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Falagario UG, Piramide F, Pang KH, Durukan E, Tzelves L, Ricapito A, Baekelandt L, Checcucci E, Carrion DM, Bettocchi C, Esperto F. Techniques for Penile Augmentation Surgery: A Systematic Review of Surgical Outcomes, Complications, and Quality of Life. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:758. [PMID: 38792941 PMCID: PMC11123079 DOI: 10.3390/medicina60050758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
The increase in practices related to enhancing penile size can be attributed to the belief that an improved genital appearance contributes to a man's virility, coupled with an altered self-perception of his body. It is crucial to tailor interventions to meet the genuine needs of patients by thoroughly assessing their history, psychological state, and potential surgical benefits, all while considering the associated risks of complications. This systematic review aims to summarize the available evidence on outcomes, complications, and quality of life after penile augmentation surgery, examining both minimally invasive and more radical techniques. A search of the PubMed and Scopus databases, focusing on English-language papers published in the last 15 years, was performed in December 2023. Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. The primary outcomes were changes in penile dimensions, specifically in terms of length and girth, as well as the incidence of surgical complications and the impact on quality of life. A total of 1670 articles were retrieved from the search and 46 were included for analysis. Procedures for penile length perceived enhancements include lipoplasty, skin reconstruction plasty, V-Y and Z plasty, flap reconstruction, scrotoplasty, ventral phalloplasty, and suspensory ligament release; techniques for increasing corporal penile length include penile disassembly, total phalloplasty, and sliding elongation. Finally, penile girth enhancement may be performed using soft tissue fillers, grafting procedures, biodegradable scaffolds, and Penuma®. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, the risks and complexities need to be accounted for.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden;
- Department of Urology and Kidney Transplantation, University of Foggia, 71122 Foggia, Italy;
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, 10043 Turin, Italy;
| | - Karl H. Pang
- Academic Urology Unit, University of Sheffield, Sheffield S10 2TN, UK;
| | - Emil Durukan
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, 2730 Herlev, Denmark;
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, 11527 Athens, Greece;
| | - Anna Ricapito
- Department of Urology and Kidney Transplantation, University of Foggia, 71122 Foggia, Italy;
| | - Loic Baekelandt
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Enrico Checcucci
- Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, 10060 Turin, Italy;
| | - Diego M. Carrion
- Department of Urology, Torrejon University Hospital, 28850 Madrid, Spain;
- Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Carlo Bettocchi
- Department of Urology and Kidney Transplantation, University of Foggia, 71122 Foggia, Italy;
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, 00128 Rome, Italy;
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Ramos M, Varanda Pereira A, Silva L, Inácio AR, Álvares Furtado I. Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament. Aesthetic Plast Surg 2024; 48:1635-1643. [PMID: 38286899 PMCID: PMC11058788 DOI: 10.1007/s00266-023-03837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Division of the suspensory ligament of the penis has emerged as a popular surgical approach for penile lengthening, but accurate preoperative predictions of lengthening outcomes remain elusive. This study aimed to identify readily measurable anatomical parameters associated with post-ligamentolysis penile length gain, facilitating more reliable preoperative estimations. METHODS An experimental cross-sectional study was performed on 16 adult cadavers. Data collected before dissection included: age at death, ethnicity, height, length of the penis before dissection and width of the suspensory ligament of penis. Following the complete dissection of the suspensory ligament of penis, the depth of the pubic symphysis and the penile length after the procedure were measured. The absolute and relative length differences pre- and post-ligamentolysis were calculated. Correlation coefficients were used to study relations between these variables. RESULTS Penile length increased uniformly after complete division of the suspensory ligament (average gain: 26.38 mm, SD = 14.83 mm; range 4-60 mm). Pearson correlation revealed a significant negative correlation between pre-ligamentolysis penile length and post-ligamentolysis increase (r = - 0.601; p = 0.014), suggesting greater gains in individuals with shorter pre-ligamentolysis lengths. Age, ligament width, and pubic arch depth showed no significant correlations. Ethnicity did not impact post-ligamentolysis length increase (t = - 0.135; p = 0.894). CONCLUSIONS This study highlights the potential to predict penile length gain post-ligamentolysis through measurable anatomical parameters. The ability to anticipate the outcome of this procedure could empower surgeons to provide informed counseling, potentially elevating patient satisfaction. An experimental cross-sectional study was performed to investigate the outcomes of penile lengthening surgery Penile lengthening was achieved in all subjects via complete dissection of the suspensory ligament of the penis Penile length increase may be predicted preoperatively using easily measurable anatomical parameters NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Márcio Ramos
- Lisbon Faculty of Medicine, Lisbon, Portugal.
- Local Health Unit of Santa Maria, Lisbon, Portugal.
