COMMENTARY

Penile Length After Prostatectomy

Do PDE5 Inhibitors Curb Penile Shortening?

Gerald Chodak, MD

Disclosures

December 17, 2013

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Hello. I am Dr. Gerald Chodak for Medscape.

Do men lose penile length after radical prostatectomy? This question was addressed in a study[1] from Memorial Sloan-Kettering Cancer Center in New York and published in BJU International.

The investigators analyzed 118 men before surgery, and again at 2 months and at 6 months after surgery. They found that the average penile length at 6 months was not significantly different compared with the length before surgery. However, whereas those men who were taking a daily phosphodiesterase type 5 (PDE5) inhibitor had no significant loss of length at 6 months, those not taking a daily PDE5 inhibitor had an average loss of 4.4 mm. Thus, it would seem that when counseling men going forward, we should strongly consider providing this information and giving them an opportunity to take the medication on a daily basis.

I have 2 problems with the study. First, a significant number of men were lost to follow-up. Although 118 patients enrolled, fewer than 55% were actually followed at 6 months. This means we cannot be sure that the data are robust, given that nearly one half the population was lost to follow-up. It would be helpful if the authors could provide additional information on those men lost to follow-up, or simply look at the men who had presurgery data and 6-month data so that we could actually see the changes that occurred.

Another piece of information that would be very helpful for counseling patients is to know the proportion of men who lost 1 mm, 2 mm, 3 mm, or more of penile length, so that we can provide a more exact explanation of what to expect and the odds of what may occur if they undergo this operation.

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