penis size and prostecomies

[James]

In my review of various literature on RRP and LAPRP etc I have come across several notes about penile shrinkage resulting as a known side effect of the procedure.   Can anyone here comment on that.  It is bad enough to think about having to overcome impotence - now you may have to overcome shrinage on top of that....it makes the odds of a normal life after seem smaller and smaller (no pun meant).

 

Any info that any one has on this is valued.

 

 

[Chris]

My penis was made smaller by LRP. My girlfriend will confirm this. I noticed immediately the catheter was removed. I thought (naively), that normal size would return in due time. But it hasn't.

I phoned the hospital about 2 months after surgery and complained; one of the "special nurses" attached to the surgeon who carried out the LRP, told me, "one or two other men had also complained about penis shrinkage".

Oh really? Now you tell me.

Since then, I have spoken to 3 other urologists, 2 of them prostate surgeons, and all three concur that penis shrinkage "does happen"--though they were careful to add, "But not in every patient". One of the surgeons couldn't look me in the eye when he told me, he had to look at the floor.

[imnotcrazy]

it is amazing how these so called great doctors tell you important information after the fact.
very very scary. but what they dont understand is, what you put out in this world comes back to you. just another reason why i question everything that comes out of doctors mouths .
most of their words are driven by $$$$$.
GOD BLESS US ALL!

[James]

Chris - not to get too personal - but can you comment on the extent of this. i.e. major issue - minor issue.
Not sure how to ask this one - but would like some idea of extent of "damage" that may be done in this area.

[Chris]

I knew you would ask me this question, James. Another forum member asked me the same question when we were discussing the matter a few months ago off-line.

The answer I gave him is the same I will give you: approximately 1cm. Of course, everything is relative. I have just Googled average penis size, and the answer came up 3.75 inches, or 9.5 cms. Now if your name is Ron Jeremy, then losing 1cm from the end of your boa constrictor sized penis is neither here nor there.

But let's just say your name is not Ron Jeremy, and you fall into the "average category" sized penis, then losing 1cm amounts to more than 10% .

That's a lot to lose.

[James]

Thanks for your candor and your honesty. This is a hard issue to talk about - but one that most men would want to be aware of. So - Thank you.

If Dr. Krongrad has any input into this item I would love to hear it based on his patient's expereinces in this area.

[Arnon Krongrad, MD]

There are sporadic reports of penis size reductions. There are also sporadic reports of penis size enlargements. Overall, I am aware only of anecdotal reports, not any sort of prospective study of this phenomenon. So the likelihood of reduction and/or enlargement is totally unquantified, as far as I know. Likewise, we have no information about the degree to which any such reduction and/or enlargement may be happening.

We're basically down to hints, suggestions, and the occasional story of a phenomenon that is uncharacterized.

[James]

Thank you Dr. I was just startled to see several medical write ups on this - so I thought I should pose the question..as I am sure there is not a man around that would want tot know that is it was a likely outcome.
As always - thank you for this forum and your input.

[Chris]

You must remember, James, that a radical prostatectomy is major surgery--and that includes LRP--and is almost exclusively performed on prostate cancer patients. That's because it's a radical solution, with possible and very serious side effects for the patient.

People considering a radical prostatectomy for chronic prostate pain, are in a different ballpark--both physically and pyschologically. For a start, they don't need the surgery; they're not going to die if they choose not to undergo surgery. Where as a cancer patient, probably will die. So is the cancer patient concerned that he might lose 1 or 2 cms from the size of his penis?--I doubt it. He'll be happy if he's still alive 6 months after surgery.

So the situation for c,p. sufferers is completetly different. They have choices; the cancer patient doesn't.

I'm guessing, but that's probably one of the reasons why this unpleasant and sporadic side effect from radical prostatectomies has been kept quiet. Another reason might be that the cancer patient might be reluctant to complain to the surgeon who has just saved his life, I don't know. But it's a possibility.

But with c.p. sufferers, the pyschological landscape couldn't be more different. They don't need the operation. They are paying a lot of money for an operation to alleviate pain; so they not only demand a pain-free life post LRP, they also demand their precious manhoods to be left in tact. And rightly so.

The interesting question is whether the surgeon should warn the c.p. patient pre-surgery. Because if he does, he runs the risk of "losing" the patient, and the financial consequences that entails. I know if I had of been warned, I would not have had the surgery.

[imnotcrazy]

very well said chris. again good luck.

[Arnon Krongrad, MD]

There are prostatitis patients who are absolutely miserable. Indeed, prostatitis patients tend to have worse sex lives than cancer patients in that the pain of orgasm keeps their libido quite effectively suppressed. Just yesterday I received a call from the UK, actually, from a man whose girlfriend left him on account of the effect of prostatitis on them. Prostatitis patients appear every bit as grateful for relief as any prostate cancer patient.

