Pre-radical prostatectomy penile length returns by 4 years after surgery

Key Points

Hannover, Germany-Post-radical prostatectomy penile length appears to return to baseline values approximately 48 months postoperatively, according to a collaborative prospective study of 105 consecutive patients at institutions in Brazil and Germany.

The researchers found that stretched penile length following radical prostatectomy for prostate cancer decreased by a mean of 1 cm at 3 months and continued to shorten at 24 months (mean, 0.9 cm) and again at 36 months (mean, 0.7 cm). At this point, the process appears to reach a nadir and reverse itself so that by 48 months, stretched length had returned to within –0.1 cm of baseline (p=.465) and appeared to be fully restored (mean, +0.3 cm) at 5 years post-op (p=.346).

The key to restoration of length appears to be recovery of erectile function following surgery. Men with no erectile dysfunction, as evidenced by an Erectile Function domain score on the International Index of Erectile Function (IIEF-EF) of ≥26, exhibited less loss of length than those with erectile dysfunction (IIEF-EF score <26). Those patients with established ED prior to the operation and continuing ED following the procedure (IIEF-EF <6) showed little to no evidence of recovery of length at the 5-year follow-up. These men were also significantly shorter at baseline than the other two groups.

"There are studies of length at 1 and 2 years, but there are no studies that evaluated penile length at longer terms, at 5 years. We found that penile length returns to baseline," first author Juliana Vasconcelos, MD, a first-year resident at Hannover Medical School, Hannover, Germany, told Urology Times. Dr. Vasconcelos worked on the study with Ronaldo Damiao, MD, and researchers from Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil.

For the study, the investigators evaluated 105 consecutive men scheduled for radical retropubic nerve-sparing prostatectomy prior to the procedure and at 3, 6, 12, 48, and 60 months postoperatively.

Dr. Vasconcelos concluded her presentation at the 2011 AUA annual meeting in Washington by saying that there was some penile shortening following radical prostatectomy but that declines in length reversed around 30 months or so and by 4 years after the procedure, most of the men with either post-procedure ED or no ED had recovered their length.

"It is important to note that no patient in this study participated in rehabilitation," Dr. Vasconcelos told Urology Times. "This means that the next question is to find out what effect rehabilitation might have. Does a patient really need to wait for 5 years?"

She added that around the world, a great variety of rehabilitation programs are available to these patients and she suspected that a number of studies assessing recovery of function and length are likely under way at present.