Purpose <p>To investigate the effects and associated factors of extended pelvic lymph node dissection (ePLND) on urinary control (UC) and sexual function recovery following bilateral nerve-sparing radical prostatectomy.</p> Methods <p>From June 2016 to December 2023, our institution treated and followed 341 patients who underwent bilateral nerve-sparing RP for over a year. These patients were divided into two groups: ePLND (<i>n</i> = 185) and no PLND (<i>n</i> = 246). To minimize potential biases, 1:1 propensity score matching (PSM) was utilized to compare functional outcomes, and complications between the groups.</p> Results <p>After adjusting for propensity scores, a total of 240 patients (120 in each group) were included for further analysis. There was no significant difference between the two groups (<i>p</i> &gt; 0.05) in terms of complete UC (0 pad) at 3, 6, and 12 months postoperatively. Regarding sexual function recovery, 21.7% of patients in the ePLND group and 35.9% in the no PLND group returned to the preoperative level (<i>p</i> = 0.015). The proportion of patients with the International Index of Erectile Function (IIEF)-5 score ≥ 17 was 5.8% and 18.2%, respectively (<i>p</i> = 0.003). Multivariate analysis further identified preoperative IIEF-5 score (<i>p</i> = 0.004), high-risk group (<i>p</i> = 0.042), and super extended pelvic lymph node dissection (s-ePLND) (<i>p</i> = 0.036) as independent factors associated with sexual function recovery. The complications occurred in 9.2% of patients in the ePLND group and 4.2% in the no PLND group (<i>p</i> = 0.121).</p> Conclusions <p>ePLND does not affect the recovery of postoperative UC or increase the incidence of complications, but it significantly impairs the recovery of sexual function. Independent factors associated with sexual function recovery include the preoperative IIEF-5 score, high-risk group, and s-ePLND.</p>