Post-prostatectomy shrinkage (or is it?)

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I have noticed that there is an odd contrast in views over whether a radical prostatectomy causes the penis to shrink or not. It seems to be a general rule that surgeons and the medical community in general regularly tell patients that prostatectomy doesn’t cause penis shrinkage. On the other hand many many people who have had a radical prostatectomy (including myself) have seen a noticeable shortening of the penis after the operation compared to before.
I’ve put a lot of thought into why there should be such a difference in views, and I think it comes down to terminology; specifically the difference between shrinkage and retraction.
When a surgeon removes the prostate new material isn't added to the urethra to fill the gap. The surgeon simply joins together the two dangling ends of the urethra, and job done. The result is that everything to the north of where the prostate used to be is pulled back a bit - and in the case of men who had a large prostate this can mean quite a bit.
So when a surgeon says that the penis itself hasn't shrunk they are quite right. But since more of the length of the penis is now retained within the body cavity, to the layman (and to the naked eye) the length of penis that protrudes out of the body is less than it was before.
 
Phil6003,

I brought this issue up with my urologist some months after my RP. His explanation was true that there is a length of the urethra removed during the surgery. However, the bladder literally “floats” in the body. That is the bladder is not held in place by any muscles or cartilage.During the RP procedure the bladder is pulled down and reattached to the urethra. Hence the reason for the catheter for some period of time after surgery to allow healing of the reattached urethra.

That is the explanation from the medical perspective. My evidence shows a shrinkage whether due to retraction of the urethra or due to loss of blood flow to the penis.
 
Whether retraction or blood flow - shrinkage in length and girth occurred to me.

I can see in a picture / diagram that the penis is outside the pelvic floor. An logically conclude that the penis length nor girth should change. I know mine did change by over a inch. Pumping helped a lot, but 2 years later I am still an inch shorter and have less girth.

My urologist says a prostatectomy does not change length. My Primary Care doctor stated that all his patience who had a prostatectomy has lost length.
 
I agree 100% ...I not I ced a little difference in length but not in gerth ...it is what it is I guess ...
 
Never had a radical prostatectomy yet thankfully, but my Urology PA told me to expect shrinkage, as I have had ultrasounds were done several times for a cysts on my testicle, and we talked about the shrinkage of the testicles and penis, and how they continue to shrink. I really don't need them if anyone needs a spare?! LOL
 
Hi - My urologist/surgeon told me that I would loose some length, roughly 1/2 to 1 inch. Shouldnt impact girth. My observation is I dont think I lost much in length, maybe a 1/2 inch. It all appears to look pretty normal so I am good with that. I am using a manual vacuum devise to encourage erections to maintain health. Now onto dealing with the incontinence!
 
OK, so here is what my urologist told me even before the robotic RP...

You have to treat the incontinence AND the ED at the same time - you can't wait for the incontinence to be cured or manageable before addressing the ED.

As he stated many times to me, "You either USE it or you LOSE it!"

He said he knows MANY patients that wait until the incontinence is under control and THEN try to address the ED. At that point, he said you can treat the ED, but you will have already lost length and girth. He said that the nerves are damaged during the operation. He said that vascularly, there are no issues, so you have to use a pump and Tadalafil (generic Cialis) to keep blood flow to the area until the nerves can recover.

I saw no improvement from the Tadalafil alone. I started using pumps (electronic and hand pumps) and they did help to get blood back to the area, but not enough for sexual activity, so my Dr. sent me to a specialist in his practice to start using a Tri-mix compound Rx for penis injections. I had a trial injection in his office so he would know the amount to prescribe - it worked! My actual Rx for home use arrives Wednesday (in two days).

My Dr. told me not to wait - the more blood flow to the area the better - any means necessary, so that you don't lose length and girth! He said on days that I don't use the Tri-mix to still use the pumps. He said that under normal circumstances before the RP, you would have erections during sex but also usually nightly during dreams, etc...so you need as much stimulation as possible to make up for that.

I don't get to treat the issue daily, but I try as much as possible and am looking forward to the Tri-mix at home. My dosage needed is relatively small and the specialist thinks I may not need long-term, but at least until the nerves repair, which may be 6 mos to a year. Not all pharmacies do compound Rx's so you may have to have the compound Rx shipped to you. It is not cheap, but the per dosage cost is not bad and it beats not ever being able to have intercourse with my wife again, but she is VERY understanding!

One last thing...I don't know how or why...and it is a little personal, but I guess ALL this is...I read on one of the threads on this forum that once you use manual stimulation/pump/masturbation/oral stimulation from a partner, etc... to reach orgasm, it actually helps with incontinence...and again, not sure why or how, but I did find that to be true! I guess it is all kinda connected!

Hope all this helps...this is what I was advised and am still on the journey myself, so can only report what I know so far!

