Current Urology Reports

, 10:468 | Cite as

Penile shortening after radical prostatectomy and Peyronie’s surgery

  • Jonas S. Benson
  • Michael R. Abern
  • Laurence A. LevineEmail author


Penile shortening following radical prostatectomy and straightening procedures for Peyronie’s disease can be a devastating and unwelcome side effect of these operations. The majority of men undergoing radical prostatectomy for prostate cancer have a measured loss of penile length, which also can occur in men with Peyronie’s disease and may be exacerbated by surgery. Recent studies have investigated the mechanisms resulting in penile shortening, and various treatments have emerged to prevent and treat postoperative penile shortening. This article reviews the recent literature on penile length loss after radical prostatectomy and following correction of penile deformity for Peyronie’s disease.


Erectile Dysfunction Radical Prostatectomy Radical Retropubic Prostatectomy Penile Length Penile Curvature 
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References and Recommended Reading

  1. 1.
    Savoie M, Kim SS, Soloway MS: A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol 2003, 169:1462–1464.CrossRefPubMedGoogle Scholar
  2. 2.
    Munding MD, Wessells HB, Dalkin BL: Pilot study of changes in stretched penile length months after radical retropubic prostatectomy. J Urol 2001, 58:567–569.CrossRefGoogle Scholar
  3. 3.
    Goodwin B, Brassil D, McCullough A: A 12 month interim analysis of the effect of nightly alprostadil vs sildenafil on penile morphometrics after nerve sparing radical prostatectomy. Presented at the Western Section American Urology Association Conference. Scottsdale, AZ; October 27–November 1, 2007.Google Scholar
  4. 4.
    Gontero P, Galzerano M, Bartoletti R, et al.: New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function. J Urol 2007, 178:602–607.CrossRefPubMedGoogle Scholar
  5. 5.
    McCullough A: Penile change following radical prostatectomy: size, smooth muscle atrophy, and curve. Curr Urol Rep 2008, 9:492–499.CrossRefPubMedGoogle Scholar
  6. 6.
    Mulhall JP: Penile length changes after radical prostatectomy. BJU Int 2005, 96:472–474.CrossRefPubMedGoogle Scholar
  7. 7.
    Zhou S, Chen LS, Miyauchi Y, et al.: Mechanisms of cardiac nerve sprouting after myocardial infarction in dogs. Circ Res 2004, 95:76–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Moreland RB: Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res 1998, 2:113–120.CrossRefGoogle Scholar
  9. 9.
    Moreland RB, Traish A, McMillin MA, et al.: PGE1 suppresses the induction of collagen synthesis by transforming growth factor-beta 1 in human corpus cavernosum smooth muscle. J Urol 1995, 153(3 Pt 1):826–834.PubMedGoogle Scholar
  10. 10.
    Leungwattanakij S, Bivalacqua TJ, Usta MF, et al.: Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 2003, 24:239–245.PubMedGoogle Scholar
  11. 11.
    Ciancio SJ, Kim ED: Penile fibrotic changes after radical retropubic prostatectomy. BJU Int 2000, 85:101.CrossRefPubMedGoogle Scholar
  12. 12.
    McCullough AR, Lepor H: The loss of penile length and circumference in impotent men after nerve sparing radical prostatectomy. J Urol 1988, 159:S98.Google Scholar
  13. 13.
    Kovanecz I, Rambhatla A, Ferrini MG, et al.: Chronic daily tadalafil prevents the corporal fibrosis and veno-occlusive dysfunction that occurs after cavernosal nerve resection. BJU Int 2008, 101:203–210.PubMedGoogle Scholar
  14. 14.
    Kovanecz I, Rambhatla A, Ferrini M, et al.: Long-term continuous sildenafil treatment ameliorates corporal venoocclusive dysfunction (CVOD) induced by cavernosal nerve resection in rats. Int J Impot Res 2008, 20:202–212.CrossRefPubMedGoogle Scholar
  15. 15.
