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Side effects of a prostatectomy

Possible side effects of a radical prostatectomy include difficulty getting an erection (called erectile dysfunction or ED), bladder problems and infertility. You may be able to have nerve-sparing surgery, to reduce the risk of developing some side effects.

Your surgeon can give you an idea of your likely risk of getting ED. This can depend on different factors, such as other medical conditions you may have. Some men find their ability to have an erection gradually returns. There are treatments that can help with ED.

After prostatectomy, although you can still have an orgasm, there will be no ejaculation. This means you will be infertile. If you are concerned about this, talk to your doctor before treatment starts. You may be able to store sperm before surgery.

A problem controlling your bladder (urinary incontinence) is a less common side effect. Most men have some incontinence after their operation but this usually goes away with time. Talk to your doctor or nurse if you have ongoing problems. They can give you advice or refer you to a continence team for expert help.

Erection problems

Surgery to the prostate can cause problems getting or keeping an erection (called erectile dysfunction or ED). This is caused by damage to the nerves and blood vessels close to the prostate that help you get an erection. Surgeons can do operations in a way that tries to protect these nerves or blood vessels. This is called a nerve-sparing technique. But this is only possible if the cancer has not spread outside the prostate. During the operation, if the surgeon thinks the nerves or surrounding structures have cancer in them, they will remove some or all of the nerves.

Whether you will have problems getting an erection after a nerve-sparing operation depends on different factors, such as:

  • whether you had erection problems before treatment
  • your age
  • whether you have any other medical conditions, such as diabetes
  • whether you are having treatment for high blood pressure
  • whether the surgeon was able to spare some or all of the nerves.

You can ask your surgeon about your risk of ED.

Some men who have surgery may find their ability to have an erection slowly returns. But it may take 1 or 2 years for this to happen. It is less likely to return in men who have further treatment after surgery, such as hormonal therapy or radiotherapy.

We have more information about things you can try to help get an erection.

Sex and impotence after prostate cancer

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how, in the face of these challenges, his relationship with Elizabeth remained strong.

About our cancer information videos

Sex and impotence after prostate cancer

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how, in the face of these challenges, his relationship with Elizabeth remained strong.

About our cancer information videos

Because of my operation, I am no longer able to get an erection naturally. I chose to take that risk after discussing it with my wife. I use either injections or a machine to get an erection.

Neil


Ejaculation

Men who have had their prostate removed can still have an orgasm, but there will be no ejaculation. This is called a dry ejaculation. A dry ejaculation may cause some discomfort at first, but this usually improves with time. Some men may pass a small amount of urine when they orgasm. Talk to your doctor or specialist doctor or nurse if you are having this problem. They may be able to give you some advice.


Infertility

Having your prostate removed will affect your ability to have children. The prostate and seminal vesicle produce semen, which is normally mixed with sperm from the testicles. Removing the prostate means you will not be able to ejaculate any more. Although there is still sperm, it cannot get out of the body.

If you want to have children after your treatment, it may be possible to store sperm before your surgery. It is important to talk to your cancer doctor or specialist nurse about fertility before starting treatment. Think about the questions you want to ask, so you can get all the information you need. If you have a partner, it is usually a good idea to include them too.

It can be upsetting to hear that you will longer be able to have children. Some men find it helpful to talk things over with a partner, family or friends. Others might prefer to talk to a trained counsellor. Your GP or cancer specialist can arrange this for you. Many hospitals also have specialist nurses who can offer support. And fertility clinics usually have a counsellor you can talk to.

Talking to other men in a similar situation may help you feel less isolated. Some organisations can arrange this for you as well as providing specialist advice and counselling. Or you can talk to people online. Our Online Community is a good place to talk to other men who may be in a similar situation.

You can also talk things over with one of our cancer support specialists.

I wanted to deal with it on my own and I had all the natural feelings of loss of manliness, worry about “performing”, worry about fertility and recurrence. My other half was great but I know she struggled to know what to do. But she was always there for me.

Jason


Bladder problems

Urine leaking from the bladder (urinary incontinence) is a less common side effect of having the prostate removed. Most men have some incontinence when their catheter is first removed. This usually improves within a few weeks or months of having your operation. You will be encouraged to do pelvic floor exercises to strengthen the pelvic floor muscles. You can do these at home. The Bladder and Bowel Community can give you more information on how to do them.

A small number of men may continue to be incontinent when they cough, sneeze, or exercise. This is called stress incontinence. It is very rare to be completely incontinent. If you are having problems with incontinence, talk to your doctor or nurse. They can refer you to a continence team, who can give you advice about coping with this problem. If treatments for stress incontinence are not successful, you may be able to have an operation.

Another less common side effect of surgery is scarring of the bladder or urethra. The urethra is the tube that runs from the bladder to the tip of the penis. It takes urine away from the bladder. Scar tissue can make the urethra narrow, which makes passing urine difficult This means that urine builds up in the bladder and starts to overflow. This problem can usually be treated with a small operation that opens up the urethra. If you are having problems peeing after your operation, talk to your specialist doctor or nurse.

Macmillan toilet card

If you need to use a toilet urgently, you can show this card in places such as shops, offices, cafés, and pubs. You can use it during or after treatment. We hope it allows you to get access to a toilet without any awkward questions. But we cannot guarantee that it will work everywhere.

Back to Surgery for early prostate cancer

Having a prostatectomy

Early prostate cancer can be treated with an operation called a prostatectomy to remove the prostate.

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.