There is another subtle point in all this. Men with prostate cancer can often live for very long periods without any discomfort. Contrasted with this are patients with prostatitis who are barely functioning. Indeed, I am aware of men with prostatitis who talk about suicide and who have committed suicide because of the prostatitis. Thus, it is not clear that they have choices and that they do not need effective treatment. In some ways, prostate cancer patients have many more effective choices than prostatitis patients.

It may be interesting to examine the whole concept of "radical." Remember that in technical surgical jargon the word denotes the whole prostate and seminal vesicles. It's an anatomical term in this context. Its clinical implications are one night in the hospital, two Tylenols on average, and no transfusions. Is this radical in the lay sense? That's subjective.

By contrast, the word "radical" used in layman sense means extreme. Are these the same concepts when for some patients the notion of not finding an effective remedy for prostatitis is extreme? So which is radical? To spend a night in the hospital or continue living in pain? Some of the patients who found relief from radical prostatitis and radically ineffective solutions when they finally had prostatectomy would surely argue that living in pain is the radical option. It would have been nice if the operation had not been named radical prostatectomy, because the dual uses of the word "radical" often clouds the operational directions patients should consider.

Agree. Surgeons absolutely have a duty to educate their patients and help them to establish realistic expectations. This includes salutary effect and risk. For example, I tell all my patients that the risks of RP include cardiovascular complications such as clot, stroke, heart attack, adn death. They include conversion to open surgery, infection, infertility, injury to adjacent organs, impotence, incontinene, pain, scarring, bleeding, persistence and/or worsening of symptoms. It is not enough to list risks. One has to put them into perspective in the individual case. So whole everyone has infertility, almost nobody has clinically meaningful bleeding (last transfusion 10 years ago). And of course the discussion of impotence is elaborate and nuanced, mandating a review of patient factors such as age, illness, obesity, smoking ...

In this context it is very hard to know what to say about penile anatomical changes. As indicated above, they are reported in both directions, they are sporadic, and they are completely unstudied. It is not enough to throw every rumor at a patient (that's what Google does). One has to help a patient develop realistic expectations and when it comes to this phenomenon we simply do not have enough knowledge to do that.

A recommendation: Patients should not demand "a pain-free life" and "their manhoods to be left intact." This is because nobody can guarantee that this will be the outcome of a treatment, be it antibiotics or surgery or grandma's home remedy. In other words, biology is way too variable for us to know with 100% certainty that things will work out the way the patient wants, no matter how much we share the patient's ambition. Instead, patients absolutely should demand help in making informed decisions based upon knowledgeable review of known and quantifiable risks and benefits. They should also demand focused, attentive, skilled, and compassionate best efforts at the delivery of care.

[Chris]

Arnon, the reason it's called a "radical prostatectomy", is because it's life-changing surgery (in some cases, life-saving). In this context, considering the changes to a man's life afterwards; the fact that he may be incontinent, the fact that he may be impotent, the word radical is entirely correct. If your considering re-naming the procedure as "routine", then that would be highly inappropriate. So please leave your spin-doctoring skills at home.

Your description of one night in hosptital and a couple of painkillers for the patient to take home, is one which I don't identify with. But it's entirely possible you may be the best LRP surgeon in the world, so your patients are lucky to find such skillful hands. As for me, I sought out a surgeon with a big reputation in the country where I live, but unfortunately, my experience still doesn't come close with your description post surgery. Also, if you read the German's post on this site shortly after his surgery, even the untrained reader can decipher that he had a very painful experience post surgery.

When you say c.p. patients shouldn't demand a pain-free life post LRP, and they shouldn't demand that their manhoods be left in tact---why shouln't they demand these things? They are paying the surgeon a lot of money--aren't they? If the surgeon is unable to guarantee a successful outcome to an elected surgery, then maybe he or she shouldn't accept the patient in the first place. Maybe the surgeon should concentrate on less complex operations, where the outcome can be guaranteed.

Or maybe he should just hang his white coat up, and stop harming patients.

[James]

Chris,
I am of two minds here. One - I want to thank you for your valuable input and insight into a procedure that I have not had.
and Two - I am hoping to tone down the rhetoric and keep the tone more civil. We are all here to learn and have discussion - and attacking one of the only doctor's that is actually trying to help men with this condition does not help.

Again - I can not begin to relate to you given your history - I just hope we can keep the tone civil so that we can all learn something through this. Otherwise the site loses all of its value and becomes another internet site where people scream at each other...