Penile length after RALP and rehab: a small, single-center case series

Over the years a number of studies have documented a reduction in penile size after open radical retropubic prostatectomy. A newly published study reports on the impact of robot-assisted laparoscopic radical prostatectomy (RALP) and penile rehabilitation on penile size.

The authors’ institution had participated in a randomized, open-label, multi-center trial of two types of treatment intended to preserve erectile function in men who claimed to have normal erectile function before having bilateral nerve-sparing surgery for treatment of localized prostate cancer. The two types of treatment were intraurethral injections of alprostadil (125 to 250 μg daily) or oral sildenafil citrate (50 mg daily) for 9 months after surgery.

Engel et al. have reported on changes in measured stretched penile length (SPL) in a subset of 127 men treated at their institution who underwent RALP by a single surgeon. (Change in measured SPL was a secondary endpoint of the original trial.) SPL was measured in a consistent manner before surgery and at 1, 3, 6, 9, 10, and 11 months post-surgery. Their results were as follows:

  • 94/127 patients completed the 11-month follow-up.
  • The mean patient age was 56.5 years.
  • Baseline mean SPL prior to surgery was 11.77 cm or 4.61 inches
  • At 1 month post-surgery, mean SPL had decreased to 11.13 cm or 4.38 inches (P < 0.0001).
  • A trend toward recovery of SPL was seen at 3 and 6 months.
  • Mean SPL was not significantly different from baseline at 9, 10, and 11 months.

It would be very unwise to extrapolate these data to suggest that there is no significant penile shortening after RALP. What we have here are data from a case series from a single surgeon at a single institution. On the other hard, these data do appear to show that men who carry out one of two forms of penile rehabilitative care after RALP can recover their normal penile length post-surgery at the hands of a skilled surgeon — despite a small initial loss of penile length immediately following surgery.

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