| | | | | | - Ana Rita Inácio
- Lisbon Faculty of Medicine, Lisbon, Portugal
- National Institute of Legal Medicine and Forensic Sciences, Lisbon, Portugal
| | - Ivo Álvares Furtado
- Lisbon Faculty of Medicine, Lisbon, Portugal
- Department of Medicine (Anatomy), Faculty of Life Sciences, University of Madeira, Funchal, Portugal
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Danino MA, Benkahdra M, El Khatib A, Yafi N, Trouilloud P, Danino RP, Laurent R. Anatomical Study of the Penile Suspensory System: A Surgical Application to Micropenis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4728. [PMID: 36699228 PMCID: PMC9831181 DOI: 10.1097/gox.0000000000004728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/14/2022] [Indexed: 06/17/2023]
Abstract
Penile enlargement surgery is the second most desired cosmetic procedure in men worldwide. The mainstay of penile lengthening procedures is a partial release of the penile suspensory ligament system. Concerns regarding erect penis stability after this procedure have been raised by the surgical community. This study describes the anatomical features of the penile suspensory ligament system and explores the stability mechanisms of the penis. Methods This study is subdivided in two parts: an anatomical analysis and a clinical analysis. The anatomical part consists of a dissection of eight male cadavers to describe the anatomy and test the stability after sectioning successively the suspensory ligaments. The clinical part consists of an analysis of 30 patients with micropenis operated on for penile lengthening by a penile suspensory ligament release and lipofilling. Results The suspensory apparatus consists of four distinct ligamentous structures: fundiform, suspensory, dense vertical, and arcuate ligaments. These different structures are lax superficially but become firm and tense posteriorly. The section of the fundiform and suspensory ligaments did not destabilize the penis. Conclusion Penile lengthening by way of cautious suspensory ligament release can be performed without erection instability.
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Affiliation(s)
| | - Mehdi Benkahdra
- Faculté de Médecine, Laboratoire d’Anatomie 7, Dijon, France
| | - Arij El Khatib
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Nazhat Yafi
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Ruben Pierre Danino
- BSc Candidate, McGill University Montreal, Department of Physiology, Montreal, Quebec, Canada
| | - Romain Laurent
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center (CHUM), Montreal, Canada
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4
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Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, Ralph D, Xin ZC, Brock G. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol 2022; 19:534-546. [PMID: 35711059 DOI: 10.1038/s41585-022-00607-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/06/2023]
Abstract
Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, Queensland, Australia.
- University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
- AndroUrology Centre and Macquarie University Hospital, Sydney, New South Wales, Australia.
- AndroUrology Centre, Sydney, New South Wales, Australia.
| | | | | | - Chris Love
- Urology South, Level 2, Holmesglen Private Hospital, Moorabbin, Victoria, Australia
| | | | - Sean Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, Korea
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Zhong Cheng Xin
- Andrology Center, Peking University First Hospital, Beijing, China
| | - Gerald Brock
- University of Western Ontario, London, Ontario, Canada
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Schifano N, Cakir OO, Castiglione F, Montorsi F, Garaffa G. Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review. Int J Impot Res 2022; 34:434-451. [PMID: 34045688 DOI: 10.1038/s41443-021-00444-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 02/04/2023]
Abstract
We aimed to provide an overview of the strategies available to manage patients concerned about their penile size and to provide useful surgical hints regarding the most common penile enlargement approaches, based on our surgical expertise in this field. A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning penile enlargement issues. The search strategy included a range of keywords; e.g. penis, penile, enlargement, augmentation, lengthening, girth. Management of penile size-related concerns represents a real challenge for the urologist, especially when dealing with patients suffering from penile dysmorphophobic disorder (PDD). A multidisciplinary preoperative assessment, including a psychiatric/psychological evaluation, may help in discerning those patients who would benefit the most from counselling/conservative management from those who would benefit from surgery instead. Conservative approaches include the use of vacuum-based and penile-stretching devices, which have shown encouraging levels of efficacy and safety. Over the last decades, different surgical strategies have been developed, aimed at either increasing flaccid penile length or improving penile girth. Penile lengthening procedures are more established, and satisfactory results can be achieved by experienced, large referrals' volume, surgeons. To date, there is lack of consensus regarding the penile girth enhancing techniques, and therefore these should be regarded as experimental. A multidisciplinary approach is necessary to identify patients with PDD, who should not be offered surgical intervention and should be referred for psychiatric/psychological counselling instead. The surgical approach should be tailored to the subject's unique anatomy and underlying conditions.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Omer Onur Cakir
- Institute of Andrology, Department of Urology, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, UCL, London, UK
| | - Fabio Castiglione
- Institute of Andrology, Department of Urology, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, UCL, London, UK
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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6
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History and future perspectives of male aesthetic genital surgery. Int J Impot Res 2022; 34:327-331. [PMID: 35538312 DOI: 10.1038/s41443-022-00580-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/08/2022]
Abstract
Since ancient times, men have tried to change the size and shape of their genitals. Bites from insects or poisonous snakes and weights were among the first methods used for this purpose. In the first half of the 1900s, the scientific push regarding male genital aesthetic surgery began. Scrotoplasty, penile suspensory ligament release, injection of hyaluronic acid as filler, use of several types of grafts, lipofilling, and liposuction are techniques currently used. The Penuma® implant has recently been described with promising results. We are living in the era of tailored surgery and regenerative medicine. Shortly the surgeons will have to know several surgical techniques and adapt them to the patient. New fillers with ideal characteristics, innovative prosthetic devices, and stem cells will probably be the protagonists of future aesthetic surgery. The main effort of the scientific community should be directed towards the design of new randomized controlled trials to increase the evidence on the efficacy and safety of the topic, with the ultimate aim of allowing clear recommendations from scientific societies.
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7
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Bettocchi C, Checchia AA, Falagario UG, Ricapito A, Busetto GM, Cormio L, Carrieri G. Male esthetic genital surgery: recommendations and gaps to be filled. Int J Impot Res 2022; 34:392-403. [PMID: 35383340 PMCID: PMC9117127 DOI: 10.1038/s41443-022-00556-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/13/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022]
Abstract
The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages. The aim of this study was to shed light on cosmetic surgery of male genitalia through minimally invasive and more radical techniques, with the purpose of laying the foundation for possible indications and recommendations for the future. A non-systematic literature review using the PubMed and Scopus databases was conducted to retrieve papers written in English on cosmetic surgery of the penis published over the past 15 years. Papers discussing cosmetic surgery in patients with concomitant pathologies associated with sexual dysfunction were excluded. The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications.
