Penile morphometric changes after radical prostatectomy: Evidence-based

Abstract

IntroductionRadical prostatectomy in all its approaches is the treatment of choice for localized prostate cancer and especially in young, sexually active patients with a desire to keep their sex life. In addition to the well-known and defined postoperative erectile dysfunction, erectile silent period causes, in many patients (9–71%), structural changes, in the penile structure, sometimes irreversible. These tissue changes, resulting in a loss of length and girth, concern patients. ObjectiveTo systematically review to date published data in the literature regarding penile changes after radical prostatectomy. Material and methodsWe performed a systematic search in: PubMed, EMBASE, Cochrane, SCOPUS, Science Citation Index period January 1990 to September 2009 for the terms “prostatectomy”, “organ size”, “fibrosis”, “sexual activity”, “erectile dysfunction”, “penile size”, “radical prostatectomy”, “prostatic neoplasms”, “body weights” and “penis measures”.Seven series of patients were selected for analysis. ResultsWe described the different measurement methods and their potential biases and differences. Also, we reviewed main physiopathogenic theories to explain this phenomenon. Finally, we detail the results of different series of patients reported. ConclusionsIt seems to be a proven fact that the penis undergoes major changes in its length and girth after radical prostatectomy. Several authors have communicated the data of their series and the different treatment options (5PDE inhibitors, vacuum devices, penile extenders, etc.). Strategies addressed to preserve and protect cavernous tissue and tunica albuginea after the procedure, as well as to increase oxygenation and allow erection to be recovered in the shortest posible time positive will impact on the quality of life of our patients.