Prostatectomy can have a profound effect on a man’s life. The primary issues are impotence, incontinence and sterility but there are many ways to deal with these side effects and have a satisfying life.

Impotence (also called erectile dysfunction) is the inability to produce an erection capable of sexual penetration. 

Most physicians believe that regaining potency is helped by attempting to achieve an erection as soon as the body has recovered from surgery. Generally this is about six weeks after the prostatectomy.

Methods of coping with impotence include:

• Medications. A class of pills called phosphodiesterase inhibitors, commonly known as erectile dysfunction (ED) drugs under many brand names, can promote erections if prostatectomy has not cut or damaged both nerve bundles. These drugs can interact dangerously with some heart medications and their use should be discussed with a physician.
  
  
• Prostaglandin E1. This fatty acid produced in the body can cause erections if injected into the penis before intercourse. Injection is said to be nearly painless. It can also be supplied as a tiny suppository inserted into the opening of the urethra at the end of the penis. Prostaglandin E1 may not work if there is severe nerve damage.
  
  
• Vacuum pump. A medically approved plastic tube is briefly placed over the penis before intercourse. Air is pumped out of the tube to stimulate an erection. A vacuum pump may work if there is nerve damage.
  
  
• Penile implant. There are several types of implants available. A typical type features inflatable plastic cylinders surgically placed in the spongy tissue of the penis. A tube connects the cylinders to a pump placed into the scrotum. A reservoir of liquid used to fill the cylinders is placed in the lower abdomen. The man can achieve an erection by pressing the pump to fill the cylinders. The liquid later drains back into the reservoir. A urologist or other physician can give more details about available implants and their usage.

Few men have permanent severe incontinence after prostatectomy. Normal bladder function usually returns within several weeks or months. Men may have occasional stress incontinence (leakage of urine when laughing, coughing, sneezing or exercising). If urinary incontinence is a problem, possible treatments include:

• Medications that affect the muscles of the bladder or its sphincter
  
  
• Performing Kegel exercises to tighten the pelvic and bladder muscles
  
  
• Use of pads, absorbent undergarments and other incontinence products
  
  
• Self-catheterization. Inserting a tube into the urethra to drain urine.
  
  
• Surgery in case of severe long-term incontinence, including collagen implants and implantation of an artificial sphincter.
  

Radical prostatectomies and many partial prostatectomies cause sterility because they result in retrograde ejaculation, where the semen is discharged back into the bladder rather than out of the penis through the urethra. In some cases, it may be possible to retrieve semen from the bladder and use it for artificial insemination. Semen also may be stored in a sperm bank before undergoing prostatectomy. Sterility is not an issue for most patients because prostatectomy is usually performed in older men, but for some it is a concern.

A physician can offer more information about treatment options for incontinence, impotence and sterility. Prostate cancer survivor groups and other men’s support groups can also help men prepare for and deal with the aftermath of the surgery.