Radical prostatectomy is a common surgical treatment for prostate cancer, involving the removal of the prostate gland. Many men considering or undergoing this procedure express concern about potential changes to their penile length. This concern is valid, as penile shortening is a recognized side effect that can occur after radical prostatectomy.
Understanding Penile Shortening
Penile shortening is a recognized consequence for some men following radical prostatectomy. Studies indicate a varied incidence, with reports suggesting that stretched penile length can be significantly reduced in a notable percentage of men after surgery. For instance, some research shows that almost half of men undergoing surgery experienced a reduction in stretched penile length of 1.0 cm or more. Other reports indicate that penile length shortening occurs in 68% to 71% of men undergoing radical prostatectomy.
This shortening can involve both length and girth, affecting the penis in both flaccid and erect states. While the degree of shortening varies among individuals, changes of approximately 1 to 2 centimeters are commonly reported.
Mechanisms Behind Penile Shortening
Several physiological factors contribute to penile shortening after radical prostatectomy. Nerve damage, or neuropraxia, can occur during surgery due to stretching or direct trauma to the cavernous nerves, which are located close to the prostate. This damage can lead to reduced nerve signals to the erectile tissue, promoting an unhealthy environment. The lack of regular erections and nerve stimulation can result in decreased oxygenation of the penile tissues, triggering a cascade of cellular changes.
Reduced oxygenation to the penis can cause changes in blood flow and lead to tissue atrophy. This diminished blood supply can result in the replacement of healthy smooth muscle in the corpora cavernosa, the main erectile bodies, with inelastic scar tissue. This process, known as smooth muscle fibrosis, can physically restrict the penis from fully elongating during an erection.
Scar tissue formation at the surgical site, particularly where the urethra is reconnected to the bladder (anastomosis), can also contribute to shortening. The contraction of this scar tissue can exert a pulling force on the penile structures.
Approaches to Managing Penile Shortening
Various strategies are employed to prevent or mitigate penile shortening and support penile health after prostatectomy. Penile rehabilitation programs often begin shortly after surgery. The aim of these programs is to maintain tissue oxygenation and prevent the formation of fibrotic scar tissue.
Phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil or tadalafil, are frequently prescribed to promote blood flow and oxygenation to the penile tissues. While their effectiveness in fully restoring pre-surgical erectile function can vary, they are widely used as part of rehabilitation protocols to potentially reduce tissue damage and support recovery. Vacuum erection devices (VEDs) are another common intervention, which use negative pressure to draw blood into the penis, thereby stretching the tissue and improving oxygenation. Early and consistent use of VEDs has shown promise in reducing the risk of significant penile length reduction.
Penile stretching exercises or traction devices can also be utilized to physically stretch the penile tissue. These devices apply gentle, sustained tension to the penis, aiming to counteract shortening and potentially increase length. Early intervention with these methods is often emphasized, as it may improve the chances of maintaining or regaining penile length and function.
Patient Experience and Support
Experiencing penile shortening can affect a man’s body image and emotional well-being. Open communication with healthcare providers, including urologists, is important for discussing these changes and exploring available management options. Many healthcare teams now include sex therapists or counselors who can provide specialized support and guidance.
Managing expectations about recovery and focusing on overall sexual health and intimacy, rather than solely on penile length, can be beneficial. Discussing these concerns with professionals and partners helps navigate the emotional landscape. Involvement of partners and participation in support groups can also provide a valuable network for coping with these changes and fostering a holistic approach to recovery.