    Klein LT, Miller MI, Buttyan R, et al.: Apoptosis in the rat penis after penile denervation. J Urol 1997, 158:626–630.CrossRefPubMedGoogle Scholar
  16. 16.
    Tuttle JB, Steers WD, Albo M, et al.: Neural input regulates tissue NGF and growth of the adult rat urinary bladder. J Auton Nerv Syst 1994, 49:147–158.CrossRefPubMedGoogle Scholar
  17. 17.
    User HM, Hairston JH, Zelner DJ, et al.: Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction. J Urol 2003, 169:1175.CrossRefPubMedGoogle Scholar
  18. 18.
    Iacono F, Giannella R, Somma P, et al.: Histological alterations in cavernous tissue after radical prostatectomy. J Urol 2005, 173:1673–1676.CrossRefPubMedGoogle Scholar
  19. 19.
    Briganti A, Fabbri F, Salonia A, et al.: Preserved postoperative penile size correlates well with maintained erectile function after bilateral nerve-sparing radical retropubic prostatectomy. Eur Urol 2007, 52:702–707.CrossRefPubMedGoogle Scholar
  20. 20.
    Tal R, Teloken PE, Mulhall JP: Erectile function rehabilitation after radical prostatectomy: practice patterns among AUA members. Presented at the American Urology Association Annual Meeting. Chicago, IL; April 28, 2009.Google Scholar
  21. 21.
    Raina R, Agarwal A, Zippe CD: Management of erectile dysfunction after radical prostatectomy. Urology 2005, 66:923–929.CrossRefPubMedGoogle Scholar
  22. 22.
    Connor J, Sawczuk IS, Benson MC, et al.: Calcium channel antagonists delay regression of androgen-dependent tissues and suppress gene activity associated with cell death. Prostate 1988, 13:119–130.CrossRefPubMedGoogle Scholar
  23. 23.
    Dutta TC, Eid JF: Vacuum constriction devices for erectile dysfunction: a long-term, prospective study of patients with mild, moderate, and severe dysfunction. J Urol 1999, 54:891–893.CrossRefGoogle Scholar
  24. 24.
    Kökler TS, Pedro R, Hendlin K, et al.: A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU Int 2007, 100:858–862.CrossRefGoogle Scholar
  25. 25.
    Dalkin BL, Christopher BA: Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Int J Impot Res 2007, 19:501–504.CrossRefPubMedGoogle Scholar
  26. 26.
    Gontero P, Di Marco M, Giubilei G, et al.: Use of penile extender device in the treatment of penile curvature as a result of Peyronie’s disease. Results of a phase II prospective study. J Sex Med 2009, 6:558–566.CrossRefPubMedGoogle Scholar
  27. 27.
    Levine LA, Newell MM: FastSize medical extender for the treatment of Peyronie’s disease. Expert Rev Med Devices 2008, 5:305–310.CrossRefPubMedGoogle Scholar
  28. 28.
    Vardi Y, Levine LA, Chen J, et al.: Is there a place for conservative treatment in Peyronie’s disease? J Sex Med 2009, 6:903–909.CrossRefPubMedGoogle Scholar
  29. 29.
    Ralph D: Peyronie’s Disease: A Guide to Clinical Management, vol 12. New York: Humana Press; 2007:133–144.Google Scholar
  30. 30.
    Schneider T, Sperling H, Schenck M, et al.: Treatment of penile curvature: how to combine the advantages of simple plication and the Nesbit-procedure by superficial excision of the tunica albuginea. World J Urol 2003, 20:350–355.PubMedGoogle Scholar
  31. 31.
    Kalsi J, Minhas S, Christopher N, Ralph D: The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie’s disease. BJU Int 2005, 95:1029–1033.CrossRefPubMedGoogle Scholar
  32. 32.
    Syed AH, Abbasi Z, Hargreave TB: Nesbit procedure for disabling Peyronie’s curvature: a median follow-up of 84 months. J Urol 2003, 61:999–1003.CrossRefGoogle Scholar
  33. 33.
    Gholami SS, Lue TF: Correction of penile curvature using the 16-DOT plication technique: a review of 132 patients. J Urol 2002, 167:2066–2069.CrossRefPubMedGoogle Scholar
  34. 34.
    Levine LA: Peyronie’s Disease: A Guide to Clinical Management. New York: Humana Press; 2007:133–151.Google Scholar