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Affiliation(s)
- Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | | | | | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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8
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Acellular Dermal Matrix Tissues in Genitourinary Reconstructive Surgery: A Review of the Literature and Case Discussions. Sex Med Rev 2021; 9:488-497. [DOI: 10.1016/j.sxmr.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
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9
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Khalil MI, Machado B, Miranda A, Eltahawy E. Penile shortening complaints in males with erectile dysfunction: a narrative review on penile lengthening procedures during penile prosthesis surgery. Transl Androl Urol 2021; 10:2658-2668. [PMID: 34295751 PMCID: PMC8261431 DOI: 10.21037/tau-21-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate 'normal' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient’s overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were “penile lengthening”, “penile enhancement”, “penile girth”, “inflatable penile prosthesis” and “glans augmentation”. Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Bruno Machado
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alexandre Miranda
- Section of Andrology & Reconstructive Urology, Department of Urology, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brazil
| | - Ehab Eltahawy
- Department of Urology, University of Michigan, Michigan, USA
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10
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Cakir OO, Pozzi E, Castiglione F, Alnajjar HM, Salonia A, Muneer A. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2021; 18:433-439. [DOI: 10.1016/j.jsxm.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
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11
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Littara A, Melone R, Morales-Medina JC, Iannitti T, Palmieri B. Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases. Sci Rep 2019; 9:6323. [PMID: 31004096 PMCID: PMC6474863 DOI: 10.1038/s41598-019-41652-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/06/2018] [Indexed: 11/15/2022] Open
Abstract
Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. In this article we report the results of a retrospective study of 355 cases of cosmetic elongation, enlargement and combined elongation and enlargement phalloplasty. We found a significant improvement in length at rest, stretched length and circumference at rest at 2, 6 and 12 months post-surgical procedure (all p < 0.0001). 5-item International Index of Erectile Function (IIEF-5) was also increased at 12 months post-surgery compared to baseline (p < 0.0001). This was consistent with an IIEF-5 improvement of 6.74% compared to baseline. This study is clinically relevant due to the large cohort of patients included and because it is the first study to use an inverse periosteal-fascial suture not described previously as part of the surgical methodology.
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Affiliation(s)
| | | | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de CP 90000, AP 62, Tlaxcala, Mexico
| | - Tommaso Iannitti
- KWS BioTest, Marine View Office Park, Portishead, BS20 7AW, United Kingdom
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
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12
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Hehemann MC, Towe M, Huynh LM, El-Khatib FM, Yafi FA. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med Rev 2019; 7:535-547. [PMID: 30612977 DOI: 10.1016/j.sxmr.2018.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder. AIM To describe the medical, procedural, and reconstructive techniques available for penile girth enhancement and to review the success and complications of each modality. METHODS A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms included penis, enhancement, enlargement, phalloplasty, reconstruction, girth, and augmentation. MAIN OUTCOME MEASURE We wanted to summarize the motivations behind penile girth enhancement and review the outcomes for girth augmentation treatments. RESULTS Various medical, traction, injection, prosthetic, and reconstructive modalities have been studied for penile girth enhancement, with increases in girth ranging from 0-4.9 cm. Complications were reported in a minority of patients, but they may be devastating and include penile fibrosis, sexual dysfunction, device infection, and death. CONCLUSION A variety of penile girth augmentation techniques have been studied. Clinical guidelines are lacking, and complications of penile girth enhancement are likely underreported. Until more rigorous investigation with accurate reporting of complications is achieved, penile girth augmentation procedures should be considered experimental. Hehemann MC, Towe M, Huynh LM, et al. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med 2019;7:535-547.
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Affiliation(s)
- Marah C Hehemann
- University of Washington, Department of Urology, Seattle, Washington, USA
| | - Maxwell Towe
- University of California Irvine, Department of Urology, Irvine, California, USA
| | - Linda My Huynh
- University of California Irvine, Department of Urology, Irvine, California, USA
| | - Farouk M El-Khatib
- University of California Irvine, Department of Urology, Irvine, California, USA
| | - Faysal A Yafi
- University of California Irvine, Department of Urology, Irvine, California, USA.
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13
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Dellis AE, Arkoumanis T, Kyprianou C, Papatsoris AG. Paraffinoma, siliconoma and Co: Disastrous consequences of failed penile augmentation-A single-centre successful surgical management of a challenging entity. Andrologia 2018; 50:e13109. [PMID: 29993129 DOI: 10.1111/and.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/03/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to present our series of patients with disastrous consequences of failed penile self-augmentation and suggested surgical reconstruction. Ten patients with median age of 23 years and a variety of penile and scrotal deformities due to injections of several substances had undergone successful surgical reconstruction of external genitalia. The injections were self-performed in nine cases and the patients reported from 4 to 20 substance injections throughout the penile shaft. Three patients presented with fibrotic scirrhous masses in their scrotum, although they did not report any injections in scrotal area. All patients underwent extended penile-shaft skin excision, while all palpable scrotal lesions were removed in one-by-one fashion, as an attempt to destroy the less possible scrotal tissue. All patients were discharged on first post-operative day and reassessed at 2 months post-operatively. As a result, penile self-augmentation with injected substances may cause severe complications. Our proposed single-staged procedure seems safe and effective.
