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Public release date: 23 November 2009
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Penile length shortening after radical prostatectomy
Erectile dysfunction is the most commonly recognized side effect of radical prostatectomy (RP) for prostate cancer (CaP).
However, post-surgery penile length shortening (PLS) is known to occur in up to three-fourths of men. The impact of PLS
has not previously been assessed.
The mechanism causing PLS is not known, but may be related to anatomic changes or fibrosis and scaring in the retropubic
space. Studies suggest that men are more concerned with penile length than women, and that men desiring penile lengthening
actually have normal penile length. The goal of this study that appears in the European Journal of Oncology Nursing was
to determine patients’ perceptions and responses to PLS after RP.
Six participants were recruited by open invitation from a CaP support group. The main criterion for inclusion was
perception of PLS at least one year after undergoing
prostate cancer surgery.
Five of the six men were married. Most were of Caucasian
descent and had completed secondary education. None of the men reported to be able to achieve adequate erections for
penetrative sex. Participants underwent one-on-one semi-structured interviews and a second interview with the principal
investigator to confirm findings. Interview analysis followed a substantive theory, within the grounded theory method.
In this process, data collection, coding and analysis occur simultaneously and coding and analysis continue after the
interview.
The central theme to emerge from the study was “resignation”, a conveyed awareness of their inability to return to a
pre-cancerous lifestyle. Men adapted to the changes of having CaP. All participants focused on the bigger picture and
this allowed them to coexist with a diagnosis of CaP. To focus on the bigger picture, they took into consideration
past experiences, current state of affairs and hypothesized how potential outcomes would impact upon them. Family
relations were prioritized, especially spousal communication. In addition, three sub-themes were identified;
unaltered masculinity, the unimportance of PLS and erectile dysfunction as a speed bump. None of the men perceived
changes in their own evaluation of masculinity after noticing penile length shortening after radical prostatectomy. While men saw themselves as being unable
to perform a “masculine” role in procuring coitus, this did not mean that they saw themselves as unmanly. The men
also felt that PLS was unimportant, in part due to the fact that they all experienced erectile dysfunction. It is
unclear how PLS might impact potent men in this regard. Finally, all men identified return of erectile function as
the event that would improve satisfaction with penile function.
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