  35. 35.
    Sajadi KP, Spears B, Shah SA, et al.: The Yachia corporoplasty for Peyronie’s disease: a single-institution 9 year experience. J Urol 2008, 179(Suppl):408.CrossRefGoogle Scholar
  36. 36.
    Daitch JA, Angermeier KW, Montague DK: Modified corporoplasty for penile curvature: long-term results and patient satisfaction. J Urol 1999, 162:2006–2009.CrossRefPubMedGoogle Scholar
  37. 37.
    Savoca G, Scieri F, Pietropaolo F, et al.: Straightening corporoplasty for Peyronie’s disease: a review of 218 patients with median follow-up of 89 months. Eur Urol 2004, 46:610–614; discussion 613–614.CrossRefPubMedGoogle Scholar
  38. 38.
    Hatzichristou DG, Hatzimouratidis K, Apostolidis A, et al.: Corporoplasty using tunica albuginea free grafts for penile curvature: surgical technique and long-term results. J Urol 2002, 167:1367–1370.CrossRefPubMedGoogle Scholar
  39. 39.
    Lue TF, El-Sakka AI: Venous patch graft for Peyronie’s disease. Part I: technique. J Urol 1998, 160:2047–2049.CrossRefPubMedGoogle Scholar
  40. 40.
    Adeniyi AA, Goorney SR, Pryor JP, et al.: The Lue procedure: an analysis of the outcome in Peyronie’s disease. BJU Int 2002, 89:404–408.CrossRefPubMedGoogle Scholar
  41. 41.
    Kalsi J, Minhas S, Christopher N, et al.: The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie’s disease. BJU Int 2005, 95:1029–1033.CrossRefPubMedGoogle Scholar
  42. 42.
    Knoll DL: Use of small intestinal submucosa graft for the surgical management of Peyronie’s disease. J Urol 2007, 178:2474–2478.CrossRefPubMedGoogle Scholar
  43. 43.
    Greenfield JM, Lucas S, Levine LA: Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol 2006, 175:238–241.CrossRefPubMedGoogle Scholar
  44. 44.
    Levine LA, Lenting EL: A surgical algorithm for the treatment of Peyronie’s disease. J Urol 1997, 158:2149–2152.CrossRefPubMedGoogle Scholar
  45. 45.
    Alenghat FJ, Ingber DE: Mechanotransduction: all signals point to cytoskeleton, matrix, and integrins. Sci STKE 2002, 12:PE6.Google Scholar
  46. 46.
    Hayashi K: Biomechanical studies of the remodeling of knee joint tendons and ligaments. J Biomech 1996, 29:707–716.CrossRefPubMedGoogle Scholar
  47. 47.
    Messina A, Messina J: The continuous elongation treatment by the TEC device for severe Dupuytren’s contracture of the fingers. Plast Reconstr Surg 1993, 92:84–90.CrossRefPubMedGoogle Scholar
  48. 48.
    Gontero P, Di Marco M, Giubilei G, et al.: A pilot phase-II prospective study to test the “efficacy” and tolerability of a penile-extender device in the treatment of “short penis.” BJU Int 2009, 103:793–797.CrossRefPubMedGoogle Scholar
  49. 49.
    Levine LA, Newell M, Taylor FL: Penile traction therapy for treatment of Peyronie’s disease: a single-center pilot study. J Sex Med 2008, 5:1468–1473.CrossRefPubMedGoogle Scholar
  50. 50.
    Lue TF, El-Sakka AI: Lengthening shortened penis caused by Peyronie’s disease using circular venous grafting and daily stretching with a vacuum erection device. J Urol 1999, 161:1141–1144.CrossRefPubMedGoogle Scholar
  51. 51.
    Moncada-Iribarren I, Jara J, Martinez-Salamanca JI, et al.: Managing penile shortening after Peyronie’s disease surgery. J Urol 2007, 177(Suppl 4):252.Google Scholar
  52. 52.
    Levine LA, Greenfield JM, Estrada CR: Erectile dysfunction following surgical correction of Peyronie’s disease and a pilot study of the use of sildenafil citrate rehabilitation for postoperative erectile dysfunction. J Sex Med 2005, 2:241–247.CrossRefPubMedGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Jonas S. Benson
  • Michael R. Abern
  • Laurence A. Levine
    • 1
    Email author
  1. 1.Urology Specialists, SCRush University Medical CenterChicagoUSA

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