AUA 2017: Changes in penile length after radical prostatectomy: Investigation of anatomical mechanism

Boston, MA ( After radical prostatectomy, penile shortening is a common patient complaint that many of us have experienced in our clinical practice. While quickly attributed to the inherent risk of the procedure, there is little literature regarding its etiology and recovery. The authors of this study help address this in a prospective study of 102 patients undergoing radical prostatectomy (RP). Stretched penile length (SPL) was measured pre-operatively, 10 days post-op, and then at 1, 3, 6, 9, 12, 18, and 24 months after RP. At the same time, the perpendicular distance from the distal end of the membranous urethra to the midline of the pelvic outlet was measured on mid-sagittal magnetic resonance imaging (MRI) slice at three time-points: preoperatively, 10 days after RP and 12 months after RP.

Figure 1 highlighted the mean SPL at the different time points. The SPL was shortest at 10 days after RP; it gradually recovered thereafter, and by 12 months, it was not significantly different from preoperative SPL.

In figure 2 (available online), the distal end of membranous urethra was found to have moved proximally (mean proximal displacement: 3.9 mm) at 10 days after RP, and to have returned to the preoperative position at 12 months after RP.

Only the volume of the removed prostate was a predictor of SPL change at 10 days after operation on univariate analysis; on multivariate analysis, the association was not statistically significant. By 12 months, there were no specific predictors of shorter SPL, as they were nearly identical to pre-operative SPL. Covariates assessed included age, BMI, nerve-sparing, use of PDE5 inhibitors.

On discussion, the authors noted that there was no regular penile rehabilitation program for all patients. Some patients received PDE5 inhibitors, but none used VED. This may affect ED recovery.

This was a very unique study and well-done. I think it helps address an important patient concern, and using this, we can reassure most men pre-operatively, that similar to urine continence, by 12 months, SPL will likely be back to its baseline.

Presented by: Yoshifumi Kadono, MD

Co-Authors: Kazuaki Machioka, Kazufumi Nakashima, Masashi Iijima, Kazuyoshi Shigehara, Takahiro Nohara, Kazutaka Narimoto, Kouji Izumi, Yasuhide Kitagawa, Hiroyuki Konaka, Atsushi Mizokami

Institution(s): Japan

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA