Yes, your surgeon may preserve the nerves on one side while removing some or all of them on the other. If some nerve tissue remains, you may still have a chance of recovering erections.
4. What Happens If One Nerve Bundle Is Spared?
If one nerve bundle is preserved, spontaneous erectile recovery may still be possible. Your age, erections before surgery and other factors can also affect your recovery.
5. What Happens If Both Nerve Bundles Are Removed?
If both nerve bundles are removed, spontaneous erections are much less likely to return because the nerves responsible for erections have been removed. However, treatments can still help you achieve an erection.
6. Can You Still Have an Orgasm If Your Nerves Are Removed?
Many men can still experience orgasm even if the erectile nerves are removed. Your orgasm may feel different, and you will no longer ejaculate semen after your prostate has been removed.
7. Will Erectile Dysfunction Tablets Work If Your Nerves Are Not Spared?
Medicines such as sildenafil or tadalafil may be less effective when both nerve bundles have been removed because they rely on functioning erectile nerves. Your specialist can discuss other options if tablets do not work for you.
8. Can a Vacuum Pump Help If Your Nerves Were Removed?
Yes, a vacuum device can create an erection without relying on your erectile nerves. Your specialist can explain whether it is suitable for you and how to use it safely.
9. Can Penile Injections Work Without Your Erectile Nerves?
Yes, penile injections can produce an erection by acting directly on the blood vessels in your penis. They can therefore work even when your erectile nerves have not been preserved.
10. What Should You Ask If Your Nerves May Not Be Spared?
Ask your surgeon whether one or both nerve bundles may need to be removed and how this could affect your erections. You can also ask what erectile treatments and support will be available after your surgery.
Final Thoughts: When Nerves Cannot Be Spared During Robotic Prostate Surgery
If one or both neurovascular bundles cannot be spared during robotic prostate surgery, spontaneous erectile recovery may be reduced, particularly after bilateral non-nerve-sparing surgery. However, loss of the erectile nerves does not usually remove penile touch sensation, and many men can still experience orgasm. Treatments such as vacuum erection devices, penile injections and, where appropriate, penile prostheses may help you maintain sexual activity.
If you are considering robotic prostate surgery in London and would like specialist advice, you can contact Prostate Clinic London to discuss your treatment options and arrange a consultation tailored to your individual needs.
References:
- National Institute for Health and Care Excellence (NICE) (2021) Prostate cancer: diagnosis and management. NICE guideline NG131. Published 9 May 2019; last updated 15 December 2021. Available at: https://www.nice.org.uk/guidance/ng131
- University College London Hospitals NHS Foundation Trust (2026) Robotic prostatectomy. Last updated 4 March 2026. Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/robotic-prostatectomy
- Cambridge University Hospitals NHS Foundation Trust (2024) Robotic radical prostatectomy: pre- and post-operative information. Approved 10 May 2024. Available at: https://www.cuh.nhs.uk/patient-information/robotic-radical-prostatectomy
- European Association of Urology (EAU) (2026) EAU Guidelines on Prostate Cancer: Treatment. Available at: https://uroweb.org/guidelines/prostate-cancer/chapter/treatment
- Prostate Cancer UK (no date) Sex and relationships. Available at: https://prostatecanceruk.org/prostate-information-and-support/living-with-prostate-cancer/sex-and-relationships
- European Association of Urology (2026) EAU Guidelines on Sexual and Reproductive Health. Available at: https://uroweb.org/guidelines/sexual-and-reproductive-health
- Marchioni, M., De Francesco, P., Castellucci, R., Papalia, R., Sarikaya, S., Gomez Rivas, J., Schips, L., Scarpa, R.M. and Esperto, F. (2020) ‘Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review’, Minerva Urologica e Nefrologica, 72(5), pp. 543–554. Available at: https://pubmed.ncbi.nlm.nih.gov/32748616