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.

 

 

[Arnon Krongrad, MD]

What's a low blow?

[Chris]

Let's have a timeout. I'm tired. I had an unpleasant procedure at the hospital this morning.

I will answer your question tomorrow, Arnon. I won't side-step it, like you have done to mine.

Imnotcrazy: Nice to hear from you. Just wait till me and you run the world. There'll be specialist prostate clinics in every major city in the world. :)

[Arnon Krongrad, MD]

No worries, mate. Feel better.

[Jon]

Chris,
I think James is correct when he says that your (wholly justified) ire is being directed at the wrong person. Perhaps this is because Dr Krongrad is one of the few doctors who seems at all concerned about helping prostatitis patients and one of the few who listens to our concerns. Unfortunately, the doctors who couldn't care less do not make themselves available to us. I agree wholeheartedly, however, that the appalling behaviour of the medical profession in this field is a central, not a peripheral, issue.

I think I can add a new slant to this. As well as abusive doctors, I even get it from pharmacists.

Scene: a crowded local pharmacy

Pharmacist: Here are your pills. How long have you been taking these?
Me: Over a year now.
Pharmacist: A year! You should be better by now!
Me: Well, it's chronic.
Pharmacist: If there was something really wrong with you the doctor would have fixed it by now. It must all be in your head. You need to see a psychiatrist, not a urologist.
Me: Er, thanks for the advice, Mr Pharmacist who wasn't clever enough to be a proper doctor.


May I make the following 'radical' proposal?

As prostatitis sufferers are clearly demented whiners, shouldn't some measures be taken to isolate them from the rest of society? I suggest that they be obliged to wear some kind of identifying patch on their clothing. I think the star thing's already been done, so perhaps a patch in the shape of an inflamed prostate. In this way, healthy members of society can, with impunity, throw stones at us when we walk down the street.

It may also be a good idea to have such people doing some labouring work to take their self-centred minds off their spurious condition. They could even be gathered together and put in some kind of camp.

Do other forum members agree, or is it just me?

[Chris]

Nice post, Jon.

I do identify with your idea of a distinguishing sympol of some sort stamped on the forehead of c.p. sufferers. For many years, I had similar such crazy dreams. These were very vivid dreams, anchored deep in my pysche.

The dream used to start with me being escorted off a small speed boat onto a beach. The beach was on a desert island. The people escorting me had guns. Once they saw I was "safely" on the island, they returned to their boat and speeded off into the distance. After the realisation hit me that the men with guns wouldn't be returning, I began to discover my new "home", hungrily scurrying from the beach to the deep foliage in the jungle searching for food. After a while, I happened upon other Robinson Crusoe-like figures, unkept men with dirty faces, beards which touched the tall grass. They immediately surrounded me, pushing and prodding me, demanding food.

Once they realised I had no food, I began to question the men, asking them how they arrived on the island. Their stories all coincided with mine--they had been dumped on the island by men carrying guns. Suddenly, it began to dawn on me....I questioned them further, about their pasts, their medical histories....Incredibly, they all had the same story to tell. The all had chronic prostatitis, and had been dispatched to the island by their urologists from various countries around the world....

As I went from one dirty-faced man to the next, asking the name of their urologist, in some vain hope that I would find a man who had been treated by my own urologist, they would put their grubby hands into the air, and shout out the name of their physician, "Dr Christian Hansit, of the Mayo Clinic," or "Dr Adrian Smith, London Prostate Centre", or "Dr Richards, Sydney Mental Hospital," or "Dr Abdul Preesh, Karachi Medical Centre for the insane".....

It was weird. We had all been marooned, hoarded onto a desert island---like a colony of lepers. One night, after going on walkabout, I eventually discovered razor-sharp fencing on the northern perimeter of the island. The fencing was very high, similar to what you would find around a prison, with uniformed armed guards strategically positioned in look-outs about 100 yards apart. I never saw any of the faces of the guards. They were always blacked-out, hooded.

The dream always ended with me standing under the fencing, staring out at the distant land mass on the horizon. Sadly, there was never any women on the island. :(

For all you amateur pyschologists out there, the dream is very easy to interpret.

Jon, as for your comment regarding, Arnon. I have no "ire" towards him. I respect him, and I would hope he respects me, and stops trying to diminish or trivialise what I'm trying to say. I have been through a lot, and I'm still going through it; so I don't need another urologist talking down to me or "spinning" what I'm trying to say. Yesterday, I was just having a little fun with him, because of his Bible-length post which said absolutely nothing. For the record, I think Arnon is one of the finest surgeons of LRP surgery in the world, and his patients are lucky to have such God-guided hands working on them.

[Arnon Krongrad, MD]

The BBC once ran a story entitled Cancer Therapy Shortens Penises. It was based upon an article published in the Journal of Urology that concluded that in Turkish men pelvic radiation and hormone treatment was associated with penis shortening. There was so many problems with the methods used in the study -- volunteer bias, data censoring, unstandardized and potentially invalid measures -- that one had to wonder how it was ever published. Nonetheless, the BBC's regurgitation circled the globe in 30 seconds.

Among the issues related to the phenomenon that James asks about is that of measures. In other words, how do you know how long your penis really is? Even if you objectively measured it with a tape, where is its exact point of origin? In the supple, mobile skin at its base? And where in the hair is the base? And can this point be established reproducibly month to month, over time, after treatment? And where does the penis end? We pretty much know that part except this part moves depending upon the traction applied to it. And is the traction uniformly applied month to month? And by whom? How hard would it be to artificially introduce a variation of 10% month to month?

What if one does not take a tape measure? What is the measure is wholly subjective? Can one's post-cancer treatment anxious and/or depressed mind not amplify and/or simply misjudge any perceptions of "loss of manhood" and interpret them as "my penis is 10% shorter now?" Do mood and perception affect subjective reports of penis length and can these change of the months after cancer treatment?

Can anything else affect subjective measures? Yes, according to How Weight Can Affect Your Penis Size, which posits that the fatter you get the shorter your penis appears to you. So is it possible that mood and/or weight gain are partly if not wholly responsible for reports of changes of penis size in the months after pelvic surgery and/or radiation? That indeed the penis size is unchanged but that its reported change is a signal that its owner is in distress?

I have no idea what to make of sporadic reports of changes in penis size. The phenomenon remains unstudied and unvalidated. Given the many possible explanations for these reports, including the subjectivity of the reports and the many variables that affect perception that are active in men with illness, it is not clear how common the phenomenon is, how much it affects the physical dimensions of the penis, and how this reconciles with reports of the penis getting larger after treatment.

[James]

Thanks Dr.

As someone whose education lies outside the surgical realm - can you explain to me how the connections are made to the bladder and urethra/penis to make up the "space" once the prostate is gone?

Is the penis "pulled" somewhat - causing the appearance of shortening?

Again - if this is a stupid question - it just goes to my ignorance of the anatomy and surgery.

But I assume the absence of the prostate has to be overcome somehow spatially.

Thanks.

[Arnon Krongrad, MD]

James, think of the bladder as a floppy jellyfish. When the prostate is removed, one is left to make up typically approximately 2 cms. The "jellyfish" flops into the space. With the abdomen then closed, the other contents and the wall itself help to keep the "jellyfish" pushed down into place as scars mature.

Please keep in mind that apart from this technical answer it is not at all clear how much, if at all, the phenomenon you ask about is real.

[James]

Thank you.
and yes - I understand the limitations of the question and its answers.

Not knowing enough about anatomy though - makes jumping to conclusions easy - thanks for taking the time to answer.

[jeffos]

http://myprostatedoc.blogspot.com/2011/06/shortening-of-penis-after...