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Affiliation(s)
- Athanasios E Dellis
- 2nd Department of Surgery, School of Medicine, Aretaieion Academic Hospital, National and Kapodistrian University of Athens, Athens, Greece.,1st Department of Urology, School of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofanis Arkoumanis
- 2nd Department of Surgery, School of Medicine, Aretaieion Academic Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christofis Kyprianou
- 2nd Department of Surgery, School of Medicine, Aretaieion Academic Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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14
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Dellis AE, Nastos K, Mastorakos D, Dellaportas D, Papatsoris A, Arkoumanis PT. Minimal surgical management of penile paraffinoma after subcutaneous penile paraffin injection. Arab J Urol 2017; 15:387-390. [PMID: 29234545 PMCID: PMC5717453 DOI: 10.1016/j.aju.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe our reconstructive technique, without flap or graft use, after penile self-augmentation with injected substances, such as paraffin, which are still performed with unfortunate consequences. Patient and methods Successful single-stage minimal surgical management of an already twice unsuccessfully managed ulcerative penile paraffinoma in a 38-year-old Greek man. Results The patient was discharged with no postoperative complications, with a five-item version of the International Index of Erectile Function score of 23/25 (i.e. normal erectile function) and flaccid penile length of 5 cm. Conclusions Penile paraffinoma is a serious complication that can be successfully managed with a single-stage minimal surgical procedure, with normal aesthetic and functional results.
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Affiliation(s)
- Athanasios E Dellis
- Second Department of Surgery, Aretaieion Academic Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,First Department of Urology, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Nastos
- Second Department of Surgery, Aretaieion Academic Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios Mastorakos
- Second Department of Surgery, Aretaieion Academic Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Dellaportas
- Second Department of Surgery, Aretaieion Academic Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Papatsoris
- Second Department of Urology, Sismanogleion General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis T Arkoumanis
- Second Department of Surgery, Aretaieion Academic Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Sarıkaya S, Ralph DJ. Mystery and realities of phalloplasty: a systematic review. Turk J Urol 2017; 43:229-236. [PMID: 28861290 DOI: 10.5152/tud.2017.14554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/03/2017] [Indexed: 12/31/2022]
Abstract
The neophallus creation is still a mystery and it remains challenging even today. In this article, we performed a comprehensive review of the literature regarding phalloplasty and penile reconstructive surgery between January 2008 and May 2016. In this review, we have included 15 research articles and the results of 276 patients were examined. Studies revealed several indications and when indications were reviewed, 191 patients were female-to-male transgender, 9 patients had disorder of sex development/micropenis, 16 had penile amputation/trauma, 9 had ambiguus genitalia, 40 had exstrophy and/or epispadias, 11 had other problems. As a result of this review, phalloplasty is a reliable and useful operation with good functional and aesthetical results.
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Affiliation(s)
- Selçuk Sarıkaya
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - David John Ralph
- St. Peter's Andrology Centre and The Institute of Urology, University College London Hospitals, London, United Kingdom
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Tran H, Goldfarb R, Ackerman A, Valenzuela RJ. Penile Lengthening, Girth, and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017; 5:403-412. [PMID: 28238678 DOI: 10.1016/j.sxmr.2016.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/30/2016] [Accepted: 11/27/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life. AIM To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion. METHODS An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed. MAIN OUTCOME MEASURES A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion. RESULTS Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles. CONCLUSION Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403-412.
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Affiliation(s)
- Henry Tran
- Department of Urology, Columbia University Medical Center, New York, NY, USA.
| | - Robert Goldfarb
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Anika Ackerman
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Robert J Valenzuela
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Augmentation Phalloplasty With Autologous Dermal Fat Graft in the Treatment of “Small Penis”. Ann Plast Surg 2016; 77 Suppl 1:S60-5. [DOI: 10.1097/sap.0000000000000782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Zhang GX, Weng M, Wang MD, Bai WJ. Autologous dermal graft combined with a modified degloving procedure for penile augmentation in young adults: a preliminary study. Andrology 2016; 4:927-31. [PMID: 27115979 DOI: 10.1111/andr.12192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/28/2016] [Accepted: 03/03/2016] [Indexed: 11/30/2022]
Abstract
In order to evaluate the effect of penile enhancement, we retrospectively reviewed the data of the patients operated with autologous dermal graft implantation combined with a modified penile degloving procedure. The patients with the complaints of small penis, asking for penile augmentation, and normal erectile function were psychologically screened and enrolled. Data of follow-up visit including patient demographics, medical history, surgical procedure, patient-reported outcomes were analysed. In all, 30 eligible persons were operated. After degloving of the penis, the suspensory ligament was incised and the tunica albuginea was fixed to the proximal tunica dartos at the penile base. Then, the dermis graft was implanted on the dorsal surface of the tunica albuginea. The file of follow-up visit was available in 17 (57%) patients. The mean age was 23.7 years (19-35 years) and the mean follow-up was 13 months (range, 4-24 months). During the follow-up period, the average gain in the penis length was 2.7 cm in flaccid and 0.8 cm in erection, respectively. And the average gain in the penis circumference was 1.5 cm in flaccid and 1.2 cm in erection, respectively. Also, psychosexual sexual self-esteem and confidence of the patients were significantly improved (p < 0.001). Overall, 13 (76%) patients reported satisfaction with the penile appearance. We believe that the surgery is both safe and effective in the enhancement of the penis, however, further clinical studies with a larger patient population are necessary.
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Affiliation(s)
- G-X Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - M Weng
- Department of Urology, Second Hospital of Beijing Armed Police Corps, Beijing, China
| | - M-D Wang
- Department of Urology, Second Hospital of Beijing Armed Police Corps, Beijing, China
| | - W-J Bai
- Department of Urology, Peking University People's Hospital, Beijing, China
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Abstract
INTRODUCTION Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. OBJECTIVE The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant. METHODS An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between 2002 to 2012. The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought. DISCUSSION Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion. CONCLUSIONS Strategies to preserve and potentially increase penile size are of great importance to all implanters. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach are simple ways to optimize penile length. A direct comparison of treatment outcomes evaluating the various approaches is not currently possible, owing to divergent study techniques. The implanting surgeon can best serve his patient by adopting a combination of different strategies that are individualized and specific to the patient's needs.
