Urology Community
19.4k Members
Avatar universal

Penile Shortening After Urethroplasty?

Greetings All,

It's three weeks after my excision primary anastomosis urethroplasty to correct a stricture in the bulbar urethra. I'm unsure of the stricture's exact length -- when I phoned to ask, I was told it wasn't included in the surgical notes -- but it was estimated 1.5-2.0 cm.

The reason I'm writing is that I've noticed a pronounced penile shortening, or rather a reduced erectile length, and am wondering about others' experiences. Has anyone else had this? Or, was your erectile length always the same? I'd say my erectile length is only at best about 50-60% of what it was before surgery. I'm hoping others have seen this and that the issue resolved fully in time.

When I asked one of my doctors about this over the phone, he reminded me that he warned of possible erectile dysfunction for up to six months after surgery. ED to me means difficulty attaining or maintaining an erection, not penile shortening (!), but I guess that's beside the point. The doctor added that the catheter prevents full erection, which I can accept, but the catheter is out now and I see no improvement. He assured me that I should return to normal in time and emphasized that I'm not achieving a full erection because that my penis underwent significant trauma.

The doctor also said that he's never seen erectile shortening with the type of surgery and stricture length I had, but I'm seeing medical surveys online showing 22-25% incidence of penile shortening after the same operation and stricture size. I don't doubt my physicians, but am just struggling to reconcile apparently conflicting information.

I specifically asked my doctors before the surgery multiple times about possible complications and cosmetic outcomes and never once was possible penile shortening mentioned. Stroke, heart attack and death were mentioned as risks during surgery and failure, recurrence, and ED were mentioned as possible side effects of the procedure. Also, scars at the incision site, of course.

I plan to ask my doctors again at a follow-up if the condition doesn't improve, but in the meantime, I would really appreciate any insight others can share.

Erectile length probably shouldn't matter if the surgery is otherwise successful, but I would've preferred at the very least a warning about the risk of shortening -- even if temporary -- so I could've at least psychologically prepared for the possibility or perhaps opted for another treatment.

I'm really hoping someone out there can confirm this reduced erection length is normal and temporary.

As a 32-year old single guy who wasn't overly thrilled with my length before, cutting it in half is not an idea I relish, to say the least. :/ Hope you can understand.

Thanks very much for reading and especially for sharing any insights. I searched the boards to see if this has been discussed before and didn't turn up anything, sorry if I just missed it.
54 Responses
Avatar universal
Hey! Thank you for replying to my post! Very helpful information. As you stated, day-by-day my symptoms are improving aswell. My erections are still painful, more in the urethra area than anywhere else. My testicule pain is slighty weird, it improves, then comes back worse. Hopefully it heals up soon.
And for your question; my erections are only about 60-70% of what they were before surgery, i sometimes am able to flex the slightest bit now, but hardly at all. It's as if it doesnt have it in it anymore. I too am a bit worried about this one, i mean im only 18 years old! Wish my doctor had warned me about this. I wasnt to thrilled with my size before either. Now im almost embarressed! I go back for a checkup in 1 1/2 months. i will ask him about this then, and keep you posted if the asnwer is any different than what you had been told. On the bright side, the flow is stronger than ever! Hope you have a speedy and full recovery too!
Avatar universal
It will take time to recover from the surgery 6 months to a year in most cases.  Usually the shortening of the penis is not temporary.  With that said, please keep in mind that a vagina has no depth perception.  Don't be afraid to ask your doctor for a drug to treat your temporay ED.  In the future be vigilant about questioning your surgical proceedures and do the research.  
Avatar universal
Thank you for taking the time to post a comment. While I appreciate the sentiment, a vagina is not part of the issue, just a mistaken assumption of yours. As I wrote originally and we agree, penile length shouldn't matter (as long as biological/sexual functioning is otherwise unimpaired). However, I think it's safe to say that no male would be happy with shortening his penis -- temporary or not -- especially as a surprise. Or, to make it more general, if anyone woke up one morning with a suddenly smaller limb or appendage of any kind without warning, I think they'd be concerned and concern would be a normal reaction. That was one of my points, and I think it stands.

