What are the effects of a prostatectomy (prostate removal surgery)?

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From the Guidelines

Prostatectomy is associated with significant effects on patients, including urinary incontinence and erectile dysfunction, with approximately 14% to 25% of men experiencing bothersome leakage after surgery, as reported in the most recent study from 2024 1.

Effects of Prostatectomy

The effects of prostatectomy on patients can be significant and long-lasting. Some of the most common side effects include:

  • Urinary incontinence: This can range from mild to severe and may be temporary or permanent. According to the most recent study from 2024, approximately 14% to 25% of men experience bothersome leakage after surgery 1.
  • Erectile dysfunction: This can also range from mild to severe and may be temporary or permanent. The exact prevalence of erectile dysfunction after prostatectomy is difficult to quantify, but it is estimated to affect 30-70% of patients, with recovery potentially taking up to 2 years 1.

Management of Side Effects

There are several ways to manage the side effects of prostatectomy, including:

  • Pelvic floor exercises (Kegels): These can help improve urinary control and are recommended to be performed 10-15 times, three times daily.
  • Medications: Medications like sildenafil (50-100mg as needed) or tadalafil (5mg daily) may help with erectile function recovery.

Recent Guidelines

Recent guidelines from 2024 recommend that clinicians inform patients undergoing localized prostate cancer treatment of all known factors that could affect continence, and counsel patients regarding the risk of sexual arousal incontinence and climacturia following treatment 1.

Quality of Life

The effects of prostatectomy on quality of life can be significant, with many patients experiencing a decline in urinary and sexual function. However, with proper management and treatment, many patients are able to recover and regain their pre-surgery quality of life. It is essential to prioritize the management of side effects and quality of life when treating patients with prostatectomy, as reported in the most recent study from 2024 1.

From the Research

Effects of Prostatectomy on Urinary Incontinence

  • Urinary incontinence is a common side effect of prostatectomy, with rates ranging from 0.3-65.6% 2
  • Incontinence can be in the form of stress urinary incontinence (SUI), urge urinary incontinence (UUI), frequency/urgency, and/or voiding difficulties 3
  • Treatment options for incontinence include pelvic floor muscle exercises (PFME), penile clamps or urethral plugs, and surgical options such as urethral bulking agents, male slings, and artificial urinary sphincter (AUS) 3
  • Surgical options are usually not recommended during the first 6-12 months after radical prostatectomy 3

Effects of Prostatectomy on Erectile Dysfunction

  • Erectile dysfunction is another common side effect of prostatectomy, with rates ranging from 11-87% 2
  • Treatment options for erectile dysfunction include oral PDE5-I, local therapy such as MUSE, intracavernosal injections, and low intensity shock wave therapy, and surgery as a third line option 3
  • Resuming sexual activity soon after the operation and using phosphodiesterase-5 (PDE-5) inhibitors or intracavernosal injection therapy can help prevent irreversible erectile dysfunction 4

Relationship Between Incontinence and Erectile Dysfunction

  • There is a significant relationship between incontinence and erectile dysfunction after prostatectomy, with patients who experience erectile dysfunction being more likely to also experience incontinence 5
  • Older age at diagnosis and erectile dysfunction are independent predictors of incontinence after prostatectomy 5

Other Side Effects of Prostatectomy

  • Other neglected side effects of prostatectomy include orgasm-associated incontinence (OAI), urinary incontinence in relation to sexual stimulation (UISS), altered perception of orgasm, orgasm-associated pain (OAP), penile shortening (PS), and penile deformity 6
  • These side effects are common after prostatectomy, but it is difficult to predict which patients are at risk 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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