+God+bless+
 
Great feedback gentlemen. I am 56 y/o and exactly one year since my surgery. I thought I lost some girth but my spouse says it actually feels bigger when I have an erection. Manual stimulation (masturbation), daily Cialis, and physical therapy helped a lot. I’m pretty close (last 5%) to no longer being incontinent and am back to having regular sex with my spouse (with a little leakage). Good luck and keep pushing yourself. During my worst days I never thought I’d get here.
 
My doctors say “use it or lose it” also, to avoid female pelvic prolapse, where everything - all the female sex organs, the bladder, the vagina, just slips right out of the body via the vagina and hangs *outside* your body. The primary solution for this is the horrible metal mesh procedure to keep it all back in. But those meshes, no matter in men or women, give people all kinds of horrible bleeding, scarring, cancer, poking out of/through the skin, etc. Prolapse happened to two of my great aunts; I wish I had spoken with them about how they handled it but they have now passed. They, like me, had hysterectomies.

But when I try to use it or lose it, I just get severely depressed that I don’t have a partner when I had partners nonstop from age 17-39. I also get depressed that I don’t have any sex drive after my partial hysterectomy and premature menopause at age 42, so the faking it part is a very accurate description. I avoid it like the plague.

Even if there was nothing physically wrong with me and I didn’t have scars and didn’t wet the bed and had zero emotional baggage from my divorce and life experiences, nationally, divorced women over age 40 only have a 15% chance of being remarried. And we all know the more times you marry, the higher the rate of the divorce, so I don’t bother dating. BUT I DON’T WANT PROLAPSE, EITHER! And it’s really common in women, who, like me, had cancer, a hysterectomy, and premature men-o-pause like I did. For now, I just try not to think about it but one of these days I guess I should commit to at least *trying* to avoid prolapse. For the time being, I do take my transdermal estrogen patch (yet another ugly, expensive thing on my body) - mostly to reduce hot flashes. I don’t use my estrogen vaginal cream, though, because it’s messy - it’s A LOT of cream to have oozing out of you all night and day. It’s expensive, also. It definitely does bring back some sex drive but what am I going to do with it when there are no male partners for women my age (46)? And it doesn’t bring back enough sex drive to have orgasms, it just brings back enough to get turned on. So it’s all just an obnoxious conundrum. *If* I had a partner and could afford it, I would try “the V shot” that you can get a plastic or cosmetic surgeon’s office, but they cost $1,500-$4,500, have to be repeated a minimum of annually and for some women, quarterly. There is, of course, no I durance coverage for such things for women, though there are for men.

I’m proud of you guys for some of the things you’re willing to go through post-prostatectomy, just to get an erection. What a lot of work, some of which - injections - sounds excruciating.

I have always avoided vibrators because they’re machine robots, not a real man. I vowed to myself when I was young, after a friend’s mom told me she accidentally got addicted to vibrators and couldn’t have an orgasm from a man unless she also used a vibrator, that I would never let that happen to me. I wanted to stick to natural methods. Back when I could still have orgasms, I was proud that I didn’t need a machine to accomplish the act. I think vibrators are obnoxious in every regard - sound, smell, sight, sensation, expense. They make me itchy, not turned on.

So, I stagnate, I guess. Maybe I won’t live long enough to have prolapse, anyway; one never knows. Car accidents happen, COVID happens, cancer happens, etc.
 
@snow I'm not going to say anything you don't know. But I must say for myself. You are a brave strong Woman. One that has been on a journey that has not been the least bit easy. Can I say this? I'm so proud of how you have gotten through all these tough struggles. You bring alot of hope into our family here. boom
 
@Boomersway Thank you so much; what wonderful things to say. I have a lot of self-doubt so I really appreciate what you said. Happy Holidays!
 
@snow You are warmly welcome, Merry Christmas & Happy New Year my friend. we pray for better times for all of us
 
@snow, I am a happily married man, but...

Every time I see one of your posts and your picture, I think how VERY attractive you are and wonder how you are single! All the circumstances you described do complicate things, but it just takes the RIGHT man to be understanding and care for you and treat you the way you deserve to be treated.

I think you just have to put yourself out there and if things go anywhere at all, be honest and explain, but let the man decide... I know that is not easy, as there is a lot of emotional risk involved, but I know they are OUT THERE!!! There are men who have been through similar things that would understand and even some that haven't that I think would. I just don't think you should shut down all men because some or the majority of men might not. Just my 2 cents...

I think from previous posts, you are not very religious (?) but, if you were or open to it, I would suggest getting involved in your/a church - certain groups/organizations inside the church as #1 a way to help others that need it and #2, to meet people. ...just a thought.

Anyhow, I always say, "Keep HOPE ALIVE"!!! As Boomersway said, you are a very brave, strong and attractive woman - don't give up hope and don't give up on all men, just because of some of us!!!

Merry Christmas, Happy New Year and +God+bless+
(sorry if that offends you, but I do pray for all here and anyone who needs God in a special way!!!)
 