Bearing that in mind, my goals here are to:
-- share my experience with urethroplasty
-- learn from others' direct experience with urethroplasty
-- highlight for patients the possibility of penile shortening as a result of urethroplasty
-- encourage patients and physicians to discuss the possibility of penile shortening, in addition to other possible complications, of urethroplasty so patients can be better informed and prepared

Ideally, doctors should provide patients a comprehensive printed list of common, occasional, and rare side effects/complications specific to the procedure. The list should be compiled by a third-party accredited professional association. Physicians should discuss the list with patients and patients should check off each side effect once it's been addressed to patient satisfaction. The patient should then sign the list and both parties should keep a copy for their records.

You suggest that I ask for drugs to treat ED. But, I've had no trouble in developing or maintaining erections. Rather, my penis is shorter. My doctor implied ED may be to blame. I accept that possibility and I'll happily seek ED treatment, if ED is truly the cause. On the other hand, penile shortening -- entirely separate from ED -- is a possible complication of urethroplasty, so I'm trying to learn others' first-and experience, while sharing my own.

When you wrote: "In the future be vigilant about questioning your surgical proceedures and do the research," it's good advice (could be phrased, spelled, and punctuated better), but it fails to recognize two things: that I did so in this case and that patient education is also the responsibility of health professionals. You must have missed the relevant paragraph in my original post. To elaborate further, I asked my doctor the following questions, among others, and took notes at every meeting:

"What are the possible side effects or complications?"
"What are the possible negative outcomes?"
"What are the possible cosmetic effects?"

In his answers, the doctor did not mention penile shortening. I researched complications in online and print resources before the procedure, and penile shortening did not come up. I think I did my due diligence, but I'm not a medical professional. Since I'm not a urologist or a genitourinary surgeon, it was impossible for me "to know what I don't know" in this case and that's why I supplemented my research by asking questions and relying on my physician to impart information on possible complications to me as a patient.

My post and questions here on MedHelp were directed more toward other urethroplasty patients to promote an exchange of experiences on possible penile shortening in an encouraging and supportive way. It can be easy to dismiss or minimize someone else's worries, especially if you haven't been through the same thing. A little more context about you -- for example, are you a physician, patient, etc -- and your sources of information would have been helpful.
Avatar universal
Hey Lothson, i had a severe motorcycle crash more than three years ago with several fractures in legs, knee, pelvis... Because i fractured my pelvis my membranous urethra was completely torn off. In the beginning after urethroplasty i had ED and had to take drugs, i also noticed a penile shortening. After time spontaneous erectile function came back, but the glans always stays cold and is not swollen during erections only if i push the penis downwards and it's hard to say but penile shortening got worse. I lost 1-1,5 inch depending on the time relayed excitement. I know this posts dates from a few months ago but i am glad i found some people to share this with. I am from Belgium and here in our proper language you can not found anything about it (penile shortening and stuff) and it is hard to try to explain it to someone who is not really affected or confronted with it. So i Hope you will still read this and to hear how everything is going for the moment.
Avatar universal
I had a anastomic urethroplasty for 2.5 cm stricture. Now , 24 days after the surgery and the penis is SHORTER. This question for people who did the surgery more than 3 months or so , Is that temporarily   ?
I am 30 years old.
Please let me know
Avatar universal
Hey Haya, thanks very much for posting. First and foremost, I'm really sorry to hear about your accident! I hope that with time, function can continue to improve for you. I wish you only the best. It's been about 8 months since my surgery. I'd estimate that I've also lost about 1-1.5 inches and it looks like it will stay that way. On another issue, the force of my ejaculation is completely gone, it just leaks out slowly. I wonder what others' experiences are with this? This is another thing my doctors did not warn me about. I asked at my 6-month follow-up appointment and the surgeon said that it's likely because a muscle involved in ejaculation was cut during the operation and that normal function probably will not return if it hasn't by now. The doctor did mention that some patients' ejaculatory function improves after the surgery, while others' is reduced like mine. I suppose it shouldn't matter, but ejaculation just doesn't feel the same or as enjoyable as before. Otherwise, the surgery seems to have succeeded, so I am grateful. I'm still a little sore and I have sharp, shooting pains as well as dull aches that come and go, but overall the discomfort seems to be lessening with time. Thanks again for commenting and please don't hesitate with any questions or if you just want to commiserate -- everything is easier in company and when you share, right.      
Avatar universal
Hey Immortal. It's been about 8 months since my surgery. Soon after the procedure, I could see and feel that my penis was shorter when I have an erection, I'd estimate by about 1-1.5 inches. I was hoping that with time, things would improve, and that I simply wasn't achieving a full erection, but so far everything is the same, unfortunately. The shortening doesn't seem to be temporary, at least not in my case. I plan to give it a few more months, until it's been a year or more for full healing, then maybe ask the doctor about medication for erectile dysfunction as a last ditch effort to see if that will help with the erectile length. Though, to be honest, I'm not too optimistic and don't want to get my hopes up (no pun intended). Over time, I'm getting used to it -- what else can we do? As long as everything works more or less, it's better than nothing. I will keep my fingers crossed for you and I wish you a full and speedy recovery.  Try not to worry too much and take it easy.    
What else can we do?  How about sue their ***?  They have ffed with our manhood!
Avatar universal
Sharing my experience in hopes it helps somebody. I was in an accident and had injuries like Haya. I'm 5 months post op and continue to have some shortening/new downward curvature, less firm glans and ejaculation weirdness. The doc tells me the u-plasty scar interrupts the blood flow through the corpus spongeosum. There's no artery or veins in the area, so no flow means the glans is soft and the urethra is too easy to cut off (so whatever stimulates you to ejaculate stops the flow of ejaculate).
Avatar universal
Thank you very much for taking the time to reply. You will never know how I appreciate it
I have another quick question that I really need help with, which is the first time you had sex after the surgery.
The emotion around this is very intense and I want to prepare myself for that (for myself and for my partner).
When was the first time having sex after the surgery , 4 weeks after , 6 weeks after .... , was there blood .... you know .....
Avatar universal
just for all of us to be hopeful:

