Crooked Erections after Prostate Surgery

The American Urology Association meeting is the world’s largest urology meeting. The program is structured around the exposition of several thousand scientific presentations that are released in preliminary reports called “abstracts.”  While reviewing the 2015 abstracts, one in particular, written by Dr. John Mulhall from Memorial Sloan Kettering in New York, caught my eye. Dr. Mulhall, a leading expert on male sexual dysfunction.

He has written several books on this topic and has been a featured speaker annually at the Prostate Cancer Research Institute's ​September patient education conference.

In Dr. Mulhall's study, 276 men underwent surgery for prostate cancer. They were subsequently evaluated for the development of crooked erections (Peyronie's disease) within 3 years after undergoing the operation. The mean age of the study participants was 56.  Dr. Mulhall reported that 17.4% of the men developed a crooked erection. The abnormality developed an average of 12 months after surgery.  The development of Peyronie’s disease in these men who underwent surgery occurred three times more frequently that the lifetime risk of a man developing Peyronie’s. About 5% of men develop Peyronie’s disease in their lifetime.

As described in Wikipedia, “Peyronie’s disease is a connective tissue disorder involving the growth of fibrous plaques in the penis.

Specifically, a sheath of scar tissue forms around the corpora cavernosa (the erectile bodies of the penis). This scar tissue causes pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. Wikipedia reports that a "variety of treatments have been used, but none have been especially effective.”

In his study, Dr. Mulhall states that Peyronie’s disease being caused by prostate surgery has been previously reported in the scientific literature on one other occasion. To me this is rather shocking. How is it possible that such a frequent and devastating sexual problem could have been overlooked by the urologic medical community for so long? Nerve-sparing radical prostatectomy has been performed in several million men over the last 30 years. If two million men have had cancer surgery for prostate cancer over 300,000 have developed Peyronie’s disease as a result.

I can only think of two possible explanations for the lack of attention this devastating problem has received. One, urologists simply aren’t talking to their patients after surgery. Could it be that they have been totally unaware of the frequent occurrence of Peyronie’s? The other possibility is that the urologists are indeed aware of this devastating side effect, but have consciously decided to remain silent. This would be consistent with the failure of urologists to report another shocking side effect  of surgery that Dr. Mulhall has brought to the public’s attention—the frequent problem of ejaculating urine during orgasm.

Dr. Mulhall and a few other experts have reported this disgusting problem which apparently occurs in about 20% of the men who have prostate surgery. "Climacturia," is a term that Dr. Mulhall has coined to describe this problem.

If surgical treatment was the only way to prolong survival in men with prostate cancer, dreadful side effects like Peyronie’s disease and climacturia might be considered a necessary evil to save a man’s life. However, in this day and age, multiple other options such as radiation, seed implants, focal therapy and even simple monitoring with active surveillance, are all considered mainstream. Even so, every year over 75,000 men continue to choose to undergo radical prostatectomy.

Given the many disadvantages of surgery compared to the other options, one can’t help but wonder why surgery remains popular. The reason is actually easy to comprehend. Studies show that 80% of the time, patients simply default to their doctor’s guidance when selecting treatment: “Whatever you say doc, you are the expert.”  The problem is that in the prostate world urologists (who are surgeons) are the doctors who are first in line to advise men with newly-diagnosed prostate cancer. Is it hardly surprising then that surgery is the top recommendation being given by the urologists.

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