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Affiliation(s)
- King Chien Joe Lee
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
| | - Gerald B Brock
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
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Penile enhancement with rectus muscle fascia and testicular tunica vaginalis grafts: an experimental animal study. Int Urol Nephrol 2015; 47:915-20. [PMID: 25827355 DOI: 10.1007/s11255-015-0961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To enhance rat penises experimentally with rectus muscle fascia (RMF) and testicular tunica vaginalis grafts (TVG). METHODS Twelve Wistar albino rats were distributed into two equal Groups, A and B. There were six rats in each group. RMF and TVG were used to enhance rat penises in Groups A and B, respectively. Circumferences of the penises were measured preoperatively and at three different times after the operation. Two, two and eight rats were killed 10 days, 1 month and 2 months after the operation, respectively, for histopathological examinations. RESULTS When we compared the measurements of preoperative and immediately postoperative circumferences, the mean increase was 23.4 ± 2.9 % in Group A and 19.9 ± 1.7 % in Group B. According to paired t test, the difference was significant (p < 0001), but the comparison between preoperative and postoperative first-month measurements was not found to be significant (p > 0.05). Histological examinations revealed an intensive inflammatory process at 10 days after the operation. Grafts were found to be totally absorbed in the first- and second-month examinations. CONCLUSION In our study, implanted TVG and RMF could not survive because of insufficient vascularization and failure to maintain satisfactory surgical success. More studies are needed to increase the effectiveness of surgical techniques.
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Abstract
This study aimed to report penile dimensions in adult Egyptian males consulting for small-sized penis (SSP) and describe their demographics and andrological profile. A case control study was designed through retrospective data analysis of patients ( n = 239) seeking advice for SSP and a control group ( n = 59). This included sociodemographics, other andrological complaints, and penile dimensions (pendulous length [PL], penopubic or total length [TL], and circumference [CF]) at flaccid and erect states and the size of the prepubic fatty pad. The results reported that most patients were single, students, and smokers and had not completed a university education. Several patients reported falsely premature ejaculation (PE), penile curvature (PC), and small-sized testes. Most penile dimensions of the patients (mean, cm) were significantly lower than those of the controls, whether in flaccid (PL: 7.4 vs. 8.05, p = .008; CF: 8.7 vs. 8.98, p = .026) or erect state (PL: 11.8 vs. 13, p = .000; TL: 14.2 vs. 15, p = .000; CF: 11.3 vs. 11.8, p = .003). However, no patient presented with a pendulous penile length <4 cm in flaccid or <7 cm in erect state. In conclusion, Egyptian men consulting for SSP did not have true small organs, but their penile dimensions were slightly smaller than those of men without such complaint. The proper sexual education program is highly advisable in these situations to avoid the myths and misconceptions about sexuality.
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Affiliation(s)
- Nader Salama
- Alexandria Faculty of Medicine, Alexandria, Egypt
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Penile subcutaneous fibrolipoma postaugmentative phalloplasty. Case Rep Urol 2013; 2013:696314. [PMID: 24195003 PMCID: PMC3806159 DOI: 10.1155/2013/696314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022] Open
Abstract
Fibrolipomas are a rare subtype of lipomas. We describe a case of a man suffering from subcutaneous penile fibrolipoma, who three months earlier has been submitted to an augmentative phalloplasty due to aesthetic dysmorphophobia. After six months from the excision of the mass, the penile elongation and penile enlargement were stable, and the patient was satisfied with his sexual intercourse and sexual life. To our knowledge, this is the first reported penile subcutaneous fibrolipoma case in the literature. The diagnostics and surgical features of this case are discussed.
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Chevallier D, Haertig A, Faix A, Droupy S. Chirurgie cosmétique de l’appareil génital masculin. Prog Urol 2013; 23:685-95. [DOI: 10.1016/j.purol.2013.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
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Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique. Asian J Androl 2013; 15:819-23. [PMID: 23792340 DOI: 10.1038/aja.2013.58] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/04/2013] [Accepted: 04/06/2013] [Indexed: 11/08/2022] Open
Abstract
Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.
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Tealab AA, Maarouf AM, Habous M, Ralph DJ, Abohashem S. The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia. Arab J Urol 2013; 11:169-73. [PMID: 26558077 PMCID: PMC4442917 DOI: 10.1016/j.aju.2013.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 01/30/2013] [Accepted: 02/16/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the use of an acellular collagen matrix (Pelvicol, Bard Medical, Covington, GA, USA), a successful agent for reconstructive surgery, for enhancing penile girth. PATIENTS AND METHODS Between June and December 2011, 18 patients (mean age 24 years, range 19-38) had their penis augmented with Pelvicol; the mean (range) penile circumference was 9.2 (7-13) cm before treatment. They were divided into two groups; the first (10 patients) had a Pelvicol sheet of 8 × 12 cm inserted through a V-Y suprapubic incision and wrapped around the shaft in a bilayer under the dartos fascia, but not covering the urethra, with division of the suspensory ligament. The second group of eight patients had the Pelvicol inserted through a subcoronal degloving incision and placed in one layer. The penile circumference was measured at 6 and 12 months after surgery. Patient satisfaction at 1 year after surgery was assessed as 'poor', 'unsatisfied', 'moderately satisfied', 'highly satisfied', or 'excellent'. RESULTS The mean (range) increase in girth (circumference) was 2.8 (2-3.2) cm in group 1 and 1.7 (1.2-2) cm in group 2. In group 1, two patients were highly satisfied, four moderately satisfied and four unsatisfied; in group 2, three were moderately satisfied and five unsatisfied. Complications were common in both groups, with five patients in group 1 and three in group 2 developing severe penile oedema and ischaemic shaft ulcers. Removal of the graft was required in two patients in each group. CONCLUSION This pilot study shows that Pelvicol is not an ideal option for enhancing penile girth, and the method of placement did not apparently influence the result.
