Life after radical prostatectomy can still include work, exercise, travel, relationships and normal daily activities. However, the operation may affect urinary control, erections, ejaculation and fertility.
Recovery is gradual and varies between men. Your age, general health, cancer location, previous urinary and sexual function, and whether nerve-sparing surgery is possible can all influence your experience.
What Happens During Radical Prostatectomy?
During your radical prostatectomy, your surgeon removes your prostate and seminal vesicles before reconnecting your bladder to your urethra. A catheter drains your urine while this surgically created connection heals.
Your surgeon may also remove pelvic lymph nodes when your estimated risk of nodal involvement makes this appropriate. Your lymph-node results provide staging information and may help your clinical team plan your follow-up or further treatment.
What Are the First Days Like?
During your first few days after surgery, you may experience tiredness, abdominal discomfort, bruising, bloating or swelling around your penis and scrotum. Your symptoms should gradually improve as your body heals.
You will normally be encouraged to walk gently because movement can support your circulation and reduce your risk of blood clots. You should balance light activity with rest and follow your surgical team’s advice about your wound care, medicines and activity.
Will You Have a Catheter?
You will normally have a urinary catheter while the new connection between your bladder and urethra heals. You will often go home with your catheter, and your clinical team will explain how to empty your drainage bag and keep the catheter clean.
Your catheter is commonly removed after approximately one to two weeks, although your timing may differ. You should make sure your catheter tubing remains free from bends and that urine continues to drain into your bag.
When Should You Seek Urgent Help?
You should contact your surgical team immediately if your catheter stops draining, falls out or appears blocked, particularly if your bladder feels painfully full. You should not try to flush, remove or reinsert your catheter yourself unless your surgical team has specifically instructed you to do so, because the new connection between your bladder and urethra is still healing.
You should also seek prompt advice if you develop a fever, worsening pain, persistent vomiting, foul-smelling urine, large blood clots or increasing redness or discharge from your wound. You should seek emergency help if you develop chest pain, sudden breathlessness or painful swelling in one of your legs, as these symptoms may indicate a blood clot.
How Long Does Physical Recovery Take?
Physical recovery after surgery usually happens gradually over several weeks as your body heals and your strength returns. The time it takes can vary depending on your health, fitness, the complexity of your operation and whether any complications occur.
Factors That Affect Physical Recovery
| Factor | How It Affects Recovery | What To Expect |
| Healing process | Your body needs time to recover after surgery | Energy and mobility usually improve gradually |
| Type of operation | More complex procedures may require longer recovery | Recovery time can vary between individuals |
| Overall health | General fitness and medical conditions can influence healing | Healthier patients may recover more easily |
| Activity levels | Gradual movement helps rebuild strength | Normal activities can be resumed over time |
| Complications | Issues after surgery may delay progress | Additional treatment or support may be needed |
| Support after surgery | Guidance from your healthcare team can aid recovery | Helps you return to daily activities safely |
Is Urinary Leakage Normal?
You are likely to experience some urinary leakage when your catheter is first removed. Your leakage may be more noticeable when you stand, walk, cough, sneeze, exercise or lift something because your urinary sphincter and pelvic floor need time to recover.
Your control often improves during the following weeks and months. You may need absorbent pads during this stage, and your clinical team should explain how you can obtain suitable continence support.
Does Continence Usually Improve?
Your urinary control will often improve gradually rather than immediately. You may notice substantial progress during your first few months, although your recovery speed will depend on your age, baseline urinary function, anatomy and details of your operation.
You may continue to experience leakage after a year. If your leakage remains bothersome, you should receive specialist assessment rather than being expected to accept it without support.
Why Are Pelvic Floor Exercises Important?
Your pelvic floor muscles contribute to your urinary control. Starting appropriate exercises before your surgery and restarting them after your catheter is removed may support an earlier return of continence.
Your technique is important, and repeatedly tightening the wrong muscles may not help you. You should ask for guidance from a pelvic health physiotherapist or continence specialist if you are uncertain about your technique or your leakage is not improving.
What If Leakage Continues?
