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
39
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!

Chadwick

I had the same exact thing happen to me! The surgeon/doctor, never said a thing about size loss after my radical prostatectomy. It should be part of pre-surgery info. I heard that that recovery from penile surgery is really rough. Was that the case with you?

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.

rdb

As a physician who had a radical perineal prostatectomy in 2005, My hat is off to the early Poster who recognized the obvious. Whatever the dimensions of your prostate are where the urethra passes through, you lose that much urethra/”tubing” when you take the prostate out.
As a physician, I would be very leery about trying to use a graft to connect the now severed urethra. The healing of a connection like this is one of the big concerns with a prostatectomy, and with a graft, you would have two connections to heal, not just one.

I do not think many urologists talk to patients about this, but I have also had some interesting experiences with the difference between what a physician has told me, and what I remembered, even though I am a physician. Too many physicians in all specialties try to explain complex issues to patients when their brains are reduced to the equivalent of scrambled eggs by the diagnosis and patients frequently do not remember much of what was said.

I would not be too hard on urologists being obsessed With completely excising the cancer. You have to remember that many men still die from prostate cancer after any of the treatments. As I remember thinking after I got the initial lecture, “dead men do not have sex and dead men do not leak urine.”

The truth is, as a Physician, I could not imagine increasing a man’s risk of dying from prostate cancer in order to maintain the length of his penis. The real truth is that this is not even possible, and that you must resect the entire prostate, and that determines the length of urethra removed, not the surgeon’s choice. The truth is, with prostate cancer, you get a few crappy choices, and even knowing that you are going to lose some penis length, 99.99999% of men are still going to have the surgery. As I told my surgeon on the way into the operating room, “You make sure I live, I will deal with the impotence and incontinence if it occurs.”

newhampshire

Greetings, at age 53, my PSA was 8.5, and a biopsies scored 7 & 8 Gleason. With a family history of Prostate cancer, I went to Lahey Woburn for a laparascopic robotic RP in 2011.
A great deal was said about nerve sparing, but there was never any mention of loss of penis length. Recovery was very rapid, and the catheter was not bothersome, removal of the catheter was done quickly and competently by an attractive young lady, and while not exactly comfortable, it was not painful.
Penile sensitivity was actually improved, and erections were fine, but I noticed immediately that:
a) Almost half of my penis was missing,
b) when my bladder began to fill, there is a painful tugging sensation that travels up the penis.
c) I was leaking like a sieve. The news came back that the margins of my prostate were cancerous, and the PSA remained high.
Next was 63 sessions of external beam radiation. PSA fell to undetectable for 9 months or so, and then began to rise slowly. The PSA fluctuates, and is still slowly rising, currently at 0.4.
The radiation apparently fried nerves, because there is very little sensation, and zero erectile function, except through the use of Tri-mix penile injections.
The penis was originally average at 6-3/4l x 5-1/2c inches, now, after RP surgery and some unfortunate episodes of priapism, it’s about 3-1/4 x 3-1/4 inches.
Your penis isn’t much shorter, it was just pulled back inside to make the connection to the bladder, so don’t blame your surgeon, they didn’t bob your wanger, they just tucked it inside.
After being widowed last year, I have been fortunate to develop an intimate relationship with a woman who is perfectly happy with the way I am, although sex is nowhere near as satisfying as it used to be for me, we find ways that are mutually satisfying and I am still able to give her intensely satisfying experiences.

Chris

Age: 63 Vancouver, B.C.
One year post radical prostatectomy and virtually no PSA count. No natural erection yet and some success with injection although 5 successes with 28 tries is crappy odds. Dr. says it is not the medication but the “landscape” which means I am injecting wrong. Hard to believe after this many times however, when it works, it is good. Some penile pain can occur and it seems mostly in the tip. Have episodic penile pain but can’t pinpoint what brings it on. Take Cialis daily and finally figured out it was better to take it at night. Sometimes you get a ” chubby” which is nice when you haven’t had a natural erection in a year. My partner says it is nice to see and feel (according to her) b tuthe rest of the time I feel like I have the cold penis of a 5 year old!!!! This is one of the few cancers that there is no visible side effect and no one wants to talk impotence at a party but “hey your hair is growing back” post treatment is common for other cancers!!!! Impotence is an absolute conversation stopper!!!! Good luck everyone, keep staying healthy and hoping for improvements.

C A Matt

It’s been two years since my nerve sparring surgery, happily my erections came Back in about a year, but did lose about 2 inches glad I was above average to begin with but it still bother me. Happy to be functioning.

Stacey

I am a 67 year old man that still has a strong interest in sex. My wife is still very beautiful & sexy. I had robotic so called “nerve sparing” surgery in 2009 and like everyone else I lost a lot of my penis length & girth and was never told by my doctor to expect this. My wife was sitting there also and she said it was never mentioned. I was well endowed so it was really a shock even though my wife said it doesn’t matter. I can get an erection only with me taking a Cialis tablet and by using a vacuum pump. Even with that I only have about 4.5″length to work with. I probably would have had the surgery but I would have been aware of the outcome. I tend to agree that the surgeons aren’t interested in that but I am.