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Affiliation(s)
- Alaa A. Tealab
- Elaj Medical Centre, Jeddah, Saudi Arabia
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Corresponding author address: Urology Department, Faculty of Medicine, Zagazig University, Zagazig 12345, Egypt. Tel.: + 966594084879; fax: + 966048157060.
| | - Aref M. Maarouf
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Safwat Abohashem
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Ghanem H, Glina S, Assalian P, Buvat J. Position Paper: Management of Men Complaining of a Small Penis Despite an Actually Normal Size. J Sex Med 2013; 10:294-303. [DOI: 10.1111/j.1743-6109.2012.02725.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Appearance of the male genitalia is linked with self-esteem and sexual identity. Aesthetic surgery of the male genitalia serves to correct perceived deficiencies as well as physical deformities, which may cause psychological distress. Attention to patient motivation for surgery and to surgical technique is key to achieving optimal results. In this review, the authors describe aesthetic surgical techniques for treatment of penile and scrotal deficiencies. They also discuss techniques for revision in patients with previous surgery.
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Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol 2012; 9:499-507. [DOI: 10.1038/nrurol.2012.150] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kang DH, Chung JH, Kim YJ, Lee HN, Cho SH, Chang TH, Lee SW. Efficacy and safety of penile girth enhancement by autologous fat injection for patients with thin penises. Aesthetic Plast Surg 2012; 36:813-8. [PMID: 22527585 DOI: 10.1007/s00266-012-9891-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 03/02/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of autologous fat injection (AFI) for penile girth enhancement (PGE) in patients with thin penises. METHODS This study investigated 52 patients with a small penile circumference who underwent AFI for PGE and were followed up for more than 6 months. The patients whose proximal one third (G1) and distal one third of their penis (G2) had a mean thickness of 7.4 cm or less were selected as subjects. After fat suction using a liposuction device, fat was evenly injected into the superficial, middle, and deep layers of the Colles' fascia. Patient age and operative time were analyzed. The G1, G2, flaccid (L1), stretched length (L2), and five-item version of the International Index of Erectile Function-5 (IIEF-5) before and 6 months after the surgery were compared. Postoperative complications were surveyed. RESULTS The patient mean age was 42.15 years (range, 22-56) years, and the operative time was 44.44 min (range, 37-49 min). The injected fat volume was 38.54 ml (range, 25-49 ml). Preoperatively, G1 was 7.01±0.39 cm, and G2 was 7.06±0.37 cm. Postoperatively, G1 was 9.29±0.82 cm (P<0.001), and G2 was 9.34±0.86 (P<0.001) cm 6 months after the surgery. The difference between L1 and L2 before and after the surgery was not significant. The IIEF-5 was 19.10±3.22 before the surgery and 19.90±3.05 after the surgery (P=0.001). The only complication was nodular fat observed in one case (1.92%). CONCLUSION The use of AFI for PGE in men with thin penises was effective and safe without major complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Penile enhancement procedures with simultaneous penile prosthesis placement. Adv Urol 2012; 2012:314612. [PMID: 22811703 PMCID: PMC3395210 DOI: 10.1155/2012/314612] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/05/2012] [Indexed: 11/25/2022] Open
Abstract
Here we present an overview of various techniques performed concomitantly during penile prosthesis surgery to enhance penile length and girth. We report on the technique of ventral phalloplasty and its outcomes along with augmentation corporoplasty, suprapubic lipectomy, suspensory ligament release, and girth enhancement procedures. For the serious implanter, outcomes can be improved by combining the use of techniques for each scar incision. These adjuvant procedures are a key addition in the armamentarium for the serious implant surgeon.
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Alei G, Letizia P, Ricottilli F, Simone P, Alei L, Massoni F, Ricci S. Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series. J Sex Med 2012; 9:1945-53. [PMID: 22568607 DOI: 10.1111/j.1743-6109.2012.02744.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. AIMS The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. METHODS Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. MAIN OUTCOME MEASURES Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. RESULTS Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.