Avatar universal
Hey Immortal! Good question about the first time I had sex after surgery. I definitely share your emotions and concern. So, about 6 weeks after the operation I resumed sexual activity, per my doctors permission. For me -- since I was single at the time -- this meant masturbating. Very gently. Very. Gently. During, I had no pain whatsoever, but afterward, there was some discomfort -- basically, an internal soreness in my penis or urethra -- and this continues to be my experience with sexual activity, but over time the post-ejaculation discomfort is mostly diminishing. There was absolutely no blood whatsoever at any point and I don't think there should be. If I remember correctly, I read on another community of one fellow's experience masturbating about two weeks after surgery and there was blood in his ejaculate, but this was too soon after the operation and he still had the catheter (!). In the end, I think he reported that he was ok. If you're doing something that is causing you pain or bleeding, stop and check with a medical professional. Take it easy and go slow. Ask your partner to be *extra* gentle and mindful of your surgery and of the fact that you're still healing, for up to a year. Do not apply pressure to the surgical site, the perineum. You may want to engage in positions that allow you to control the action so that you can avoid unexpected movement that could cause pain or injury and so that you can stop if need be. I recently started dating for the first time after surgery and had my first post-operation sex: I had no pain at the time, but afterward, there was some discomfort, more than with masturbation, but it subsided after a day or two. My partner was a little rougher than I would have liked, even though I asked for gentle treatment and talked about my surgery. I think people can get carried away in sex. Ordinarily, this can be a good thing, right? ;) In our case, though, don't be shy about reminding your partner to be careful and gentle and stop if you experience pain! Your healing and health are the most important things. To manage expectations, warn your partner ahead of time about the possibility of pausing or stopping; this was beneficial for me and my partner and we did pause and change positions a couple of times due to my condition. I hope this helps and I wish you a full recovery. Good luck and I hope enjoy the sex! Thanks for the link about length possibly returning -- this does give us all reason to be hopeful!
Avatar universal
Thank you for being so informative , you described exactly what I have been through so far...
Stay healthy
Avatar universal
Thanks for posting a comment, alzak, I'm really glad to know you found it informative. I hope you're healing well and I wish you full recovery. Happy holidays!
Avatar universal
Hey JohnnysQ, sorry to hear about your accident, surgery, and not-so-fun side effects. I hope they're getting better. Thank you for sharing, I know it's helpful for me to hear others' experiences, and I'm sure I'm not the only one. Wishing you a complete recovery and happy holidays!
Avatar universal
I have had a similar experience. I am 60 years old, and my wife and I agree that I have lost about 2 inches of length! That is substantial, and it is making sex difficult. A certain amount of length is necessary to fully penetrate the vagina and be able to move back and forth without coming out. It is still fairly soon after the surgery (6 weeks), so maybe this will improve, but it sounds like most people are not experiencing any improvement. Additionally, my "erect" penis does not point up, but out, so it is very uncomfortable when pressing against sheets, pajamas, or clothing.