JDP

I wanted to do a follow-up post to my earlier Oct 15 post and give a brief acknowledgement to RDB who made some salient points. I would have loved to have talked to my surgeon about these issues i.e. regarding the use of a graft and the complications that could come with healing and recovery from such a procedure, etc. Also, the reminder of “dead men do not have sex and dead men do not leak urine” is another salient point (the dark sense of humor is appreciated!). It is also a fair statement to note that the impact of getting the diagnosis does evoke a number of intense emotions. Fortunately, my wife was with me during the bulk of my appointments. And, there is no question, survival being “short dicked” beats death any day of the week. I never doubted the sincerity of my surgeon. I believe him to have been an excellent “cutter” as well as genuinely a good man. I would recommend him to anyone any day of the week, unfortunately he has since retired. I have to confess that I felt bad for him because he seemed to have high expectations for my recovery. I had all the indicators for a very good surgical outcome (i.e. was young, great health, good pre-surgical sexual functioning, “didn’t drink, smoke, chew, or do” etc.) yet my recovery was problematic. At our last office visit, he was apologetic about my frustrations, took ownership, and literally stated that the postsurgical problems “it was my work”. I did remind him it was also “his work” that saved my life, the life of my wife’s husband, and the life of the father of my children. I also truly appreciated his honesty and candor. I felt that to be a courageous acknowledgment especially in our “litigious” society. I have a future, and I intend to make good use of it. I should’ve made that more clear in my earlier post. My apologies.
However, I stand by my position that MDs inadequately inform their patients about the postsurgical sexual repercussions and this seems to be a pervasive problem. There are hard truths to face about the sexual repercussions with radical prostatectomy in even the best-case scenarios. As RDB (who acknowledges he is an MD) noted in his 10/23 posting, it is not possible to preserve penis length in a radical prostatectomy because the section of urethra running through the prostate is removed along with the prostate itself (I would like to express my thanks to RDB for pointing out this fact). And there lies in the problem. For an MD to suggest anything other than there being loss of length congruent to the size of the prostate is to outwardly mislead the patient. The 1st MD who did my biopsy flatly stated that my bladder would fall into the space previously occupied by my prostate and therefore would have negligible effect on length. The MD who actually conducted my surgery, dodged the issue (I can’t say that I blame him). Just as erectile dysfunction and incontinence are facts of radical prostatectomy, so is penile shortening and that needs to be clearly stated. To not share that information upfront is to subject the patient to an additional “shock” that does not need to be. For me, I want to be told everything upfront so I can be mentally and emotionally prepared for “what comes next”. It is inappropriate to leave out a postsurgical repercussion that will be a reality, not a possibility. MD’s run the risk of putting up obstacles (albeit unintentionally) to the formation of MD/patient trust early on in the doctor-patient relationship which is NOT a good idea. The patient’s trust in their MD is blind. But in all fairness to the MDs, it has to be a hell of a thing to look someone in the eye and tell them they have cancer and that their lives will never be the same again, or God forbid, they be terminal. Our MDs carry a heavy burden which is not to be overlooked. But as harsh as this may sound, that’s the discipline.
Even now, there are times when I wonder if there was anything else my surgeon “held back” … But I am fortunate. I can remind myself my MD came clean in the end. I was convinced then he was shooting straight with me and there’s no reason to doubt it now. But from what I’ve read, there are many guys out there whose MDs may not be as forthcoming as mine. I find that very worrisome.
RDB, thank you for your candor. Your patients are fortunate to have you.

Lloyd Noel

LEN
Three years post radical prostatectomy I experienced my first proper erection but like all the other posts it is about 40mm shorter and has a distinct downward bend which is not particularly attractive. I used the vacuum pump religiously and took the Cialis for months and that gave me cause for hope. I eventually quit taking the Cialis and the vacuum pumping became less frequent but I never tried the injections, mainly due to my wife’s influence, but now I am wondering if they might have helped with the shortening and / or the change in shape.
Being in my seventies I am not as concerned about the reduction in intimacy as the younger guys might be and luckily my wife is even less concerned but nevertheless it still sucks. So much for the surgeons assurances that the nerves fell away nicely etc. Of course my psa has constantly risen and following a PET scan I will no doubt be looking forward to radiation treatment soon which also sucks. Funny thing though, even at my age, I have seldom been physically fitter or felt better.
So gentlemen, my recommendation is to qtry to minimise worrying about it and get yourself to the gym or your choice of intense exercise and things will probably improve for you.