If your leakage remains troublesome, your clinical team should assess its severity, pattern and possible cause. You should be offered supervised pelvic floor muscle training for stress incontinence and advised to continue your exercises for at least three months before other options are considered. You may also need bladder advice, suitable continence products or investigations for narrowing, urgency or another urinary problem.
If your stress incontinence remains severe or difficult to manage, you should be referred to a specialist continence surgeon. An artificial urinary sphincter is an established option when conservative treatment has not controlled your symptoms. Your specialist should explain which procedures are appropriate for you, together with their possible benefits, risks and long-term follow-up requirements.
How Are Erections Affected?
You are likely to experience difficulty achieving erections after radical prostatectomy because the relevant nerve bundles lie very close to your prostate. Even when your surgeon preserves the nerves, temporary injury and inflammation may prevent normal erections during your early recovery.
Your improvement may continue for up to two years or longer, but your previous erections may not fully return. Your outcome depends partly on your age, erectile function before surgery, general health and whether one or both nerve bundles were preserved.
What Is Nerve-Sparing Surgery?
Your nerve-sparing surgery aims to preserve one or both nerve bundles involved in erections. Whether this is appropriate for you depends on your cancer’s location and whether preservation would compromise your cancer treatment.
Your cancer control must remain the priority, and your surgeon may need to remove one or both nerve bundles. Even successful nerve preservation improves only your possibility of erectile recovery and cannot guarantee it.
Can Erectile Dysfunction Be Treated?
Your treatment options may include PDE5 inhibitor tablets, a vacuum erection device, penile injections or, in selected circumstances, a penile prosthesis. Your most suitable treatment will depend on your health, nerve-sparing status, recovery and preferences.
Your team may discuss penile rehabilitation to support blood flow, maintain penile tissue and help you resume sexual activity. You should understand that no rehabilitation programme can guarantee the return of unassisted natural erections.
Can You Still Have an Orgasm?
You may still experience an orgasm after your prostate has been removed, including when you cannot achieve an erection. However, your orgasm may feel weaker, stronger, shorter, delayed or different from your experience before surgery, and you may occasionally find it difficult or painful to reach orgasm.
You may experience urine leakage at orgasm, known as climacturia. Leakage during sexual arousal can also occur, but this is described separately as arousal incontinence. Emptying your bladder before sexual activity, performing your pelvic floor exercises and seeking specialist sexual support may help you manage these symptoms.
Will You Still Ejaculate?
You will no longer release semen after your radical prostatectomy because your prostate and seminal vesicles have been removed and your sperm-carrying tubes have been disconnected from your urethra. This permanent change is commonly called a dry orgasm.
You may still experience sexual pleasure and orgasm, but you should expect the sensation to feel different. You should discuss any concerns with your specialist nurse or sexual-health team.
Can You Still Have Biological Children?
After radical prostatectomy, natural conception through sexual intercourse is no longer possible because you cannot ejaculate semen. This happens because the prostate and seminal vesicles, which contribute fluid to semen, are removed during the operation.
- Fertility impact: Removal of the prostate and seminal vesicles means semen is no longer produced during ejaculation
- Natural conception: Pregnancy through sexual intercourse is not possible after this procedure
- Sperm storage: Freezing sperm before surgery may preserve the option of having biological children in the future
- Early planning: Discussing fertility concerns before treatment allows you to explore available options
- Specialist guidance: Your healthcare team can explain fertility preservation choices and support your decisions
If having biological children is important to you, it is helpful to discuss this before surgery takes place. Planning early can give you more options and help you make informed decisions about your future family goals.
Does Surgery Reduce Testosterone?
Removing your prostate does not stop testosterone production because your testes produce most of your testosterone. Your beard growth, voice and other testosterone-related characteristics should not change simply because your prostate has been removed.
However, some men may experience a temporary or persistent fall in testosterone after radical prostatectomy for reasons that are still being studied, and levels often recover over time. If you also receive hormone therapy, this is specifically intended to lower testosterone and may cause additional physical, sexual and emotional effects. Your specialist can arrange testing if you develop symptoms that could suggest testosterone deficiency.
