FrankTalk.org

. . . after a prostatectomy.

This has been discussed on other threads, and has interested me because I have it too. When soft, at times it looks like I was never circumcised. It doesn't hurt or anything but I can feel it and it's annoying.

Someone else here said that maybe it's because of the shortened urethra after gland removal and re-attachment of the urethra to the bladder, stretching it. That sounded pretty logical to me, but apparently that is not the main reason. I googled around, ending up here: http://myprostatedoc.blogspot.com/2011/ ... ctomy.html

A few excerpts:

Many theories have been advanced, speculating about the root cause of shortening of the penis. One such theory that has been debunked (for the most part) is that of tension from the urethra. It was thought that because the prostate is removed, tension is created in bringing together the bladder and urethra. As a result, the urethra is pulled up towards the bladder, simultaneously pulling the penis into the body and shortening it. This theory does not make much anatomic sense as the urethra is tethered to the part of the pelvic muscles called the urogenital diaphragm. As a result, the urethra cannot really get pulled much in either direction, limiting its ability to shorten the penis.

Short-term problems are discussed also, but as for long-term problems:

Long term shortening, in contrast, is caused by progressive, irreversible changes to the structure of the penis. These changes are brought about through two mechanisms:

1) Permanent nerve damage experienced during surgery: When nerve damage occurs anywhere in the body, the tissues to which the damaged nerves supply impulses usually experience atrophy or breakdown. This can often be seen in paraplegic, wheelchair bound people in whom the loss of nerve signal causes a significant decrease in the size and muscle mass of the legs. The same can be said of the penis after nerve damage during prostatectomy. If permanent nerve damage occurs, the lack of impulses to smooth muscle of the penis leads to an atrophy or breakdown of the tissues responsible for erections and causes the penis to shrink both in length and girth.

There is plenty of other good info there also. Unfortunately, I don't think any of it will do me any good at this late date.

Because everything (especially concerning medicine) is shades of gray, I got a slightly different opinion from my uro. I saw him Friday; PSA still zero at +1 year from surgery -- so that was good news. Instead of every 3 months, I don't have to go back for 6 months.

I asked him about the loss of dick meat and asked was it nerve damage? (as the article above suggests). I have one nerve bundle gone anyway. He said yes, but also because the urethra was pulled up to compensate for the loss of the prostate -- as others here have mentioned. So apparently, it is a combination of both, according to my uro who is the head of urology at a major hospital.

I also asked if it will correct itself, and of course, no guarantees, but it should get better to some degree especially if using pump. The last month or so I have been pumping more and the "turtle effect" does seem to be a lot less than it was.

On injecting: I asked about scarring or damaging the old boy, and he said it was not that common. He suggested I inject twice a week for therapeutic reasons if nothing else.

This is frequently called "turtling." Some guys are really bothered by it, and other guys don't really care -- being cancer-free and also able to have erections is what's important. But this is totally a person thing.

Actually, the pulling of the urethra is a myth...even among doctors. First of all, most uros insist there is no loss of penile size. They insist on discussing patients' complaint of "perceived loss of penile size" and how to dissuade patients that it is not true.
I have sat at sessions at the American Urological Association Annual meetings...and it's all I can do to not scream at them. They nearly unanimously agree to present a united front to patients that this is a myth. Some of them even insist it's because the last time men measured their penis they were teenagers and now that they are old men, their penis is shortened by age. (But let's not discuss how or why a penis shortens with age! Hint: It's the same mechanism that shortens it after surgery!)
A large part of the attraction of the 'tugging of the shortened urethera' idea, is that it means doctors get to avoid much harder conversations. Hell hath no fury like a woman scorned? Hell hath no fury like a man robbed of penile size. So, it's much easier to patronize the patient that it is all in his head, his penis is still all there, don't worry, you're being silly.
So, if your doctor tells you your penis has not lost any mass (even if you KNOW it has) he is either lying to you, or he is simply ignorant. It does not necessarily mean he is a bad surgeon, doctor or person. But urologists are surgeons. They simply do NOT want to get involved in sexual medicine. They do not want to discuss it. And they only want your adulation that you are alive and kicking...and not angry about loss of penile size. Their life is so much easier if they can make you believe it.
Paul

Paul: Wow, interesting post, thanks.

Do you know what percentage of men lose some length after an RP? The majority?

Andy425 wrote:Paul: Wow, interesting post, thanks.

Do you know what percentage of men lose some length after an RP? The majority?

Those are good questions; to which I would add how much length is lost?

I'm of the opinion that if you have an enlarged prostrate when removed ... you will lose length. My prostrate was 105 mm (4.1") ... so once removed and they stitch the urethra back you can imagine what I looked like once I got home. Yikes! ... the Turtle effect.

I was able to regain that loss (2") with daily VED for 6 months ... before I saw any results.