Preserving penis length after radical prostatectomy

Following radical prostatectomy, a significant number of patients notice a progressive shortening of the penis, a fact confirmed in recent studies. To better understand why, Italian researchers measured the length of the flaccid and stretched penis in 126 patients at five time points: just before surgery, when the catheter was removed 7 to 10 days later, and at 3, 6, and 12 months postoperatively. They reported that shortening peaked at the time the catheter was removed and continued, though to a lesser extent, for at least a year. (The average reduction in length after one year was just over a half inch when flaccid and nearly an inch when stretched.) Interestingly, men who had nerve-sparing surgery, as well as those who recovered some erectile function during the year of follow-up, lost less length than other study participants.

The researchers theorize that the death of nerve cells and reduced blood flow (and thus a loss of oxygen) to the penis during surgery and recovery may contribute to shortening. Although penile rehabilitation remains controversial, they suggest that it might help temper shortening, a conclusion supported by a study from a team of researchers in Minnesota. They found that starting the use of a vacuum erection device one month after surgery improves sexual function and helps to preserve penile length.

Sources: Gontero P, Galzerano M, Bartoletti R, et al. New Insights Into the Pathogenesis of Penile Shortening After Radical Prostatectomy and the Role of Postoperative Sexual Function. Journal of Urology 2007;178:602–7. PMID: 17570431.

Kohler TS, Pedro R, Hendlin K, et al. A Pilot Study on the Early Use of the Vacuum Erection Device After Radical Retropubic Prostatectomy. BJU International 2007; 100:858–62. PMID: 17822466.

Originally published Oct. 1, 2007; Last reviewed April 11, 2011

Comments
22
Robert Johnson

Twenty years post radical (not nerve sparing) and I can maintain good blood flow by wearing my soft penile wrap during the night. If I wear it slightly tighter I can get an erection every time. Look up Johnson Soft Penile Clamp on Google.

Harry Hersh

This discussion may be missing the obvious. The problem may be that the prostate is approximately 1.5-2″ long. When removed, where is this replacement length of urethra to come from? Most obviously, it comes from pulling up the penis, thus shortening it. One solution, not yet considered, is rather than shortening the penis, to replace the piece of urethra within the prostate with a substitute piece of “tubing” from another source.

Brendan

Yes why has no one thought about that .As a person who’s had a prostectamy it’s a worrying enough time having to think about surgery ,then to be told apart from being important your also going to lose an inch of your willy .Wouldnt it be just as easy to put an extention tube in to replace the prostate

Rod

I just wish my urologist had discussed this with me pre surgery rather than convince me that, because I’d had laparoscopic nerve sparing surgery, I had a good chance of having normal erections down the track.
After 8 years and the loss of my partner due this my erectile disfunction I had a saline pump implant which works amazingly well but discovered I’d lost 2 inches from my erection. I had no knowledge of the reason for this until I Googled it.
Borders on neglect!

Miss Ann Thropist

Rod, welcome to the medical profession, where 95%+ of practitioners are bone-headed Neanderthal morons.
5cm loss must be devastating.
No one gives a flying fluck about you, except you.
EVERYONE is incompetent until proven otherwise.
It does not matter how qualified they are or how much they charge.
It’s all pretention and wank.
EVERYONE!!
If you deal with everyone on that basis, you’ll often avoid paying money to some jackass low-life scumbag filth as well as paying the extra price later of a poor health outcome.
I hope your stupid reedy Urologist dies a slow painful death from bone cancer!!
He deserves it.
It does not just border on neglect.
It’s your health. You must take it into your own hands. Trust no one. They’re only interested in your money, not you.

Àdriaan Classen

Hi.
I am from South Africa. I am going into surgery the 13th of Jan 2017 for a sling. Two years and 4 months down the line and no erection yet. Caverject and the other injections does not work. a Big loss of about 50mm penis length… What is the best we can do to rectify this. We are planning an Penile Implant in June , but if the Penis is short, the will only implant the short tube… What can I do ??

Hank

My surgeon only discussed the possibility of nerve removal prior to having my laparoscopic prostate surgery two years ago. I immediately noticed a huge difference in penis length, so tried the vacuum pump method and low dose Cialis suggested by my GP. I have to this day, not regained the 50 mm lost after surgery. My pride gets in the way sometimes. I’ve stopped going to the gym and swimming pool etc. Fortunately I have a very understanding partner, however intimate encounters have become much less frequent.