@iuwogeo Thank you so much for your kind words. Maybe I’m the one - not men in general - who has to feel better about revealing my bedwetting diapers before I get into a serious relationship. I’ve dated eight men in the past six years - briefly - because I don’t want to tell them about my diapers. If we’ve slept together, I just make sure I stay awake all night, which isn’t fun, so I just give up. I should work on that in therapy - learning how to relax enough to tell a man about diapers and disabilities. I have no problem talking with my friends and family about my diapers.

Once I turned 40, my rate of being asked out tanked; I find that biologically fascinating. I also used to get approached far more often in the 18 years I lived in LA than I do in Salt Lake now. Part of that is most people here are married, and most are Mormon, so even if they are divorced or single, they date through their prolific church activities, rather than risk being with a non-Mormon. I don’t blame them for preferring one of their own; that’s fair. I think I’d have better luck if I was in a bigger city with more singles and greater socioeconomic diversity.

Curiously, everyone who has hit on me since my divorce has been quite a bit younger than me, like 5-20 years younger. I have dated some briefly, but I also feel shy because I’m divorced.

When I met my husband, I immediately realized the intensity and profound nature of our attraction. It still amazes me, even though in the end, we couldn’t make it last. Now when I date, I don’t feel anything like that magnetism, so I just want to pass on them until I find a similar spark again. But practice dates until then are a good idea. I miss sophisticated, intelligent men that I found in the big cities I lived in. Also, I’m not sure I’d even be looking for a marriage anyway, though that would certainly be lovely to have again with a better-suited man this time. In short, yes, you’re correct, I should give dating a go again soon. I have so much love to share. I’m a loyal and generous partner.

Even if I don’t necessarily miss sex, I ***absolutely*** miss cuddling, hugging, kissing, and holding hands. I’m a very affectionate, physically warm person. There is an acronym for people who are asexual whether by choice or disability; they’re called ACES. There is at least one dating website just for ACES that I’ve promised myself I’ll try once I finish unpacking the condo I just moved into seven weeks ago. It’s been challenging to unpack solo with my bad knees and back and gobs of mandatory overtime for work, but I’m getting there.

Maybe with the right man, I wouldn’t feel asexual, either, so maybe I’m not necessarily an ACE.

Great idea about doing group things. I volunteer every couple of weeks with Ballet West, producing VIP events. I volunteer every few months with the Olympic venues here, because they still hold World Cup events throughout the year. I also volunteer with The Sierra Club and a couple of other wilderness-protecting groups, intermittently - a few times a year. Until last year, I regularly skied and snowboarded via a season pass at Snowbird, where I also had a locker in the locker room - which is a *scene.* I made a couple of friends there, lots of acquaintances, but by and large I’ve had a really hard time making friends here, too, which is very unlike me. Snowbird was a community I definitely appreciated but is gone from my life thanks to disability.

With my lack of confidence over the past seven years of medical problems, former unemployment, and divorce, I haven’t been my most confident self, either, which reportedly repels new people.

One thing I haven’t tried hard enough at yet is MeetUp. I’ve also been thinking that I ought to expand to some different volunteer groups because I know most of the people where I already volunteer.

It’s pretty likely I’ll return to LA after I get my knees fixed here in SLC, where I’ll have my mom’s assistance. I realllllllllly miss working in Hollywood rather than remotely. I miss my friends, who are really family, there. The only thing I don’t miss about LA is it’s lack of snow and that my mom lives here, not there. But by far, it’s my favorite place on the planet. It’s the global headquarters of my hard-won career.

In summation, me and dating = a work in progress, lots of which is possibly just in my head. I do feel my heart expanding again lately, so hopefully within a year I’ll actively try dating again, via a dating app(s). I used to have good luck with those, though I haven’t used one in 13 years.

I appreciate your concern and vote of confidence. I’m the kind of person who truly values a compliment, so I thank you for a kind gift this time of year.

Merry Christmas to you and may your prayers fill you with warmth and peace. Thanks for thinking of all of us here :) 🤗 Also, Happy Solsticemas today (still 12/21 here)!
 
@snow, put yourself out there and KEEP HOPE ALIVE!!!

The first step is definitely getting out of your own way! LOL!!!

=)
 
My penis is definitely shorter than before my prostatectomy. My surgeon acknowledged the possibility and explained how he would try to bring the bladder to the urethra rather than vice versa. He has prescribed sildenafil and recommended I use a VED (after 6 weeks of healing first) to promote blood flow to the penis. And yes, the cancer is gone so I have to put everything in perspective. The nuisance is that my penis no longer hangs beyond my scrotum, so urine hits my scrotum unless I physically hold myself away from it. That's fine when standing but not so, when sitting. And while I deal with incontinence all dribbles run down the scrotal skin too. This irritates that skin so I have taken to using Desitin to help. Anyone else have this issue? What do you do that works?
 
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