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Maintenance of Penile Length After Robot-Assisted Laparoscopic Radical Prostatectomy
Kristofer R. Wagner*, Jason D Engel
George Washington University, Washington, DC
Introduction: Penile length may decrease after radical prostatectomy. This negative outcome may affect self-esteem, sexual function, and overall quality-of-life. Our objective was to evaluate changes in penile length after robot-assisted laparoscopic radical prostatectomy (RALP).
Methods: We prospectively enrolled patients who underwent RALP. Inclusion criteria include: age less than 70, International Index of Erectile Function > 26, sexually active, no history of penile deformity, Peyronie's disease, or penile/urethral surgery. Patients were randomized to daily alprostadil 250 mcg intraurethrally or sildenafil 50 mg orally for penile rehabilitation (PR) between months 1-9 after surgery. Stretched penile length (SPL) was measured preoperatively and 1, 2, 4, 7, 10, 11, and 12 months postoperatively. Preoperative and postoperative SPL were compared using a paired Student's T-test (two-tailed, p < 0.05).
Results: Currently 96 patients are enrolled. Mean preoperative SPL for all patients was 11.66 cm. SPL significantly decreased from baseline at 1 month postoperatively (mean change = 0.495 cm). Mean SPL did not significantly decrease from baseline at 2, 4, 7, 10, 11, and 12-month follow-up. Of 42 patients with 7-month follow-up, there appears to be similar recovery of penile length that approaches baseline in both treatment groups.
Conclusions: Penile length may decrease after RALP with a mean change of 0.5 cm at one month postoperatively, less than reported previously. After 2 months, penile length returned to baseline. This may be due to surgical technique or effects related to PR. Further study is necessary to determine mechanisms of shortening and recovery.
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