How Can Surgery Affect Relationships?
Your urinary leakage, erection difficulties and changes to orgasm may affect your confidence, intimacy and relationship. You and your partner may need time to understand and adapt to these changes.
You may find it helpful to communicate openly and explore forms of intimacy that do not depend on penetrative sex. You should ask about specialist nursing support, psychosexual counselling or relationship support if these changes are causing distress.
When Can You Return to Work?
Your return to work will depend on your energy, urinary control, travel and the physical demands of your role. You may be able to return to desk-based work sooner than work involving lifting, prolonged standing or strenuous activity.
You should discuss your planned return with your surgical team rather than relying on a fixed timetable. A gradual return or temporary changes to your duties may make your recovery easier.
Will You Need Long-Term Follow-Up?
You will need regular PSA tests after radical prostatectomy. Your PSA should fall to a very low or undetectable level, although the exact reporting threshold will depend on the laboratory assay used.
NICE recommends checking your PSA no earlier than six weeks after treatment, at least every six months during your first two years and at least annually afterwards. Your follow-up may be adjusted according to your pathology, PSA results and individual recurrence risk.
Key Takeaways
- Your radical prostatectomy removes your prostate and seminal vesicles.
- You will normally have a catheter while your bladder-to-urethra connection heals.
- You are likely to experience some urinary leakage after your catheter is removed.
- Your urinary control often improves gradually, but your recovery cannot be guaranteed.
- Your pelvic floor exercises may support your continence recovery when you perform them correctly.
- Your erectile recovery may take many months or longer.
- Your nerve-sparing surgery cannot guarantee that your previous erections will return.
- You will permanently stop ejaculating semen and will no longer be able to conceive naturally.
- You may still experience an orgasm, although it may feel different.
- You will need regular PSA monitoring after your surgery.
Myth vs Fact
| Myth | What You Should Know |
| You cannot live normally without your prostate. | You can return to many of your usual activities after your recovery. |
| You will definitely be permanently incontinent. | Your leakage is likely to improve, although you may need longer-term support. |
| Your nerve-sparing surgery guarantees normal erections. | Your nerve preservation improves your possibility of recovery but cannot guarantee it. |
| Your erections should return immediately. | Your erectile recovery may take many months or longer. |
| You cannot experience orgasm without your prostate. | You may still experience orgasm, although your sensation may change. |
| Your ejaculation may return after you heal. | Your loss of ejaculation is permanent after radical prostatectomy. |
| Your surgery stops your testosterone production. | Your testes continue producing most of your testosterone. |
| You no longer need cancer checks after your prostate is removed. | You will need regular PSA monitoring after your surgery. |
Frequently Asked Questions
1. How long will your recovery take after radical prostatectomy?
Your physical recovery will be gradual and may take several weeks, while your energy, urinary control and sexual function may continue changing for months or longer. Your recovery will depend on your health, operation and any complications.
2. Can you live a normal life after radical prostatectomy?
Yes. You can return to work, exercise, travel and many of your usual activities. However, your operation permanently stops ejaculation and natural conception and may cause lasting urinary or sexual changes.
3. Is urinary leakage normal after your prostate is removed?
Yes. You are likely to experience leakage after your catheter is removed. Your bladder control often improves as your urinary sphincter and pelvic floor recover, although your individual recovery cannot be guaranteed.
4. How can you improve your bladder control after surgery?
Your correctly performed pelvic floor exercises may support your continence recovery. You should follow your clinical team’s advice about when to restart them after your catheter is removed and seek physiotherapy support if you are unsure about your technique.
5. Will you have erection problems after radical prostatectomy?
You are likely to experience erection difficulties because the relevant nerves lie close to your prostate. Your recovery depends on your age, previous erections, general health, cancer location and whether your nerves could be preserved.
6. What is your nerve-sparing prostate surgery?
Your nerve-sparing surgery aims to preserve one or both nerve bundles involved in erections. Your surgeon will attempt this only when it is considered safe for your cancer, and preservation cannot guarantee that your erections will return.