Don

Having read all the comments, I have to add that I am 70 and did not even think of nerve sparing surgery, just GET IT OUT! I (as was my wife) was perfectly happy to choose between zero cancer and intercourse – we can still cuddle and caress, which beats an earlier grave. BUT I do have a problem, which I have not seen discussed here – the problem is that with a much shorter penis (and I think it is shorter not only due to the loss of some plumbing length, but also to the fact that it is never getting ‘stretched’) and still (after 7 months) some leakage when I strain at anything (going to see a therapist about pelvic floor strengthening, though I am doing the kegels) I am still wearing pads during the day. Well, when I to to ‘pee’ I have to pull back the skin (even though I was cirsumsized as a baby) or I dribble onto the skin. I am not sure if there is any way to stretch the penis enough to ‘hang out’ past the scrotum without stretching the skin as well. Anyway, until I get senile, I will continue to pull the skin back past the head of the penis before peeing…

Rick

Before surgery, I read extensively (I thought) about robotic prostatectomy and possible side effects. I never came across anything about penile shortening nor was it discussed with the two surgeons I interviewed. I did read about the theory of
“use it or lose it” and penile rehabilitation; basically that even with nerve sparing surgery it can take up to two years for the nerves to heal. This can result in decreased blood flow and loss of erections even after the nerves have healed. I chose a surgeon from a university based urology program who had performed over 2,000 surgeries. The schools program is recognized as one of the best in the country. Before surgery, I asked him about this idea of “use it or lose it.” He discounted the idea and said it sounded like high school locker room talk.

After successful surgery, I read more about penile rehabilitation. It concerned me enough that I again contacted the surgeon to ask about it. He told me that they had recently hired a new doctor on staff and this was one of his specialties. I had an appointment with this new urologist and was told that the most common complaint from men after prostate surgery was penile shortening. I was very surprised. So, I have started taking Cialis and using a vacuum pump.

To put it all in perspective, I had very successful surgery with close to a 100% chance of no recurrence. I had very little incontinence and none after 6 weeks. I am 65 years old, have been married for 46 years and sex really isn’t a primary importance any longer. I think I’ve had some minor shortening. I am very fortunate and thankful for my recovery. Today, my understanding is that the sooner (after surgery) you start penile rehabilitation, the better. I wish I had known this so I could have started rehab sooner and possibly not had any loss of size.

René South Africa

I had a radical prostate removal operation by the “MR Prostate” of South Africa. Before the opp I asked him if there will be any bad effects afterwards. He assured me if I had no sexual problems then,everything will be fine after the opp. I lost 4.5cm in length and during erection the head of my penis bows over backwards, making sex about impossible. I made an appointment with another urologist and after six injections into my penis!, everything is exactly the same!How can we stop these Jokers from lying to patients and be scared for the rest of our lives?

Tony Mutu

I would like to let all know that the size of your Penis really matters in your relationship or marriage. I got married to my wife about 1 month after we met on a photo studio, we lived happily for the first 3 months of our marriage until i and

Marko

I had robotic prostate removal surgery in December 2016. My doctor made no mention of penis shortening. It is 1 year and three months later and I am still hoping that things (a lengthening and a decent erection) will return to at least 3/4 of what I had before surgery. These urologists should make it very clear there WILL BE PENIS SHRINKAGE and discuss the associated psychological damage that may follow.

A question was asked about what we can do.

1. We can start by all of us committing to giving the Urologist a terrible grade in Health Grades. I believe this surgery to be simply a money-making scheme for urologist since they can’t make money from recommending radiation instead.

2. Post the side effects of prostate surgery everywhere possible to help those considering the procedure.

Les

21-5-18, open surgery removal done 6 weeks ago, lost 50% penis, not advised about this pre surgery.

EJH

I had RP nine months ago. PSA is <.01. While I haven't had a full,unaided (pump) erection yet I haven't noticed any sizable decrease in flaccid or erect penis. The surgeon I had didn't directly mention size issue but he did have a pre-op class with plenty of literature. The literature mentioned shrinkage and recommended a pump one month after surgery. I started using it and take Viagra. Maybe that is why shrinkage isn't an issue for me. BTW there are a myriad of sex toys out there that you can use to help overcome any problems. Your partner will appreciate it.

Mark Beach

18 months post surgery. Considerable shrinkage that has not improved, and limited erections. And no, my surgeon never mentioned the possibility (I’m pretty sure I would have remembered something like that). I firmly believe our surgeons don’t mention this shrinkage issue, because we would have taken a harder look at radiation treatment. My guess is, no loss of prostate tissue, no loss in length. If there are any post radiation patients out there who could confirm or deny, I’d like to hear from you. In the mean time, I wonder if this lack of disclosure is actionable in court?

Quentin Kessel

I was trying to make a decision between radioactive implants or RP and feel I was conned by the surgeon – who has since moved on to Sloan Kettering in NYC. When he explained the surgery, I said wait a minute, that is going to shorten me! His response was that the bladder would pull into the space vacated by prostate. He also remarked that I could have radiation if the surgery failed to get all the cancer cells, but that after radiation he could no longer perform surgery. This was a true, but misleading statement, used to push me toward surgery.

End result: I lost close to three inches; he failed to get all the cancer and I had to undergo radiation treatments to enjoy the worst of both worlds. This includes muscle and joint damage in the pelvic area that continues to plague me eight years after the radiation treatments.

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