And, like you, I was not told that this was a possible complications, though I asked.
Avatar universal
I have had a similar experience. I am 60 years old, and my wife and I agree that I have lost about 2 inches of length! That is substantial, and it is making sex difficult. A certain amount of length is necessary to fully penetrate the vagina and be able to move back and forth without coming out. It is still fairly soon after the surgery (6 weeks), so maybe this will improve, but it sounds like most people are not experiencing any improvement. Additionally, my "erect" penis does not point up, but out, so it is very uncomfortable when pressing against sheets, pajamas, or clothing.

And, like you, I was not told that this was a possible complications, though I asked.
Avatar universal
Hey Brian! Oh man, I'm sorry to hear that and I do hope you see some improvement with time. I encourage you to press your doctor about this issue in your follow-ups. I can't believe that doctors are not counseling patients better about this possible complication beforehand, even when we ask, like you and I did! Thanks for sharing your experience. Maybe if other patients and doctors see these postings, patient education and expectation management can improve. Wish you an improved recovery and all the best.
Avatar universal
I HAD MY OP 2 WEEKS AGO ,the op where they take skin out your mouth, HURTS LIKE HELL WHEN HARD .POINTS OUT INSTEAD OF UP, I ALSO LOST ABOUT 2INCH   , CAN WE SUE  AS 2INCH A BIT CHUNK .  AT LEAST IT GOES UP haha!!  but very uncomfy ,hurts like hell      my surgeon did not mention shorten penis size WTF
Avatar universal
Not necessarily directed at Brian, more so everyone.  My question - is there anyone here who can report a return to pre-op penile length or the same angle - even after a year?   I had anastomosis urethroplasty to correct a stricture that was only like 1.0 cm, but I lost probably an inch in length and the angle of my erection, if lying on my back is straight up, where as prior to surgery it was more pointing at 45 degrees (more back towards my head).  It's been 14 weeks, its a better angle than it was 2 weeks after surgery, but it's still concerning.  My Doctor is a good, thorough and I had no complaints about his competency.  I saw him today, my first visit since surgery...and frankly, I think he was blindsided by these complications (the shortening and the angle) - as though it shouldn't have happened.  Even questioning him as to whether it will get better with time, it was somewhat of a guarded affirmation (he wasn't sure, but said "it should" correct over time).  

Let's all be clear...it's not right for this to happen.  If it is not called out as a possibility by the Doctors in advance of surgery, then it should not have happened.  Not that I'm going there, I like my chances for returning to normal, but I'm curious if any of you have researched a lawsuit?  
Thinking about it.
Avatar universal
Hello Guys,

I get very happy to find a community of information like yours. I am 30 years old and live in Brazil. For more than 5 years I've been suffering with my urethral stricture. I have done 6 internal urethrotomies, but none of them gave me good final effect, only relief from 6 to 10 months, nothing more than that. At the moment I know it is important to get more options to definetely solve my problem too. What I think it is strange is that here in Brazil very few doctors recommended me to have an Urethroplasty because they say I am too young for that, but in the other hand, all the post operative effects differently than you they alerted me like ED, penile reduction, etc...Now I don't know what to decide, please give me your opinions if I should proceed urethroplasty, my stricture lenght is a about 1.0 cm in membrous-bulbar transition urethra
Avatar universal
Hey, i was wondering, the urethroplasty you guys had, was it repaired with a buccal mucosal graft? and was the incision made through the perineum?
Avatar universal
Hey WONTGOUP. First and foremost, I wish you a good recovery. I hope that you're healing and the pain is diminishing day by day. Thanks for sharing your experience and the fact that your doctor -- like the rest of ours -- did not mention possible changes in penis length or angle.

I have yet to learn of a single case of a doctor in the United States warning urethroplasty patients of this possible complication ahead of time. That's very worrying. I thought that my experience was perhaps rare, that I was one of few. Sadly, the opposite seems to be true.

I'm considering ways we can help improve doctor-patient communication and education nationwide on this point and if anyone has suggestions, they are most welcome. About your question, can we sue, I'll share my thoughts below in a reply to norcali22. Thanks for posting and again, I hope you get better soon.    
Avatar universal
Hello norcali22 and thank you for considered posting. To answer your first question -- can anyone report a return to pre-op penile length or the same angle, even after a year -- it's been about 1 year 4 months since my surgery and while I believe there has been some improvement, which has been encouraging, unfortunately there has not been a return to my previous length, angle, or ejaculation.

