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Surgeons seem to leave out one important thing

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Posted 6/5/2018 6:29 PM (GMT 0)
The surgeons I saw all talked a lot about ED it seems like ....but no one of the told me I would lose anywhere from 1to 2 inches length ....anyone else have this happen to them ..I think that is a big deal to a lot of people ....
Posted 6/5/2018 6:37 PM (GMT 0)
Yes Stan,

I am certain I lost some. Others claim no change. No one claims to have gained anything.🙂
I believe the official position of the surgical community is that an RP results in no change to the penis, but those who believe this probably never had an RP.
Posted 6/5/2018 8:57 PM (GMT 0)
ED issues after 6 months RP, but no noticeable loss of girth or length.
Posted 6/5/2018 9:43 PM (GMT 0)
None of the three surgeons I spoke with brought the loss of length up before I specifically asked. When, I asked the question, they admitted it could happen. One surgeon did tell me that the larger the prostate, the more chance for loss of length. Don’t know if his response was based on facts but intuitively made since to me.
Posted 6/5/2018 9:52 PM (GMT 0)
Maybe I am the only one who has noticed a gain in average size. In my case it is clearly a bit longer at rest now. And for some reason it does not shrinks so much as I remember it did sometimes before. The "only" problem is that it does not grow much either. For the time being, I can claim a cosmetic improvement and practically complete ED. I had a large prostate.
Posted 6/5/2018 10:57 PM (GMT 0)
When they remove your prostate gland, they also remove that part of your urethra that passes through the gland..Then they must bring the two ends of the urethra back together and stitch them up...That missing length has to come from somewhere....
Posted 6/6/2018 1:10 AM (GMT 0)
It has nothing to do with removal of the urethra - the heavy bladder moves down, it does not pull the penis in.

The loss of length and girth is well known, and it is scandalous that Uros don't mention it. It mostly comes from penile atrophy from the loss of blood supply and nerve innervation. Penile rehab may be able to restore some size - frequent master bation, daily use of the pump, ED meds, and trimix.
Posted 6/6/2018 3:11 AM (GMT 0)
As Allen says, the bladder drops to fill the space. And yes, unless one is on the fast recovery end of the bell curve for ED, an aggressive rehab program is the best means to stave off atrophy which is the likely true cause of shrinkage. The loss of natural nocturnal erections after surgery is a big factor in this.

When I asked my surgeon about lost length, he explained how the bladder gets pulled down to close the gap. He described the sutures he used on the urethral repair, and then mentioned using sutures to keep the bladder in the down position. It presumably helps keep some stress of the rejoined urethra during healing.

A couple years after my surgery I became well acquainted with a nurse on a DaVinci team that does mostly urology cases. Being curious, I have asked a lot of questions and learned a lot about prostatectomies, ranging from routine to considerable complications. Surgeons generally aim to treat the cancer risk first, focus next on recovering continence, and reduce risk factors for ED third. When a post surgical patient is focused on dealing with challenges on the second or third, it generally means a favorable prognosis on the cancer front.

None of this is meant to minimize the impact or struggles with ED. It is just an attempt to put shrinkage in perspective.
Posted 6/6/2018 4:09 AM (GMT 0)
It does shrink from atrophy. I went straight into penile therapy. Used a VED and started trimix at 12 weeks post RP. I also thought removing a 1 inch prostate would let my penis sink back in 1 inch. Not true. Get a picture of your anatomy if you are concerned. There are 2 muscles attached to your thighs and your pubic floor. Your penis / cavernosa muscles are anchored into these cruse muscles. Removing the prostate has no effect on these muscles. Did loose 1 inch somewhere but hoping implant will stretch it back out.
Posted 6/6/2018 4:34 AM (GMT 0)

Tall Allen said...
It has nothing to do with removal of the urethra - the heavy bladder moves down, it does not pull the penis in.

The loss of length and girth is well known, and it is scandalous that Uros don't mention it. It mostly comes from penile atrophy from the loss of blood supply and nerve innervation. Penile rehab may be able to restore some size - frequent master bation, daily use of the pump, ED meds, and trimix.

^^^^ this is me

i haven't used the various accoutrements that TA mentioned...but the meds have become mandatory for the mission. I also don't go on near as many sorties as before the surgery. I don't know why that is. But they're needed if ya wanna keep it....I believe.
Posted 6/6/2018 5:04 AM (GMT 0)
Looking at these images of the male plumbing system, it looks like the bladder is well supported and unlikely to "move down" . The penis on the other hand is virtually unsupported and could easily be pulled back a little..

/www.google.com/search?q=male+bladder,+prostate+and+penis&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjYnafJoL7bAhXJ3VMKHVd-A8AQ_AUICigB&biw=1024&bih=517
Posted 6/6/2018 12:08 PM (GMT 0)
If you cut one piece out of rope, you definitely make it a shorter.
Penis is pulled in to be able to connect two ends after cutting prostate out.
I had my surgery 19+ months ago and shortening was visible right after I woke up from anesthesia.
I did extensive penile rehabilitation and was not able to recover a bit of what was lost due to RP.
I lost 2+ inches oh length and also some girth. What is left, looks pathetically small now even with BIMIX induced erection. Big disappointment.
I exhausted all non invasive options and still nothing spontaneous, no sign of life.

MK
Posted 6/6/2018 12:11 PM (GMT 0)
Most surgeons will tell you that there is no SURGICAL reason for shortening to occur. TA is right, they pull the bladder down to make the connection. And, honestly, surgeons are mechanics at heart, and their job is to do the mechanical things--what happens next really isn't their problem. I also like the point that says their primary job, as they see it, is cancer control. Second is continence, and ED takes the back burner.