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Affiliation(s)
- Giovanni Alei
- Department of Plastic Surgery, Sapienza University of Rome, Rome, Italy. giovanni.alei@uniroma1
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Khan S, Somani B, Lam W, Donat R. Establishing a reference range for penile length in Caucasian British men: a prospective study of 609 men. BJU Int 2011; 109:740-4. [PMID: 21711435 DOI: 10.1111/j.1464-410x.2011.10338.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES • To establish a reference range for adult male genital size in the UK using penile length measurements. • To compare the reference ranges for normal penile length reported from several different countries and the anthropometric differences noted between different nationalities and ethnic backgrounds. METHODS AND MATERIALS • Over 20 months, genital measurements were taken from all men undergoing routine examination in clinics (n= 499) and in operating theatres during examination under anaesthetic (n= 110). • Using a rigid metric ruler three penile measurements were taken: flaccid pendulous penile length, flaccid penopubic penile length (to the pubic arch) and stretched flaccid penopubic length. In addition, testicular size was measured using an orchidometer. • The patient's age and the reason for referral were recorded. • Statistical analysis was carried out using Pearson correlation analysis. RESULTS • Measurements from 610 patients aged 16-90 years were available for analysis. • The mean penile lengths were: pendulous length 8.7 cm (sd 1.6 cm), penopubic length 10.2 cm (sd 1.4 cm) and stretched length 14.3 cm (sd 1.7 cm). The mean testicular volume was 19.8 mL (sd 5.4 mL) for both left and right testicles. • Men with penile disease (including phimosis and Peyronie's disease) had slightly reduced penile length (pendulous -3.3 mm, P= 0.014; penopubic -2.3 mm, P= 0.029; stretched -5.1 mm, P < 0.001) compared with other referral groups (erectile dysfunction, testicular disease, prostate and bladder disease). • There was no significant correlation between penile length and age or testicular size CONCLUSION • These data establish a reference range for adult male genital size in the UK, which should be helpful for urologists when counselling patients.
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Affiliation(s)
- Shahid Khan
- Department of Urology, Western General Hospital, Edinburgh and St John's Hospital, Livingston, UK.
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Perovic SV, Sansalone S, Djinovic R, Ferlosio A, Vespasiani G, Orlandi A. Penile Enhancement Using Autologous Tissue Engineering with Biodegradable Scaffold: A Clinical and Histomorphometric Study. J Sex Med 2010; 7:3206-15. [DOI: 10.1111/j.1743-6109.2009.01545.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ralph D, Gonzalez-Cadavid N, Mirone V, Perovic S, Sohn M, Usta M, Levine L. Trauma, Gender Reassignment, and Penile Augmentation. J Sex Med 2010; 7:1657-67. [DOI: 10.1111/j.1743-6109.2010.01781.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Caso JR, Myers MD, Wiegand L, Rodriguez A, Hann S, Carrion R. Phalloplasty and penile implant surgery. Curr Urol Rep 2010; 10:475-7. [PMID: 19863860 DOI: 10.1007/s11934-009-0075-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Impotence is often accompanied by loss of phallic length. To enhance penile prosthesis surgery, it is possible to perform simple adjuvant procedures that will increase perceived or true length. This article presents an overview of these techniques, which may be categorized as involving removal or fixation of tissue above or below the shaft of the penis; division of the suspensory ligament; and augmentation of the corpora cavernosa through stretch or grafting. We believe that the use of these techniques will become increasingly commonplace as patient satisfaction is reported.
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Affiliation(s)
- Jorge R Caso
- University of South Florida, School of Medicine, Department of Urology, South Tampa Center, 2A Columbia Drive, 7th Floor, Tampa, FL 33606, USA
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Gontero P, Di Marco M, Giubilei G, Bartoletti R, Pappagallo G, Tizzani A, Mondaini N. A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’. BJU Int 2009; 103:793-7. [DOI: 10.1111/j.1464-410x.2008.08083.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang B, Liu XR, Hong QQ, Qiu RS, Ji CY. A comparative study on two kinds of surgical procedures of penile corpora cavernosa augmentation. J Plast Reconstr Aesthet Surg 2009; 62:357-64. [PMID: 19121613 DOI: 10.1016/j.bjps.2008.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 10/03/2008] [Accepted: 11/07/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Penile augmentation surgery is still a controversial issue because of the uncertain indication, the possibility of severe complications and a variety of surgical techniques. The purpose of this study is to provide two surgical procedures of penile corpora cavernosa augmentation and to investigate its effect by implanting autogenous saphenous vein grafts or expanded polytetrafluoroethylene (ePTFE) vessel patches. METHODS Between January 2001 and December 2005, 20 patients underwent surgeries in which bilateral longitudinal incisions were placed on the tunica albuginea and the penile corpora cavernosa were extended by means of implantation of saphenous grafts or PTFE artificial vessel patches. The patients included in this study presented either with congenital idiopathic micropenis or normal penile length and perimeter (dysmorphophobia). Before the operation, the penile length and perimeter in the flaccid and erectile states were as follows: flaccid length 2.5-7.5 cm and flaccid perimeter 3.0-7.5 cm; erectile length 4.9-10.5 cm and erectile perimeter 4.5-10.0 cm. RESULTS Immediately after surgery, the penile corpus circumferential measurements (on table), showed remarkable increases which were 1.0-2.3 cm and 1.5-3.0 cm in the flaccid and erectile states, respectively; then, at 12 months to 5 years' follow-up, these girth gains had reduced by 0.5-1 cm in some cases. All cases in the two groups obtained satisfactory surgical results with satisfactory erection and no serious complications, such as infection and fistula. In 20 cases, 17 married cases resumed regular and satisfactory sexual activities 1 month after the operation without any functional limitation. CONCLUSION The two kinds of surgical procedures for augmenting penile corpora cavernosa were proved to be effective and reliable, with few complications. Both saphenous grafts and ePTFE artificial vessel patches are excellent materials for reconstructing the tunica albuginea. These augmenting phalloplasties can not only be used for patients with micropenis, but also applied to satisfy the cosmetic and functional requests of patients with normal penile length and perimeter. However, the long-term outcomes of these surgical procedures need a further, detailed follow-up study.
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Affiliation(s)
- Bin Yang
- Department of Plastic Surgery, The First Affiliated Hospital, Guangzhou Medical College, 151 Yanjiang Road, Guangzhou 510120, PR China.
