Undergoing treatment for prostate cancer raises concerns about recovery and long-term quality of life. While the primary focus is successful cancer treatment, many men question the impact of surgery on their physical and sexual health. These concerns include changes to physical appearance, beyond issues like urinary function and erectile capacity. Acknowledging potential side effects is important for preparing for recovery and managing expectations.
Is Penile Shortening a Common Side Effect
Penile shortening after prostate surgery is a frequent concern for patients. This side effect is documented following a radical prostatectomy, the procedure that removes the entire prostate gland to treat localized cancer. Other procedures, such as a Transurethral Resection of the Prostate (TURP), typically do not cause this change. Shortening is a recognized consequence, and studies suggest that many men experience some degree of length loss.
Estimates regarding the incidence of shortening vary, but 40% to 70% of men who undergo radical prostatectomy perceive or measure a decrease in length. The average measured reduction is modest, often 1 to 2 centimeters. This physical change impacts body image and self-esteem. The risk of shortening is interconnected with post-operative erectile dysfunction, suggesting a shared physiological basis.
Anatomical and Physiological Causes of Length Reduction
Shortening after radical prostatectomy results from a combination of anatomical and physiological changes. One immediate cause is the removal of the prostate gland, which necessitates rejoining the bladder neck to the remaining urethra (urethrovesical anastomosis). This surgical reconnection can cause retraction or tension on the urethra, resulting in a slight reduction in length. This structural rearrangement is responsible for the immediate post-operative shortening.
A long-term physiological mechanism involves the corpora cavernosa, the spongy tissue columns that fill with blood during an erection. Post-operative erectile dysfunction, often resulting from nerve damage, leads to “erectile silence.” Without regular, full erections to supply oxygenated blood, the smooth muscle tissue degrades and is replaced by non-elastic scar tissue, known as fibrosis or corporal atrophy.
This replacement of elastic muscle tissue with rigid scar tissue reduces the penis’s ability to stretch and fully engorge, causing a permanent size reduction. Injury to the nerves responsible for erection disrupts blood flow regulation, leading to low oxygenation that promotes further tissue damage. While changes in support structures like the suspensory ligaments may play a role, the primary culprits are urethral retraction and tissue changes within the erectile bodies.
Measuring Post-Operative Changes and Timeline
Penile length change is typically measured using the stretched flaccid length (SPL), the most reliable proxy for actual erect length. This measurement is taken by applying maximum manual traction to the flaccid penis and measuring the distance from the pubic bone to the tip of the glans.
The timeline for length changes is predictable, with initial shortening often occurring immediately after surgery and peaking when the urinary catheter is removed. The average stretched length is reduced by about 1 centimeter three months post-procedure. This reduction may persist for up to two years, though some studies show length stabilizing or returning to near pre-operative values by four years.
A man’s perceived loss of length is sometimes greater than the measured loss. This discrepancy is influenced by changes in erectile function, body image concerns, and psychological distress. The recovery of erectile function is a strong predictor for the recovery of penile length over the long term.
Strategies for Maintaining Penile Length
Length preservation involves proactive measures grouped under a penile rehabilitation program. The goal is to restore oxygen-rich blood flow to the erectile tissues, preventing scar tissue formation. Early intervention, starting soon after the catheter is removed, is the most effective approach.
A core component of rehabilitation involves oral medications called phosphodiesterase-5 inhibitors (PDE5i), such as sildenafil or tadalafil. These medications improve blood flow to the penis, oxygenating the tissue and maintaining smooth muscle cell health. Regular, early use of these drugs aims to reduce tissue atrophy, even if they do not initially produce a full erection.
Another effective tool is the Vacuum Erection Device (VED), often called a penis pump. The VED creates negative pressure, manually drawing blood into the corpora cavernosa to create an artificial erection. This mechanical action stretches penile tissues and promotes oxygenation, directly counteracting the fibrotic process. Studies show that men who use a VED regularly and early post-operatively have a lower risk of length loss.
Penile Traction Devices (PTDs) offer a mechanical method of stretching the penis to preserve length. These devices are worn externally and apply a consistent, low-level pull to the flaccid penis. This sustained stretching encourages tissue growth and counteracts surgical retraction. Additionally, a medically advised early return to sexual activity, including achieving erections through any means, contributes to tissue health and length preservation.