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radical prostatectomy and 'penile shrinkage'

William Parkinson
Posts: 60
Joined: Oct 2009

Hi everyone. I am wondering how bad the shrinkage is with radical prostatectomy. When they take out the prostate, they also take the urethra. Prostates are typically an inch or more in length (and thus so is the urethra they take out). They do lower the bladder down when they attach the bladder neck to the urethral 'stump', in order to lessen this problem, but many men still suffer from a loss of size right out of the box, so to speak. Also later on, in the aftermath of the surgery, the nerves are not functioning, thus muscle atrophy can occur, as well as hypoxia (low oxygen levels), due in part to lack of tumesence (engorement). Hypoxia, in turn, can lead to fibrosis. All of this can lead to shrinkage. The best way to ward this off (to the degreee it can) is the early use of some type of vacumn device. So, I am wondering how bad this effect can be. Has anyone had this problem and did you use the device or not and did it get better later on? Thx for the help in advance!
Cheers
Bill

lion1
Posts: 241
Joined: May 2007

Bill,
1 inch----------------never used a vacuum device.

Lion1

jemesj
Posts: 4
Joined: Sep 2005

I had surgery Aug of 05, with shrinkage of more than an inch right after surgery.

I must say, I tried all the various pills that the doctor would prescribe for help with erections but the side effects were not good for me. So, I had to quite taking them. I have also used injections and at times have problems with it. I have used the vacuum device which seems to help but still cannot maintain a erection long enough to have any fun.

I still talk to the doctor about the problem, which I have taken several tests to see if I have other problems but none have been found.

Hoping to get some more help someday.

bigblueowx
Posts: 3
Joined: Dec 2014

Had the same issue until I bought a poste vac penis pump...comes with restriction bands to keep the blood trapped inside the penis...it'll give an erection hard enough to penetrate for 30mins or until u climax. lube inside & outside of tube about a 1/2 in above the edge of The tube..Place band on the lubed area. Place tube over penis...pump...release...pump release..over & over until it's erect...slide band on erect penis...then release air pressure inside tube..ur ready to go....it works...and it's better than nothing....at least until u completely heal....doc says use every to every other day to speed up normal erections...before u start with pump...have oral sex to help prime the penis with a good amount of blood inside....then use pump...don't forget to have the band already set on the tube...to trap the blood.  Oral 1st  Will add a 1/2 to 1 extra inch of length and girth. 

One more thing...believe it or not...KEGELS really help...urinary and erection recovery.  Downloaded a tabata timer to help keep track of time and sets.  Now I'm up to holding 30sec for 40 sets.  I do them in the car on my way to work every morning.

1st set of 20 I hold the 2nd set of 20 I do quick pulses. I started out with 10 sec holds and worked up to 30 sec at a 50% squeeze force. 50‰ squeeze is a constant,from 10sec up until  whatever.

 

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Hey Bill,

While many of your comments are true, there are some differences.
the nerves are not functioning, Yes there is the chance of nerve interuption or damage but, over time this function returns.
muscle atrophy can occur, okay but, muscle tissue can regain strength
hypoxia (low oxygen levels), due in part to lack of tumesence (engorement) many of the ED meds (i.e. Cialis) help increase blood flow to this area, thus minimizing noted side effects.
All of this can lead to shrinkage. Gives a different meaning to "Bigger is better"

I am almost 6 months post DaVinci and I have had many of the same thoughts as you. Don't give up!

jim (shubbysr)

DRC
Posts: 3
Joined: Jan 2010

I am 57 yrs old and almost 3 yrs post surgery and about 1.5 yrs post radiation. The shrinkage for me is considerable, approx 2+ inches. It did not happen right away and really only some “shape changing” happened after the surgery. The end curves down when erect due to uneven pulling of the salvaged nerves (according to doc).

The real shrinkage came after radiation (PSA went back up after 1 yr). Not sure if it was the radiation or delayed results from surgery.

I use the pump several times a week for 10 minutes alternating applying pressure and releasing to keep it from getting worse (recommendation from doc) but I do not use it for intimacy.

I still maintain a fairly satisfying intimate relationship with my wife thanks to Cialis (minimal side effects) but things are certainly different. This is a physical condition that makes be glad I have life long partner. I’d hate to be single and trying to impress the ladies with this going on! But the bottom line is that allthis is manageable and I wouldn’t (and didn’t) let knowing any of it sway making the right decision for treatment.

