What Happens When You Have Your Prostate Removed? What to Know

Having your prostate removed is a major operation that changes how your body works. The prostate sits below the bladder and wraps around the urethra, so taking it out directly affects urination, sexual function, and recovery. Most men who have this surgery do so because of prostate cancer, and while the cancer is removed, the side effects are real and often permanent. Expect to manage urinary leakage for weeks or months, and expect erectile dysfunction that may or may not fully resolve.

What Exactly Is Removed During Prostate Surgery?

The most common type of prostate removal is a radical prostatectomy. The surgeon removes the entire prostate gland, the seminal vesicles, and sometimes nearby lymph nodes. The seminal vesicles are small glands that produce a large portion of the fluid in semen. Removing them means you will no longer produce semen, and you will have dry orgasms.

In some cases, the surgeon also removes the neurovascular bundles. These are thin bands of nerves that run alongside the prostate and control erectile function. If the cancer has spread close to these nerves, the surgeon may need to remove them to get clear margins. If the nerves can be spared, your chances of regaining erectile function improve significantly.

The surgery itself can be done in different ways. Some men have open surgery with a single incision. Others have laparoscopic surgery with small incisions, often assisted by a robot. The robotic approach usually means less blood loss and a shorter hospital stay, but the long-term cancer outcomes are similar across techniques.

How Long Is Recovery After Prostate Removal?

Most men stay in the hospital for one to two days after surgery. A catheter remains in place to drain urine while the connection between the bladder and urethra heals. This catheter typically stays for about one to two weeks. You will go home with it, and it is removed in your doctor’s office.

The first few weeks at home involve significant rest. You should avoid heavy lifting, strenuous exercise, and any activity that strains your abdominal muscles. Most surgeons recommend waiting four to six weeks before returning to full activity. You will likely feel tired and sore for the first two weeks, but this gradually improves.

Bowel function can be sluggish after surgery, partly due to pain medication. Constipation is common. Drinking plenty of water and using stool softeners as directed by your surgeon can help. If you strain on the toilet, you put pressure on the healing area, so this matters more than it sounds.

What Happens When You Have Your Prostate Removed and Need to Urinate?

Urinary incontinence is the most predictable short-term side effect. The prostate sits right below the bladder, and the muscles that control urine flow are closely connected to it. After surgery, many men have no control over urine for the first few weeks. This is expected, not a sign that something went wrong.

Most men see significant improvement within three to six months. The external urinary sphincter, a muscle below the prostate, eventually takes over the job of stopping urine flow. Pelvic floor exercises, often called Kegels, strengthen this muscle. Starting these exercises before surgery and continuing afterward can speed up recovery.

Some men regain full control. Others have lasting leakage that requires pads. Stress incontinence — leaking when you cough, sneeze, laugh, or lift something — is the most common pattern. A smaller number of men have urgency incontinence, where they suddenly need to go and cannot hold it.

If leakage continues beyond a year, options exist. A surgical sling or an artificial urinary sphincter can be implanted to restore control. These procedures are effective for many men, but they are additional surgeries with their own risks. Your urologist can discuss whether you are a candidate.

How Does Prostate Removal Affect Sexual Function?

Erectile dysfunction is the other major side effect. The nerves that trigger an erection run directly alongside the prostate. Even when surgeons spare these nerves, the manipulation during surgery can temporarily stun them. Blood flow to the penis may also change.

Recovery of erections is gradual. Some men notice improvement within months, but it can take up to two years. Age, erectile function before surgery, and whether the nerves were spared all influence your outcome. A man who had strong erections before surgery and had both nerve bundles spared has the best chance of recovering.

Even if erections do not return to their previous quality, treatments can help. Oral medications like sildenafil or tadalafil work for some men. Others need penile injections, vacuum devices, or a penile implant. These options are well established and have high satisfaction rates, especially the implant.

Orgasms feel different after prostate removal. You will have dry orgasms because the seminal vesicles are gone. The sensation of orgasm is preserved in most men, but it may be less intense. Some men also report a condition called climacturia, where a small amount of urine leaks during orgasm. This is more common than most men expect, and it often improves over time.

Are There Other Long-Term Changes to Expect?

Your PSA level will drop to nearly zero after surgery. This is the point of the operation — removing the source of PSA. After recovery, your doctor will check PSA regularly to make sure it stays undetectable. If PSA rises, that means prostate cells are present somewhere, and further treatment may be needed.

Some men experience changes in bowel habits after surgery, but this is less common. The rectum sits behind the prostate, and it can be irritated during surgery. Most bowel changes resolve within a few months.

Hormone levels are not affected by prostate removal itself. The prostate does not produce testosterone; the testicles do. So removing the prostate does not cause low testosterone. If you have low energy, low sex drive, or other hormonal symptoms after surgery, that is a separate issue worth discussing with your doctor.

What Are the Risks of Prostate Removal Surgery?

Any major surgery carries risks, and prostatectomy is no exception. Bleeding, infection, and blood clots are possible but uncommon. Anesthesia complications are rare in healthy patients. Your surgical team will take standard precautions to minimize these risks.

One specific risk is a narrowing of the urethra where it is reconnected to the bladder. This is called a bladder neck contracture. It can make urination weak or difficult, and it may require a minor procedure to widen the area. This happens in a small percentage of men.

Injury to the rectum is rare but possible. If it happens, the surgeon repairs it during the same operation. Long-term problems from this are uncommon.

Lymphedema, or swelling in the legs, can occur if lymph nodes are removed. This is more likely if you also receive radiation therapy. It is manageable with compression garments and physical therapy, but it can be a chronic issue.

Do All Men Need Their Prostate Removed for Prostate Cancer?

No. Prostate removal is one option, not the only option. Many prostate cancers grow slowly and never cause problems. Active surveillance — monitoring the cancer with regular PSA tests and biopsies — is a standard approach for low-risk cancers. Radiation therapy is another primary treatment that avoids surgery entirely.

The decision depends on your cancer grade, your PSA level, your age, and your overall health. A man in his 50s with aggressive cancer may benefit from surgery. A man in his 70s with low-grade cancer may do just as well with active surveillance. Your urologist and oncologist should walk you through these options with your specific numbers.

Some men choose surgery because it offers a definitive removal of the cancer. Others prefer to avoid the side effects. Both are reasonable choices. The key is making an informed decision with your medical team, not rushing into surgery because a diagnosis feels urgent.

How Do You Prepare for Prostate Removal?

Preparation starts weeks before surgery. You will have blood tests, possibly a cardiac evaluation, and a meeting with your anesthesia team. If you take blood thinners, you will need to stop them before surgery. Your surgeon will give you specific instructions.

Pelvic floor exercises should begin before surgery. Learning to identify and contract the right muscles takes practice. A physical therapist who specializes in pelvic health can teach you. Men who start Kegels before surgery tend to regain urinary control faster.

Plan your home setup for recovery. You will need loose clothing, pads for urinary leakage, and a way to manage the catheter at home. Have someone available to drive you to appointments. Stock up on meals and supplies so you do not need to shop during the first week.

Talk to your partner about what to expect. Sexual recovery can be emotionally challenging for both of you. Open communication about expectations, fears, and timelines makes the process easier. Couples who discuss this openly report better adjustment than those who avoid the topic.