I don't think it's that they don't care about the side effects, it's that side effects are not their primary focus.

Shrinkage, curvature (peyronie's), loss of function--those are all aspects of what I see as the reality of messing around down in a very complex, very tightly constrained, very fragile part of our anatomy. And, really, whether we are getting cut, fried, or frozen, they are messing around is this really important and hard to get to place. Which, by the way, is one basic reason that suggests to me that eventually--and probably sooner than later--the standard of care for low risk PC will become AS, and the standard for intermediate risk will become some version of SBRT.
Posted 6/6/2018 12:19 PM (GMT 0)
Fairwind,
If they drop the bladder like they say, we would never recover continence back.
For condition known as bladder prolapse experienced by females after multiple births, they performed surgery called bladder suspension to rise bladder and stabilize it.
It is visible from anatomical diagrams how well bladder is fixed and supported .
MK
Posted 6/6/2018 5:27 PM (GMT 0)
Fairwind, I'm glad you don't teach anatomy. The bladder is a rubbery bag that moves as it fills. It moves down over the prostate when unfilled, and up away from the prostate when filled (which is why we guys who have had radiation need to have a full bladder during treatment). It gets heavy when filled, and it is not at all supported. It is only connected to the kidneys by two rubbery tubes (the ureters) and to the urethra (another rubbery tube) at the bladder neck.
Posted 6/6/2018 5:42 PM (GMT 0)
Not so sure ta teaches anatomy either...Not so sure atrophy is instantaneous either...I noticed a decrease also and also noticed a major dimple indentation at the base of the same length...a full erection brings it all back into perspective...so based on perspective...I suppose we can all be right...I mean...what is truth...its only recognizable from a distance...never when it is standing right in front of you...tho if choosen...even then it is realized....y'all chew on that for a bit tongue
Posted 6/6/2018 5:47 PM (GMT 0)
it only needs to be long enough to get the job done.

just say'n.
Posted 6/6/2018 6:10 PM (GMT 0)
Its called the flicker effect...use coke glasses so as not to be offended...thimk
Posted 6/6/2018 6:42 PM (GMT 0)
On average, this topic comes up here every 295 days, or nearly every 10 months:

days since last … date … thread name
… 2/1/2007 … Ahem, (shyly clears throat) mmm, What about penile shrinkage with surgery (esp. da Vinci)?
390 … 2/26/2008 … There is hope for restored penis size after surgery - two articles  
43 … 4/9/2008 … Shorten penis syndrome caused of pudendal nerve problem  
529 … 9/20/2009 … penis length after prostate removal  
2 … 9/22/2009 … penis length shortening...is it because the urethra is shortened  
152 … 2/21/2010 … Penis Length restoraton after prostectomy  
326 … 1/13/2011 … Penis length decrease after RP  
472 … 4/29/2012 … Smaller penis after prostatectomy??  
184 … 10/30/2012 … The Natural History of Penile Length After Radical Prostatectomy
66 … 1/4/2013 … Does Size Really Matter?  
337 … 12/7/2013 … Penis Size  
165 … 5/21/2014 … Penis size after prostate surgery 
196 … 12/3/2014 … Penis smaller after prostatectomy  
742 … 12/14/2016 … Just found out reduction in size  
538 … 6/5/2018 … Surgeons seem to leave out one important thing  
295.8571429
9.861904762
Posted 6/6/2018 6:55 PM (GMT 0)
Norm,
Do you have a lot of spare time on your hands? 🙂
Posted 6/6/2018 6:59 PM (GMT 0)
Easy to look up...entered "penis size" into search bar.
Posted 6/6/2018 7:06 PM (GMT 0)
It just seemed like something Spock might say. 🙂

All in good fun, no flame intended.
Posted 6/6/2018 7:09 PM (GMT 0)
I love Nimoy's Spock character. (I never really got into the movies.) So...logical, yet a human side, every now and then with some wry humor which not everyone gets (and that's fine!).

Post Edited (NKinney) : 6/6/2018 1:21:33 PM (GMT-6)

Posted 6/6/2018 8:22 PM (GMT 0)
2 points here:

1) When I got radiation, they had me empty my bladder before each treatment in order to hit the upper rear area where the gland had been where that pesky 1mm positive margin was. I had a treatment that was different from some of you guys, but that is how it was done to me.

2) My little guy often just sucks right up into my body cavity like a Sumo wrestlers' can, I have to fish for him when I gotta pee sometimes. I too think (beyond the atrophy) that cutting an inch out of the urethra then stitching it back together would tend to pull it back in.

Sometimes reality looks different than the pictures in the book. turn
Posted 6/6/2018 10:22 PM (GMT 0)
logoslidat,

I agree with you. From the day of surgery I had an indentation at the base of the penis. It looks like the penis was pulled inward into the body cavity. And I too had penis shortening right after surgery. I had nerve sparing robotic surgery, and never experience ED (or incontinence) and therefore I would assume I had very adequate blood flow into the penis (corpora cavernosa and corpora spongiosa) to negate atrophy. My urologist of course said surgery doesn't surgically shorten the penis. That might be true, but I believe other physiological factors comes into play.

Like I told the urologist, if you have two 50 foot telephone poles, and you bury one 10 foot deep, and the other 20 foot deep, they both are still 50 feet long, but you will swear one is 10 foot shorter.
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