Lew Jack - Helensburgh, Scotland

Hi guys. In July 2015 I was diagnosed as having an aggressive cancer in my prostate. There was a slight break/tear of the covering membrane & at that time, no protruding tumour. My wife & I were both devastated. My urologist advised I speak to specialists with a view to treat by radiotherapy, hormone therapy and chemotherapy or a mixture of all. She also suggested I speak to a professor of urology for surgery. After discussions & some soul searching, I (& my loving wife) was emphatic that a prostatectomy was the way forward, no matter the side effects which were fully explained to me by Professor Leung – Queen Elizabeth University Hospital, Glasgow, UK. At this point it is important to say that at that time I was age 63 and our one child was a married Mother with two lovely children.
Surgery took place in November 2015 and post-op results showed no cancer cells remained. Good job – well done and my grateful thanks to Prof Leung & his excellent team. Here I am 15 months later and my most recent PSA results are still ‘0.01 non-detectable’. I for one, hope that those of you who are much younger than me can get some medical help or therapy to overcome the problems associated with your shortened penis (I have little comprehension of how I would feel if I were 20 or 30 years younger) but I can assure you and all other readers of this rather lengthy post, I am totally accepting of my shortened penis & inability to achieve an erection. At least I am still alive. Good luck to all.

In 2014 I underwent nerve sparing robotic radical prostatectomy following biopsy of my prostate. My Score was 8 with a PSA of only 4.7. During the surgery the surgeon removed 26 lymph nodes, all tested clear and it was felt the cancer was confined to the prostate. I am not sure what there was a need to remove so many. I began a very good recovery and even had erection.
Within 6 weeks I started having pain in my lower abdomen and low grade fever. I discussed with the surgical oncologist-urologist. He said it would clear up. The pain increased daily and the night sweats and testicular swelling became unbearable.
I went to the surgeons office for a 3 month follow up and discussed the issues and the intense pain. He had a CT scan performed in his office. He found a large pocket of fluid in the prostate bed due to the removal of the prostate and lymph nod removal. He informed me he could open me up with a surgical procedure and remove it or just let my body absorb the fluid and I will be fine. He didn’t perform any lab work. That same day I had an appointment with my regular medical doctor within an hour of the previous visit. As soon as he walked into the room he said something was wrong. He examined me, took a look at the swelling of my lower extremities. He had me go directly to the hospital lab”STAT” and have blood cultures along with other lab work. My CRP (normally 0-5) was hit 192. The following morning my doctor called and woke me up and had me report to the hospital as soon as possible. After 9 days of IV antibiotics and the placement of 2 drain tubes I was able to return home and take oral antibiotics for another month. From that time I had loss of bladder control that I had regained within the first 6 weeks of surgery and not able to have an erection. The infection and the drain tubes damaged the nerves.
A few months later my PSA began to rise and I had 7 weeks of radiation treatment. The side effects from the surgery and complications and radiation treatment have given me 3 years to reflect on this and If I can share one thing— if you are confronted with prostate cancer seek treatment early and go to a major cancer hospital like M D Anderson or John Hopkins. I would never use a local surgeon-urologist that may have done many surgeries but is one person with one view point. Remember– a surgeon recommends surgical solutions, a radiation oncologist recommends radiation and a chemical oncologist recommends chemicals. A hospital like M D Anderson has treatment teams that look and agree on the best plan for you.

John G

The first time I heard about “penile shortening” was when I saw it on the consent forms about an hour before I was scheduled for my radical prostatectomy at Johns Hopkins in 2008. As soon as the abdominal/groin swelling from the operation went down I know that something was not as it had been. The surgeon’s assistant said that it would affect me only in the non-erect state – which was a lie. Finally, during a visit to a new urologist a couple of months ago, he stated that on average following a radical the penis loses approximately 2cm to 3cm in lenth. With ED meds I can get an erection, so I do have nerve function, but there is 1.25 inches less of me – flaccid or erect. Obviously, the cause was removing the prostate and pulling in the penis to reconnect the urethra.

Mai Wong

My husband had his surgery in july 2015 and at no point was he warned that his penis would become shorter. He was also not prepared for the lack of bladder control after the operation as again, his doctor failed to discuss this side effect. He is extremely self conscious about the size of his penis now, even though I constantly tell him that to me it doesn’t make a difference. I’m struggling to find a way to help him come to terms with this new reality.

Robert F

It is so nice to know I am not alone…this isnt the kind of thing you discuss with anyone. All the articles mention a sight reduction of 1 to 2 centimeters…well if a centimeter equals an inch, then they are correct. I wasn’t going to star in any adult films before surgery but the loss of 3 inches erect is a major blow to my self confidence…yes sorry I am vain.