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A Critical Analysis of Penile Enhancement Procedures for Patients with Normal Penile Size: Surgical Techniques, Success, and Complications. Eur Urol 2008; 54:1042-50. [DOI: 10.1016/j.eururo.2008.07.080] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/30/2008] [Indexed: 11/19/2022]
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Abstract
Penile size is a considerable concern for men of all ages. Herein, we review the data on penile size and conditions that will result in penile shortening. Penile augmentation procedures are discussed, including indications, procedures and complications of penile lengthening procedures, penile girth enhancement procedures and penile skin reconstruction.
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Cavallini G, Caracciolo S. Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature. Asian J Androl 2008; 10:512-9. [DOI: 10.1111/j.1745-7262.2008.00329.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ghanem H, Shamloul R, Khodeir F, ElShafie H, Kaddah A, Ismail I. Structured Management and Counseling for Patients with a Complaint of a Small Penis. J Sex Med 2007; 4:1322-7. [PMID: 17419818 DOI: 10.1111/j.1743-6109.2007.00463.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Penile augmentation surgery has become increasingly common though there is no consensus about the management strategy for men with a complaint of small penis. AIM To introduce and evaluate the outcome of a structured management and counseling protocol for patients with a complaint of a small-sized penis. METHODS A structured protocol for consultation and management of (physically normal) patients with a complaint of a small penis through a descriptive study comprised of a series of 250 patients. MAIN OUTCOME MEASURES Percentage of patients who elect to undergo penile augmentation surgery. RESULTS Only nine patients (3.6%) chose to seek further surgical intervention. Two had a buried penis, two had true micropenis and five had normal penile size. CONCLUSIONS Using a structured management and counseling protocol, most men chose not to undergo penile augmentation surgery, even when offered for free.
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Spyropoulos E, Galanakis I, Dellis A. Augmentation Phalloplasty Patient Selection and Satisfaction Inventory: A Novel Questionnaire to Evaluate Patients Considered for Augmentation Phalloplasty Surgery Because of Penile Dysmorphophobia. Urology 2007; 70:221-6. [PMID: 17826474 DOI: 10.1016/j.urology.2007.03.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Revised: 02/25/2007] [Accepted: 03/16/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To introduce a novel questionnaire by which we attempted to identify the most suitable candidates for augmentation phalloplasty surgery for penile dysmorphophobia and to objectively estimate the outcome. METHODS A total of 45 physically normal young adult men who presented with complaints of a "small penis" and were seeking surgical correction were included in the study. In addition to the ordinary evaluation, all completed the questionnaire devised by our department, the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI). The APPSSI aims to quantitatively assess the severity of the condition and the degree of the patient's willingness to undergo penile augmentation and to numerically measure the postoperative result. The APPSSI consists of four questions, with each having five possible answers (scale 0 to 4). Questions 1 through 3 were asked preoperatively (suitability assessment) and questions 1, 2, and 4 postoperatively (outcome evaluation). The eligibility threshold for surgery was a preoperative score of 6 or less. The preoperative scores ranged from 0 (surgery justified) to 12 (surgery not justified), and the postoperative scores ranged from 0 (disappointed) to 12 (excited). The Student t test was used for statistical analysis, and P <0.05 was considered to indicate statistical significance. RESULTS Of the 45 patients, 13 (28.8%) with an APPSSI score of 6 or less (mean 3.18) underwent penile lengthening (n = 7), lengthening-enlargement (n = 4), or celioplasty-penile lengthening (n = 2). Postoperatively, the score increased by 4.36 (mean 7.54, P <0.001), and the condition improved by 25% to 50% in 11 patients, 66.6% in 1, and remained unchanged (0%) in 1 patient. CONCLUSIONS The APPSSI questionnaire properly identified patients who significantly benefited from augmentation phalloplasty. Nevertheless, because of the small sample size and nonrandomized study, the questionnaire's validation requires a larger number of patients tested in a randomized manner by more researchers to become a valuable clinical instrument and patient eligibility criterion for this type of surgery.
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Abstract
The male is often troubled by concerns that his penis is not large enough to satisfy his partner or himself. He is ashamed to have others view his penis, especially in the flaccid state. Such concerns might be unfounded in reality and might be a presentation of social anxiety or some other clinical problem, such as erectile dysfunction. Concern over the size of the penis, when such concern becomes excessive, might present as the 'small penis syndrome', an obsessive rumination with compulsive checking rituals, body dysmorphic disorder, or as part of a psychosis. However, it is often a worry that can be described as within the normal experience of many men. Various potential causal factors are considered. A thorough assessment, normalizing the worry and then exploring the treatment options in detail with the man, is essential to allow the matter to be consolidated satisfactorily within the male ego.
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Affiliation(s)
- Kevan R Wylie
- Porterbrook CLinic, Sheffield Care Trust, Sheffield, UK.
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Lever J, Frederick DA, Peplau LA. Does size matter? Men's and women's views on penis size across the lifespan. PSYCHOLOGY OF MEN & MASCULINITY 2006. [DOI: 10.1037/1524-9220.7.3.129] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vardi Y, Lowenstein L. Penile enlargement surgery--fact or illusion? ACTA ACUST UNITED AC 2006; 2:114-5. [PMID: 16474686 DOI: 10.1038/ncpuro0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/15/2005] [Indexed: 11/08/2022]
Affiliation(s)
- Yoram Vardi
- Neuro-Urology and Male Sexual Dysfunction Unit, Rambam Medical Center, Haifa, Israel.
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Vardi Y. Is Penile Enlargement an Ethical Procedure for Patients with a Normal-Sized Penis? Eur Urol 2006; 49:609-11. [PMID: 16439051 DOI: 10.1016/j.eururo.2005.12.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/27/2005] [Indexed: 11/18/2022]
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