7. Can you still experience an orgasm after radical prostatectomy?
Yes. You may still experience orgasm, even without an erection, but your sensation may feel different. You may also experience delayed orgasm, discomfort or urine leakage during orgasm.
8. Can you still have biological children after radical prostatectomy?
You cannot conceive naturally after your surgery because you will no longer ejaculate semen. You should discuss sperm storage before treatment if having biological children may be important to you.
9. When can you return to work after radical prostatectomy?
Your timing will depend on your recovery, urinary control and job demands. You may return to desk-based work sooner than a physically demanding role, but you should follow your surgical team’s individual advice.
10. Will you need follow-up after radical prostatectomy?
Yes. You will need regular PSA tests and a review of your pathology results. NICE recommends your first PSA no earlier than six weeks after treatment, followed by testing at least every six months for two years and at least annually afterwards.
Final Thoughts: Life After Radical Prostatectomy
You can return to many of the activities that matter to you after your radical prostatectomy, including your work, exercise, travel and relationships. However, you should expect permanent changes to your ejaculation and ability to conceive naturally, while your urinary control, erections and experience of orgasm may take time to recover or may remain different.
Your recovery will depend on your age, health, cancer characteristics, urinary and sexual function before surgery and the details of your operation. You should receive ongoing PSA monitoring and access to continence, erectile-function and emotional support when you need it.
If you are considering prostate surgery or would like expert advice about your diagnosis and recovery expectations, you can contact us at Prostate Clinic London to arrange a consultation and discuss your treatment options.
References
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- British Association of Urological Surgeons (2024) Robotic-assisted radical prostatectomy (RARP). Published March 2024, leaflet O24/103. Available at: https://www.baus.org.uk/_userfiles/pages/files/patients/leaflets/Rad%20prost%20robot.pdf
- Donovan, J.L. et al. (2023) ‘Patient-reported outcomes 12 years after localized prostate cancer treatment’, NEJM Evidence, 2(4), article EVIDoa2300018. Available at: https://pubmed.ncbi.nlm.nih.gov/38320051/
- Fossati, N. et al. (2017) ‘The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review’, European Urology, 72(1), pp. 84–109. Available at: https://pubmed.ncbi.nlm.nih.gov/28126351/
- Gacci, M., De Nunzio, C., Sakalis, V., Rieken, M., Cornu, J.-N. and Gravas, S. (2023) ‘Latest evidence on post-prostatectomy urinary incontinence’, Journal of Clinical Medicine, 12(3), article 1190. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9917389/
- Hammad, M.A.M. et al. (2026) ‘Etiology of testosterone deficiency after radical prostatectomy’, Urologic Oncology: Seminars and Original Investigations, 44(5), article 111035. Available at: https://pubmed.ncbi.nlm.nih.gov/41775590/
- Kannady, C. and Clavell-Hernández, J. (2020) ‘Orgasm-associated urinary incontinence (climacturia) following radical prostatectomy: a review of pathophysiology and current treatment options’, Asian Journal of Andrology, 22(6), pp. 549–554. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7705983/
- National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management. NICE guideline NG131. Last updated 15 December 2021 and last reviewed 13 August 2025. Available at: https://www.nice.org.uk/guidance/ng131
- NHS (2025) ‘Treatment for prostate cancer’. Page last reviewed 31 July 2025. Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment/
- Prostate Cancer UK (2024) Surgery: radical prostatectomy. Updated July 2024. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/surgery
- Sari Motlagh, R. et al. (2021) ‘Penile rehabilitation strategy after nerve-sparing radical prostatectomy: a systematic review and network meta-analysis of randomised trials’, The Journal of Urology, 205(4), pp. 1018–1030. Available at: https://pubmed.ncbi.nlm.nih.gov/33443457/
- Yang, J.-M. et al. (2023) ‘Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: an umbrella review of meta-analysis and systematic review’, Clinical Rehabilitation, 37(4), pp. 494–515. Available at: https://pubmed.ncbi.nlm.nih.gov/36305082/