My surgeon said that my erections would not be the same…I guess I should have pressed him to tell me what exactly he meant by that. After the catheter was removed (ouch) the nurse said that she wanted to schedule me to meet with the penis pump sales rep…silly me I didnt follow thru with that.

2 years later, I ordered a penis pump and use it several times a day. IDK this late in the game, if it will reverse the loss of length.

My only advice is to start using the pump as soon as you are cleared by your Doctor. hind sight is 20/20 but I bet if I had used it within a few weeks post surgery, I wouldnt be hon this blog.

John Concannon

It is amazing how much more discussion of this issue is occurring now. My surgery was in 2001 and my urologist basically called me a liar when I told him I was about 2″ shorter in length. Tried to blame it on scar tissue and blood flow but unless the scar tissue occurred over night that was simply a lie on his part. Would I have had the RP surgery anyway, you bet but could something more have been done to preserve my rather average length, I wish I knew. Since the medical community does not like to discuss this with the public what the art of the possible is, with what risk and cost is unknown to the public but maybe with more blogs like this more will surface.

Henry

I had prostate surgery at MD Anderson eleven years ago. Been non detectable since. Lost only .25 of an inch.

barry white

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Martyn Bassett

I didn’t think I would find a thread about this subject but it is comforting, having read the other comments that my total loss of length is not an uncommon problem.
I have recently had surgery and everything is progressing very well apart from the penile area which has appeared to have completely disappeared. That area has been an area of concern anyway having been diagnosed with Peyronie’s disease some five years ago so life in the sex department had been challenging anyway.
What the thread has given me is a comfort that I am not alone. Having been married to the same loving and understanding lady for 42 years, lack of length is not going to ruin our relationship, it is just making us more inventive. I wish all other contributors a safe and prolonged health have taken this course of action.

Jim

I am going in for a RP this August 8. I heard about penis shrinkage from a friend who had the same surgery last week, and in his exploration of his options, was told by someone that his penis lost length.

This whole situation is upsetting: I’m a cyclist, eat healthy food, never been a smoker, not a heavy drinker, but I have a Gleason 8 and two Gleason 7s (a 3+4 and a 4+3). I am nervous, despite the fact that a bone scan was negative and it’s not in my surrounding lymph tissue.

The penis shrinkage is very disappointing. My doctor was not upfront about this. I’ve overcome my concern about the catheter, but shrinkage is a bummer. But thanks for your frank discussion.

Terry Hember

July 12,2017 3 p.m.

I had a radical prostatectomy in 2003. Slightly elevated PSA year and a half later. Seven weeks of radiation. Everything fine, non detectable PSA’s. However, penis when erect is now only 4 1/2 inches long, before surgery 6 1/4 inches long. Girth now 4.75 inches, before it was over 5 inches around. No one told me this would happen. Nerves saved but drugs like Viagara,etc. do very little for me. Used needle for bout year and a half. Worked fine but left my penis with much scar tissue. (Used needle a lot, about 5 or 6 times per week.) Now have a penile implant which works fantastic and my penis is hard like a rock but the size of a boys pecker. I’ve got a super wife who says it doesn’t matter but I really think it does. I’m sure she’d like it bigger but she’d never say that because she loves me and knows how devastated I really am. I wish they could put bigger implants in but I don’t think they would. Yeah I’m still alive but I think about my dick every single day.

Terry.

David McCracken

Thanks for all the comments, which on the one hand let me know I’m not alone when it comes to this painful and embarrassing subject — but on the other hand reinforce my initial suspicion, once I realized that my already modest penis was smaller still, that there was NOTHING to be done about it. I had an RP in July 2014 by one of the absolute top docs in the country for nerve-sparing surgery, so sensation down there is good. He said nothing about the surgery shortening the penis, and as has been noted, OF COURSE IT DOES; part of the urethra is gone. I am so grateful for his skill and dedication — my PSA remains nearly undetectable after almost 3 years — but I cannot understand how this side effect can go unaddressed. My wife and I had some sexual issues even before the RP, but that’s a non-problem now; we havent had sex in 3 years, and its mainly because of my deep embarrassment. I feel maimed.

Lizzy

How do I say this? I am so glad to see we are not alone. But do trust me I know your pain and I truly feel for all that have had this surgery. Yes still alive but how nice it would have been to have been warned about the disappearance. All we were told was his prostrate was extremely large. So it turns out that means a loss of more than average. Never any mention of a pump. Also the nerve sparring robotic surgery is a myth at least in our case. 2013 was the end for us. We are still together but it is sad for him.
There has to be a better way.