The way you describe your doctor's reaction to your report of the complications is very similar to how my doctor responded at my first visit after surgery! He seemed a bit caught off guard or certainly not as accustomed to addressing complaints of changed penile length or angle; in my case, I also reported diminished -- rather, absent -- ejaculatory force and overall altered ejaculation, which he seemed somewhat better prepared to answer and even said that other patients had infrequently reported similar results. Unfortunately, he estimated that there would be no improvement, and after 1+ years I can confirm that there indeed has been no improvement. He did indicate that the reduced ejaculatory force "should not" impact fertility, though I did not express a particular concern about this.

To answer your other question, if any of us has researched a lawsuit: considered, yes, only in passing and only because others suggested it, but I have not researched a lawsuit. If I pursued any sort of action, it would be primarily to seek a change in standard practice to help future patients: I'd like to see the following:

Doctors should provide patients a comprehensive printed list of common, occasional, and rare side effects/complications specific to the procedure, including possible changes in penile length and angle and ejaculation (all problems I've encountered, but was never warned of, even though I asked many questions about possible outcomes ahead of time). The list should be compiled by a third-party accredited professional association. Physicians should discuss the list with patients and patients should check off each side effect once it's been addressed to patient satisfaction. The patient should then sign the list and both parties should keep a copy for their records.

I think that such a simple step would help both patients and doctors alike in many ways, including managing expectations, not to mention improve patient education and experience.

I'm no lawyer by any means, so keep that in mind, and I realize this wasn't your question, but for what my two cents are worth, I suspect that malpractice would be difficult to prove on our cases. Don't let that sway you one way or the other though; if you're interested, even just to set your mind at ease, you can consult an attorney specializing in medicine, medical malpractice, or a related field; many state bar or other associations offer a lawyer referral service and often a quick informal phone consult can be arranged for a reasonable flat fee. I think I paid $40 for 30 minutes on the phone with lawyer who specialized in real estate issues, among other areas. Also, some attorneys offer a free consultation. Here is the link to the California Bar Association lawyer referral service, if it can be of some help. I'm guessing California based on your user name ;)

Keep us posted on your recovery and what you decide! I wish you a full and quick recovery. Take care.

Avatar universal
Hello and welcome MUALFE. Sorry to hear about all the trouble you've been having with your recurrent stricture. Urethroplasty seems to be the standard of care in many similar cases here in the United States, but each patient and his best treatment is unique. I also had a number of unsuccessful cystoscopies and urethrotomies before finally being referred for a urethroplasty. Even with the negative side effects, I'm glad I underwent a urtheroplasty, but that is just my experience and I can only speak for myself. Not every doctor or surgeon is trained, experienced, or comfortable with performing every procedure; I remember that one of my urologists said that while he *could* perform the urethroplasty, it was a complex surgery and he wanted a more experienced surgeon to operate, so he referred me to another doctor in a larger city nearby. I would recommend finding surgeons who focus and specialize in genitourinary reconstructive surgery, specifically urethroplasty, and see what they have to say about your case.

I found these Brazil doctors in a cursory Internet search, maybe you could start there, but please perform your own queries. It seems like urethroplasty may not be as common or well practiced in Brazil. Perhaps that's why your doctors are reluctant to suggest or perform the surgery? I can't blame them, in that case, I wouldn't want someone inexperienced operating either. That's another question each patient should be sure to ask of surgeons: how many of these procedures have you performed? What percentage experience complications? Maybe you could consider traveling abroad, depending on your circumstances. I wish I had gone to this center in California:


Brazil Doctors:

Dr. André G. Cavalcanti


Dr. José de Ribamar Rodrigues Calixto

Dr. Gustavo Cavalcanti Wanderley

Dr. Sergio Ximenes

Have an Answer?
Top Urology Answerers
11369760 tn?1449507972
Southwest , MI
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Dr. Jose Gonzalez-Garcia provides insight to the most commonly asked question about the transfer of HIV between partners.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.
In You Can Prevent a Stroke, Dr. Joshua Yamamoto and Dr. Kristin Thomas help us understand what we can do to prevent a stroke.