Radical Pelvic Surgery and Penile Length Loss

A new diagnosis of cancer is always daunting, and for men diagnosed with prostate and bladder cancer, it is particularly anxiety-provoking. After going through an unpleasant biopsy, many tests, and numerous doctor visits, patients must decide which treatment option is the best.

The gold standard treatment option for prostate cancer and invasive bladder cancer is removal of the prostate (radical prostatectomy) and removal of the bladder (radical cystectomy).

Sexual dysfunction can manifest in other ways including ejaculatory dysfunction and penile shortening

While effective at treating cancer, radical pelvic surgery is not without risks. One of the primary consequences of urologic cancer surgery is erectile dysfunction. However, sexual dysfunction can manifest in other ways including ejaculatory dysfunction and penile shortening. Significant developments in technology and surgical technique minimize risks, but these side effects are still very possible.

Penile shortening after radical pelvic surgery is rarely discussed but commonly experienced. Shortening can negatively impact a man’s body image perception and confidence, and result in sexual and urinary dysfunction. Be proactive and put together a game plan with your physician to mitigate shrinkage.

Why does the penis shrink?

It’s all about blood flow. After the prostate and bladder are removal the penis and the nerves that control erections go into a state of shock. During this time, there is less blood flow to the penis than before surgery. With less blood flow, the spongy tissue inside the penis becomes stiff and inelastic. This process is called fibrosis, a scientific term for scarring. Over time, as more spongy tissue is replaced with scar, the penis begins to shrink and lose its ability to stretch.

So what if my penis shrinks, At least my cancer is gone

Yes. Stay positive! At the end of the day, you had your prostate or bladder removed because of cancer. If you are cancer-free, that is fantastic news and fundamentally a great outcome. Now that you don’t have to worry as much about your cancer, you can now think about restoring quality of life and sexual function.

How do I prevent shrinkage after prostate removal?

Several treatments exist to help prevent length loss and restore size. Shortly after surgery, I start patients on an aggressive penile rehabilitation protocol. Phosphodiesterase-5 inhibitors (PDE5i) such as tadalafil (Cialis^®) and sildenafil (Viagra^®) are mainstays of therapy. These oral medications promote increased blood flow, maintain penile tissue health, and slow the scarring process.

Oral ED medications promote blood flow, maintain penile tissue health, and slow the scarring process

I also encourage patients to use a vacuum erection device (VED). The VED is designed to bring fresh, oxygenated blood into the penis and stretch the penile tissue. By doing this, the penile tissue can maintain its ability to stretch which is essential to length maintenance.

VED for Penile Rehab

The VED is used daily or as directed by your physician without use of the tension ring. Creating multiple erections in one session is a unique advantage of VED therapy that other rehabilitation methods cannot achieve.

1. After erection is created, hold the erection in the penile tube for 1-3 minutes.
2. Release the erection in the tube while maintaining seal between body and device.
3. Repeat the process 3-5 times for a total of 10-15 minutes per rehab session.

While there are no guarantees, use of a vacuum erection device and intake of PDE5-inhibitors may prevent significant length loss after radical pelvic surgery.

Can this also happen to me if I have ED?

Yes! The same scarring process can also occur for those who have long-standing erectile dysfunction. Men with long-standing, moderate to severe ED have less blood flow to their penis compared to men who have normal erectile function.

Nocturnal erections (‘morning wood’) are the body’s way of maintaining penile health. By nourishing the spongy penile tissues with fresh, oxygenated blood and making the tissue stretch, these spontaneous erections allow the tissue to stay supple and elastic.

For these patients, the use of a VED is a fundamental component of penile rejuvenation

As ED worsens, nocturnal erections decline or stop altogether. When this happens the penile tissue becomes less stretchy and more scarred resulting in shrinkage. For these patients, the use of a vacuum erection device is a fundamental component of penile rejuvenation.

It’s not too late to start a program to restore what you may have lost

Penile length loss can occur after the prostate or bladder are removed for cancer surgery and in men with long-standing ED. Fortunately, several things can be done to minimize these losses including using sildenafil or tadalafil, using a vacuum erection device, and penile traction therapy. If you are reading this for the first time and have noticed that your penis has shrunk, it’s not too late to start a program to restore what you may have lost.

Author:

Jeffrey Loh-Doyle, MD

Urologist
Keck Medicine of USC
keck.usc.edu

1516 San Pablo St, Ste 3500
Los Angeles, CA 90033