Penile shortening after radical prostatectomy and Peyronie’s surgery

Benson, Jonas S.; Abern, Michael R.; Levine, Laurence A.

doi:10.1007/s11934-009-0074-z

Cited by 18 publications

(9 citation statements)

References 53 publications

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“…This is underlined by the results of the studies mentioned above, although the precise mechanism is unknown [34–37]. With regard to sympathetic overactivity, it has been proposed that the sympathetic nerves recover faster than other nerves, thus causing chronic contractions of the cavernous smooth muscle tissue [41]. However, no studies have confirmed this hypothesis.…”

Section: Resultssupporting

confidence: 55%

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Neglected Side Effects After Radical Prostatectomy: A Systematic Review

Frey¹,

Sønksen²,

Fode³

2014

The Journal of Sexual Medicine

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Introduction A series of previously neglected sexually related side effects to radical prostatectomy (RP) has been identified over the recent years. These include orgasm-associated incontinence (OAI), urinary incontinence in relation to sexual stimulation (UISS), altered perception of orgasm, orgasm-associated pain (OAP), penile shortening (PS), and penile deformity. Aim The aim of this article is to conduct a systematic review of the literature regarding the above-mentioned side effects. Methods A predefined search strategy was applied in a thorough search of Medline, Web of science, and the online Cochrane library. The PRISMA guidelines for systematic reviews were followed, and protocol as well as search strategies was registered at http://www.crd.york.ac.uk/Prospero/ (RN: CRD42012003165). Main Outcome Measure The main outcome measure was incidence rates for the relevant side effects. Results A total of 43 articles were included. OAI and UISS are experienced by 20–93% of RP patients at least a few times after surgery. Although these issues are associated to postoperative daytime incontinence, previous transurethral resection of the prostate (TURP) is the only known predicting factor. Alterations of orgasmic function are experienced by approximately 80% after RP. Erectile dysfunction seems to play an important role in waning orgasmic function. OAP is only experienced by a subset of the patients with reported rates varying between 3% and 19%. Sparing of the tips of the seminal vesicles has been shown to double the risk of OAP. PS occurs in 15–68% of RP patients. Nerve sparing and preservation of erectile function may help preserve penile length. With regard to all side effects, studies indicate that they are reduced over time. Conclusions The sexually related side effects summarized in this review are common after RP. Meanwhile, it is difficult to predict which patients are at risk. Daytime incontinence, previous TURP, a lack of nerve sparing, and erectile dysfunction are all associated with the above-mentioned sexually related side effects.

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Section: Resultssupporting

confidence: 55%

“…The pathophysiology of PS is largely unknown, and trials in human subjects are scarce. A number of mechanisms have been proposed and count anatomic alterations, neural damage, sympathetic nervous system overactivity, and histological alterations [41].…”

Section: Resultsmentioning

confidence: 99%

Neglected Side Effects After Radical Prostatectomy: A Systematic Review

Frey¹,

Sønksen²,

Fode³

2014

The Journal of Sexual Medicine

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“…Indentation, hinging, or buckling of the erect penis when axial forces are applied, as well as shortening, should also be determined. Shortening appears to occur in 70% of patients presenting with PD, which can be less than a centimeter to as much as 10 cm [10]. Although curvature is considered the most common presenting complaint to the physician, penile shortening tends to be one of the most devastating complications to the patient.…”

Section: Clinical Diagnosismentioning

confidence: 99%

Standard Operating Procedures for Peyronie's Disease

Levine

Burnett

2013

The Journal of Sexual Medicine

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108

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Introduction Peyronie's disease (PD) refers to a penile deformity that is associated with sexual dysfunction. Aim To provide recommendations and Standard Operating Procedures (SOPs) based on best evidence for diagnosis and treatment of PD. Methods Medical literature was reviewed and combined with expert opinion of the authors. Main Outcome Measures Recommendations and SOPs based on grading of evidence–based medical literature. Results PD is a fibrotic wound-healing disorder involving the tunica albuginea of the corpora cavernosa. The resulting scar is responsible for a variety of deformities, including curvature, shortening, narrowing with hinge effect, and is frequently associated in the early phase with pain. Patients frequently experience diminished quality erections. All of these conditions can compromise sexual function for the affected male. The etiopathophysiology of PD has yet to be clarified and as a result, effective, reliable, mechanistic directed non-surgical therapy is lacking. Conclusions The management of PD consists of proper diagnosis and treatment, ranging from non-surgical to surgical interventions. The main state of treatment for PD rests at this time on surgical correction that should be based on clear indications, involve surgical consent, and follow a surgical algorithm that includes tunica plication, plaque incision/partial excision and grafting, and penile prosthesis implantation.

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“…Sexual dysfunction three years post-treatment is common across all modalities (nerve sparing RP 68%, non-nerve sparing RP 87%, external RT 68%, brachytherapy 36%, ADT 98%) [4]. Treatment-induced changes in sexual function include erectile dysfunction (ED), absent or diminished ejaculate, changed orgasmic sensation, urine loss during arousal or orgasm (climacturia), decreased libido and penile shortening [5-7]. In addition to these physical side-effects, men also report impaired body image and self-esteem [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

The struggle towards ‘the New Normal’: a qualitative insight into psychosexual adjustment to prostate cancer

2014

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BackgroundDespite the growing body of literature which highlights the potential for significant and enduring side-effects of prostate cancer treatment, there is limited research exploring the experience of living with the treatment-induced side-effects such as sexual dysfunction, and their repercussions for men and their partners. The aim of this qualitative study was to explore factors influencing psychosexual adjustment, self-perception, and unmet information and support needs of prostate cancer patients and their partners.MethodsTwenty-one men, recruited via a prostate cancer support group newsletter, participated in face-to-face semi-structured interviews, which were subjected to thematic analysis.ResultsThe qualitative analysis revealed three inter-connected main themes which contributed to men’s psychosexual adjustment: i) Psychosexual impact, ii) Communication and support, and iii) Integration process. Men reported distressing sexual and urinary difficulties, tainted self-perception and altered intimate relationships. Receiving adequate information and support, and having good communication with their doctors and partners facilitated better adjustment to prostate cancer treatment. Coming to terms with the significant impact of treatment had involved making lifestyle changes, coping with emotional struggles and striving to accept and integrate their post-treatment “new normal” self and sexual life.ConclusionsThe importance of adequate communication with health professionals and partners, especially regarding treatment effects on sexual function and rehabilitation options, was highlighted as a key factor facilitating the adjustment process. Prostate cancer patients would benefit from improved access to timely and tailored information and decision-making resources, ongoing multidisciplinary care, and support groups, as well as appropriate referrals for sexual and psychological counselling.

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Penile shortening after radical prostatectomy and Peyronie’s surgery

Cited by 18 publications

References 53 publications

Neglected Side Effects After Radical Prostatectomy: A Systematic Review

Neglected Side Effects After Radical Prostatectomy: A Systematic Review

Standard Operating Procedures for Peyronie's Disease

The struggle towards ‘the New Normal’: a qualitative insight into psychosexual adjustment to prostate cancer

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