Good Luck!

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

Since last May 21, I've had the Davinci & 37 radiation treatments. Although I've never used the "ruler" I guestimate I've lost at least an inch. I took a few viagra after surgery but didn't like the side effects...got a hi end vac pump and use it occasionally to promote flow. Hard to get used to the dry ejaculations....erections 30% less.
Good bladder control though & able to do all the other stuff I did before PCa.
Keeping the faith & moving forward.

Regards...

Look2tFuture
Posts: 1
Joined: Apr 2012

Hello DRC.I am experiencing something similar. Were you ever able to get fully erect after prostatectomy? Would the end curve down even then? My front half does not seem to get erect on its own but it eventually fills out and the penis becomes straight and looks normal, at least with Cialis. Also the front 2/3 feels smaller and firmer when flaccid, is it the same for you?

josborne3
Posts: 1
Joined: Dec 2012

I had a Da Vinci prostatectomy last July. Bladder control is fully restored. My guess is my penis is about 1" shorter when erect. It seems about the same length as it was prior to surgery when flaccid.

I had erectile dysfunction prior to surgery. As my doctor predicted, it is worse now than before. I do not believe I have nocturnal erections. Viagra doesn't work for me. I have a pump which works good, although the erections don't last long enough for intercourse. I also inject tri-mix on occasion which works pretty well. It is an expensive option though at a little over $100 per prescription.

The odd thing is that my penis seems more sensitive then before. I hope this indicates that the nerve connections are recovering well. When I ejaculate, it is squirts of urine, since there is no semen factory left. When fully erect, my penis curves up as it always did. Being somewhat shorter, it appears fatter....probably an optical illusion.

Like someone else here said, I am glad that I am in a long term relationship (48 years) since I doubt I could impress anyone with my sexual powers these days.

The really great news is that we caught the cancer early on and it was fully contained within the prostate. My last PSA was .02 which means the cancer is undetectable. My six month check up is in about a week. I am not expecting anything but good news again.

John_Jax
Posts: 1
Joined: May 2013

If your having pain with Trimix, switch to Bimix. World of difference. On my pump, the documentation states a maximum of 30 minutes with restriction on penis. If your band is too big diameter, it's letting bood flow out of penis, giving you a reduced time. I hope it's that easy, probably not.   You can vacuum again up to 30 minutes then you have to let blood flow in penis.  30 min of  band restriction total. Read your documentation. It may differ. 

bigblueowx
Posts: 3
Joined: Dec 2014

Oral 1st to prime the penis....then use the pump...u'll get more blood in...more length...more girth....i'm a witness.

 

Fixed
Posts: 1
Joined: Mar 2013

What you really need is a good blood flow suppy into your corpus cavernosum. That will reduce any chance of shrinking. If you don't use it, you lose it. That is very true in the penis. You should get injections ASAP. These injections should not be formulated for penetration, but for a mild 40% erection to start. Every other day apply a dose. Over time, you build your base up again and you can then increase the dose to penetration. I work with these patients each day, it takes time but it works.

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

To my party, it happen and it is a part of life. I think I lost my mind, we all lose your mind at this game.

Good luck, I think the best!

Trew
Posts: 897
Joined: Jan 2010

I sometimes wonder if I might get a 2nd "bellybutton" down under.

 

1- 2 inches are gone, but so are errections.  Most discouraging after affect of PCa. 

 

When I was still using the urologist that did my Devinci surgery- the surgeon who I never saw again- his PA told me any shrinkage was in my mind.  I hung around that urologist's office 2 or 3 visits too long. 

 

 

 

 

bs13178
Posts: 1
Joined: May 2013

I had a radical prostatectomy in September 2003. The reduction in penis size was noticable following the surgery. I thought like several men that the size would come back eventially. Well after almost ten years after my surgery nothing has changed. The erect size was reduced by approximately 40% to 45% both in length and girth after surgery and has not reversed at all since. The nerve sparing part of the surgery worked great. I am able to have erections, although much smaller and orgasms. I have tried several suiggestions from my urologist, such as taking Vitimine E and Vitimine C. I even tried the topical Verapamil treatment. I have used the pump and Viagra and all of the other type medicines. Nothing has increased size from the post-operative size. When not erect the penis looks like it is uncircumsized and looks more like "innie" versus an "outtie". The every day problem is urinating. Sometimes I have a hard time finding the tiny penis and pulling it far enough so I don't urinate on my pants.

hopeful and opt...
Posts: 2214
Joined: Apr 2009

that indicated that taking large amounts of vitamin e increases incidence of prostate cancer

http://nccam.nih.gov/research/results/spotlight/101111.htm

Afterward, another study was done at the Cleaveland Clinic which confirmed the results.