J T

I am now 4 months past RP, with undetectable PSA at 3 months. The shortened urethra is uncomfortable often, drawing the head towards the bladder. No mention prior to surgery about this issue. I asked if I could expect it to stretch & the doc said “yes it may, but over years”. Why are we not at a point where a section of animal urethra or other suitable replacement material has been developed? Who wouldn’t agree to pay an added fee to have this issue addressed? Sure it would take some more effort and an increased chance of healing issues, but I would think those issues could be overcome. Why should we have to live with the discomfort and somewhat shortened erection? Frustrating.

JDP

Had my radical prostatectomy in October 2013. So far my numbers have been good and there have been negligible continence issues (however, climacturia has been a nightmare) Wish I could say the same thing for the length of my Johnson. For one, a successful surgery was defined to me as a 70% return to functioning with PDE 5 inhibitors. They may think that constitutes a successful surgery, I think their definition leaves much to be desired. Right now I would settle for 40% return to functioning with the PDE 5 inhibitor. The notion of return to functioning within 6 to 12 months (which was what I was told) is almost laughable. I was diagnosed at the age of 48, with no family history of prostate cancer, and I do not drink smoke chew or do, i.e. probably the lowest possible risk group. I never had the 1st symptom or prostate related problem. I was fortunate to have a family doctor with good instincts who happened to test PSA along with my usual bloodwork. I found a well-known surgeon in the field with an excellent reputation who did an open prostatectomy. He was dumbfounded that I had zero nerve activity/erectile activity by 12 months. At 1st he did not believe me. When I told him that I had recently taken 80 mg of Cialis plus another 100 mg of Viagra with 0 response, which my wife confirmed, he seemed more convinced. He seemed to believe my wife’s report more so than he did mine. I then finally gave in and attempted the injections. We started off with an injection in his office to determine my responsiveness. I responded so well that I ended up with a mild priaprism (on 1/10 of the initial dose!) and a trip to the emergency room which fortunately did not require medical intervention. Just a whole lot of ice. A very painful and chilling experience. Interestingly, the injections did give me an erection which, low and behold, was about 2-2.5 inches shorter than I was before.

When at 18 months I still had no sign of nerve functioning, my surgeon did have the stones to apologize to me and he did acknowledge responsibility. I respected that and we shook hands. He did save my life and he does get the credit for that. It was obvious to me what the problem was. The dimensions of the prostate are 2X3X4 centimeters and I had roughly 3 – 4 cm loss in length. Interestingly, when I surf various prostate cancer support blogs, I hear a great deal about loss of length post radical prostatectomy. Ironically people are losing anywhere from 1 – 4 cm, i.e. roughly 1/2 to 2 inches. Go figure. I told this to my surgeon, he told me that was very unlikely because the bladder would fall into the space where the prostate once was. WRONGO!

The lesson learned? The MDs are only interested in getting the cancer. They are only interested in saving your life. Quality-of-life issues post radical prostatectomy are an afterthought. They may say they have an excellent success rate when it comes to restoration of erectile ability. My surgeon told me his was in the 90th percentile per patient report (remember how he defined a successful surgery). My personal opinion is they are outright lying. He never did any measurements prior to my surgery and he never even looked at me after he removed my staples. How in the hell can he quote a success rate of any kind?! If my surgeon was 1 of the leaders in the field and this was the attention he gave to post radical prostatectomy erectile functioning, they are no more tracking their success rate than a podiatrist would track hemorrhoids!

As the gentleman noted in an earlier post, how could they not notice this and not identify the need to some way fill the gap between the bladder and the base of the penis with either donor urethra or something. If you change the length of the urethra you will always change the length of the penis, period! It’s simple arithmetic. When I read that there is new attention being given to post radical prostatectomy erectile functioning, I cannot help but laugh. I am now 52 and my wife and I have not been intimate since the night before my surgery. We celebrated our 30th year anniversary in August of this year. It is entirely possible I could live another 25 to 30 years. That is more than half of my marriage without intercourse! That is asking a hell of a lot from my wife. We were high school sweethearts and have known each other since elementary school. But… I have my life, my wife, and was healthy when my 2 daughters married earlier this month and this past June. Better yet, I should be around for grandkids. Is the doctor having saved my life good enough? Sure it is. But not being able to make love to my wife is definitely a life sentence for us both.

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