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

This is a little off topic.  I had castration, and I will add that the shrinkage in my case was very large, like 50%.  It kind of looks like a worm left out on a hot tennis court, all shriveled and tiny.  My friend says, "So what.  You cannot use it for anything anway other than to pee thru, and you can do that sitting down."  However, I am sure I will not be going to the gym ever again and showing off my ex-manhood.

 

   I have a lot of experience with both Ciallis and Viagara and used plenty of both.  I preferred Cialis because of the longer time window.  However both had unpleasant sides effects like head ache and nausea.  Here in Asia there is an over the counter product called Robust.  It is chinese herbs, and I found it to be just as effective as Ciallis, but had no side effects.  I do not know if it is available in USA, but if you come to Davao, I have a good supply that I can no longer use, so you are welcome to it. 

I am 81, but am married to a gorgeous 26YO Pinay, and now I am totally unable to perform, but I get to see that perfect body every day.  I guess this must be pay-back for my long time previous life style.  I love the acceptance and optimism I see on these posts.  You guys are wonderful. love, Rakendra

bigblueowx
Posts: 3
Joined: Dec 2014

Sir...the poste vac penis pump will do wonders for u...it will pull the blood in for u...I have both the man and battery op...I personally like the battery op best...bought it off EBay...waaay cheaper than from other company sites. Look above at the post I left...it'll give a bit more info on how to use it

MK1965
Posts: 147
Joined: Jun 2016

I lost completely my sex tool. My shrinkage was 2+ inches and continues to get smaller.

My erect penis after BIMIX injection is one inch of shaft and pehis head (glans).

According to this old tread and others that I mentioned before, penile shrinkage mostly after RP, is not anectdotal.

It is most negative surprise for way to many after RP.

MK

 

VascodaGama's picture
VascodaGama
Posts: 2792
Joined: Nov 2010

MK,

We have discussed shrinkage here before but for whatever reason it is rarely mentioned when comparing treatments. After all a burred penis would not cause recurrence so that discussions on treatments tend to focus on the cancer alone and how to get rid of it. The same goes with the urologist that rarely provide such information to patients at the time one needs to decide on an option. For them the important matter is to treat cancer. In any case, they could care on this shrinkage issue when dissecting the gland by simply freeing the bladder to displace it lower. However, robot arms do not reach the upper area of the bladder which condition (if informed to patients) would certainly prejudice the present worldwide trade on Da-Vinci. The procedure used to be part of open surgeries protocols in the old times.
The worse in shrinkage is the buried penis. Erections can be achieved with pumps and pills but the buried penis can only be avoided with surgical intervention.  

VG

 

 

Grinder
Posts: 426
Joined: Mar 2017

And there it is again... a variable. If the urologists would inform patients of that particular side effect, the patient could take all of this into consideration and make an informed decision.

I find this reprehensible... It should be the patient's decision. Each patient should be able to decide what losing up to 2" of length would mean, and how would that affect their quality of life. For some losing length may not be as problematic,anad for some, their age may make ED issues irrelevant, and for some, coitus may not be an issue anyway. 

 And these are pre-op variables... length prior to surgery, age related factors, pre-op sexual activity, etc. Yes, they may lose a significant number to open surgery, but the waiting list for Davinci surgery is evidence that it is in TOO great a demand. IIf the hospitals suffered decreased demand for Davinci surgeries of any type, it would make waiting times more contemporary with the diagnosis, instead of months waitiing it would be weeks, and in the case of the best surgeons, a three to six month wait could be reduced to a three to six week wait.

Is it any wonder I have gone through six urologists counting the surgeon? Maybe my background causes me to be suspicious of motivation, and assess each person.

MK... you think your issue is with RP... no, your issue is tgt same issue we all have... who do you trust to give you all the variables to make the right decision for YOUR case. Your crusade should not be against Davinci surgery, your crusade should be against urologists that do not give the patient enough information to make the decision for his quality of life post-op. In my case, I was lucky because my GP was a accomodating with my reticence when I felt i was being hustled.

Grinder
Posts: 426
Joined: Mar 2017

I should note that the urologist i settled on told me about side effects, but not about the shortening length. However, he did encourage me to consult with other post-op Davinci patients. I did not need to do this because my friend had pretty much told me his previous experience, and I went in to RP expecting i may never have sex again... but in my condition at the time, sex was a distant memory, and my other issues were more prevalent than ED.

So I think THIS is the litmus test:

Is your urologist giving you a wide range of treatments, noting side effects for each one, treatment outcomes, frequency of successful treatments, quality of life post-op, and how your own variables can influence those outcomes, such as pre-op length, age, frequency of sexual activity, etc?

OR

Is the urologist making all your decisions FOR you? Are you being steered toward a certain direction? Are you getting the "next in line" surgeon just because he belongs to the same clinic as your urologist?

There it is. We can argue all day about anecdotal outcomes. Is it any wonder so many of us depend on VdG's advice? Excluding the surgeon/urologist, my success rate for the  above litmus test was only 20%! Only one in five gave me all the information about five different procedures, their side effects, and outcomes. How is that possible? Only one in five gave me enough information to make my own decisions, instead of making the decisions FOR me.

 

Clevelandguy
Posts: 362
Joined: Jun 2015

Hi All,

Vasco hit it on the head, is your cancer gone.  Surgery or radation ask yourself that question.  Hopefully after a few years I can say yes.  If my member is an inch shorter I don't really care, if I stress leak a little I don't care as long as the cancer is gone(the main goal IMO).  As I have said before ALL TREATMENTS HAVE SIDE EFFECTS, study them wisley before you make your choice.

 

Dave 3+4

Chuckect's picture
Chuckect
Posts: 37
Joined: Jan 2018

I have had no surgery, wasn't dx until i had stage 4 metastatic prostate cancer.. I take lupron to lower my testosterone + i am 80 years old.. so, i can only say if your lucky enough to live as long as me i assure you your penis will shrink.. Sorry...

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2986
Joined: May 2012

Thank you Chuckect !  Perspective is priceless, but rare.  

max

Grinder
Posts: 426
Joined: Mar 2017

I am NO fan of litigation, but if urologists continue to hide side effects, especially penile shortening, arent they opening themselves up to malpractice suits? If I was their liability insurance company, i would insist they tell RP patients up front that they will suffer a loss of 2" , and if they cant afford to lose that then they need to know... there's hordes of medical malpractice attorneys itching to sue the hospital, the urologist, the surgeon etc. And if someone can stand to endure several years of courtroom litigation talking about the shortened length of his business and how it ruined his QoL, he would stand to make a law firm very wealthy. (He wont see much of it though). 

Better just to tell the patient upfront as standard procedure.

I dont know anything about the law, but i am familiar with liability in our business. You dont mess around when it comes to liability protection, and procedures adjustments. That's why we are a limited liability corporation.

Ive seen successful cases of liability that were a lot less convictive than loss of QoL from shortening.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2986
Joined: May 2012

There was an episode of Seinfeld during which the gang went to the beach....George later asked Jerry in confidence, after getting out of the cold water, "Do women know about 'shrinkage?'   Do doctors ?

max

MK1965
Posts: 147
Joined: Jun 2016

I read on other forums  about this scam going around for 10 years praying on prostate Ca patiemnts.

BEWARE!!!!!!!

MK

jeffman
Posts: 15
Joined: Oct 2017

I had surgery in sept. and there is some shrinkage. Still no erections. But I gladly sacrafice an inch to see my grandkids have kids. The other stuff is between my wife and I, and it's not hard (pun intended) to figure something out. 

Steve1961
Posts: 149
Joined: Dec 2017

I agree with Jeff as long as I live long enough to see and play with my grandkids who reall6 cares about sex..then again I’m 57 and been married fir 30 years ..I feel like al bundy but with 3 wonderful grown kids  lol ...still don’t know if I am doing surgery or brachytherapy...my doc is confident I wont need any radiation after surgery but u never knowc

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