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Schifano N, Capogrosso P, Antonini G, Baldini S, Scroppo F, Salonia A, Zerbinati N, Dehò F. The Application of Hyaluronic Acid Injections in Functional and Aesthetic Andrology: A Narrative Review. Gels 2023; 9:gels9020118. [PMID: 36826290 PMCID: PMC9957416 DOI: 10.3390/gels9020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Hyaluronic acid (HA) is a glycosaminoglycan widely utilised in different fields of medicine. We aimed to provide a comprehensive overview of the scientific evidence on the use of HA in andrology. A review of the literature to identify pertinent studies concerning the use of HA in andrology was carried out on the Medline, EMBASE, and the Cochrane databases, with no time restriction up to December 2022. Penile girth enlargement (PGE) using HA proved to be safe and effective in enhancing the diameter of the penis, with durable and satisfactory outcomes in long-term follow-up. Injection of HA in the glans seems to represent an alternative treatment option for those patients with premature ejaculation (PE) who fail to respond to conventional medications. HA intra-plaque injections represent a valid option which may contribute to restore sexual activity in patients with Peyronie's disease (PD). The adoption of HA filler injections should always be tailored to the patient's peculiar anatomy and underlying condition. More robust evidence is required to achieve a uniformed consensus regarding the use of HA in andrology, and further efforts should continue to improve the current injection techniques and HA products.
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Affiliation(s)
- Nicolò Schifano
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Paolo Capogrosso
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Gabriele Antonini
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
- Antonini Urology, 00185 Rome, Italy
| | - Sara Baldini
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Fabrizio Scroppo
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Andrea Salonia
- Department of Urology, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- Unit of Urology, Division of Experimental Oncology, Urology Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Nicola Zerbinati
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Federico Dehò
- ASST Sette Laghi–Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
- Correspondence:
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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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Zucchi A, Scroppo FI, Capogrosso P, Salonia A, Duante J, Bini V, Liguori G, Bartoletti R. Clinical use of hyaluronic acid in andrology: A review. Andrology 2021; 10:42-50. [PMID: 34297894 PMCID: PMC9135118 DOI: 10.1111/andr.13083] [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: 05/03/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
Background Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the synthesis of pro‐inflammatory proteins and its activity against oxidative stress, a feature of many degenerative illnesses. Objectives The objective of the present review is to provide a comprehensive narrative review of the most recent literature on the use of hyaluronic acid in andrology in order to facilitate the use of this therapeutic device in the common clinical practice of many physicians. Specific conditions covered in the review are Peyronie's disease, premature ejaculation, and penile enlargement. Materials and methods A broad and comprehensive literature search included Medline, EMBASE, and the Cochrane Libraries, with no time restriction up to December 2020 and restricted to English language publications. Unpublished studies were not included. The study was registered as “The role of hyaluronic acid in andrology: A systematic review and meta‐analysis” in PROSPERO with the ID CRD42021223416. Discussion and conclusion Hyaluronic acid is a valid choice for the treatment of Peyronie's disease in terms of the resolution of the acute phase of the disease and of contributing to stabilizing the disease as a bridge to potential surgery. Data, furthermore, suggest that hyaluronic acid is frequently associated with an overall clinical improvement, allowing the patient to resume normal sexual activity. With regard to premature ejaculation, data suggests hyaluronic acid‐based treatments were effective in prolonging intra‐vaginal ejaculation time. Furthermore, hyaluronic acid was found to be safe and well‐tolerated, with main adverse events limited to local discomfort, ecchymosis, papule formation, and glans numbness, all of which were reported to resolve spontaneously. Last, with regard to penile enlargement, the overall perception of experts is that hyaluronic acid may be an extremely well‐tolerated compound with potential for application in specific areas of male sexual health that are often neglected as compared to more common, and relatively simpler to treat, conditions.
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Affiliation(s)
- Alessandro Zucchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Salonia
- Urology dept., University Vita-Salute San Raffaele, Milan, Italy
| | - Jacopo Duante
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vittorio Bini
- Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Pisa, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Yordanov YP. Nonsurgical Correction of Secondary Contour Deformities of the Penile Girth. Aesthet Surg J 2021; 41:944-949. [PMID: 33592089 DOI: 10.1093/asj/sjab089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dealing with remaining penilе deformities following surgery to correct complications after injection of nonabsorbable substаnces tends to be troublesome. There is a lack of adequate information regarding the options for the management of such residual irregularities. In morе than 2 decades of clinical application, hyaluronic acid (HA) fillers have proved to be a safе and reliable solution fоr a great variety of age-related changes, tissue atrophy, and contour deformities. OBJECTIVES This brief clinical study aimed to demоnstrate the author's initial еxperience with the novel use of an HA-based filler for the correction of secondary deformities of penile girth. METHODS Rеtrospective analysis was conducted, encompassing patients who underwent correction of secondary penile deformities with HA between August 2018 and February 2020. Тhe procedures were carried оut in an ambulatory setting and a blunt cannula was used for filler infiltration. A 9-month follow-up was established. RESULTS Five patients aged between 29 and 44 years (average, 35.8 years) were found and included in the study. The mean volumе of HA product used for the correction was 3.32 mL. An analysis of the outcomes demonstrated a high satisfaction ratе among pаtients with no complications in thе series. CONCLUSIONS The procedure is safe, effective, and relatively simple with reproducible and reliable outcomes. Due to its excellent spreading and good tissue integration, the selected HA filler was very useful in cases where fibrosis was present because of previous surgeries. LEVEL OF EVIDENCE: 4
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Abstract
BACKGROUND There is no standardized approach for nonsurgical techniques for penile augmentation despite the increase of demand for this intervention. OBJECTIVE To compare the efficacy and safety between different injection techniques. MATERIALS AND METHODS On October 8, 2019, a literature search was performed on PubMed, Embase, Ovid, and Cochrane database. All articles describing penile augmentation were included. RESULTS Thirteen studies were included in this article with a total of 1,311 patients. Five studies were prospective cohort. The most commonly described technique was hyaluronic acid fillers with a total of 4 articles and 205 patients. The mean injected volume ranged from 20 to 40 mL. In all included studies, a minority of patients had side effects, but some had disabling complications. CONCLUSION There are no defined clinical guidelines for penile augmentation techniques implemented yet. Hyaluronic acid seems to be safe, efficient, and with a high satisfaction score. Further randomized control trials are warranted. EBM LEVEL OF EVIDENCEBASED MEDICINE 2a.
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Marlino S, Cagli B, Vitale A, Boccia A, Avvedimento S, Madonna G, Santorelli A. Bleeding in Plastic-Aesthetic Surgery: A Prognostic Pathway with Clinical Application. Aesthetic Plast Surg 2020; 44:201-206. [PMID: 31822961 DOI: 10.1007/s00266-019-01557-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/23/2019] [Indexed: 11/30/2022]
Abstract
One of the potential complications of aesthetic surgery is bleeding. Given the high surgical activity carried out in our center and the variety of interventions performed, the risk of bleeding is not negligible: A clinical practice that could reduce this postsurgical complication is necessary. The goal of this article is to value effectiveness of a bleeding score obtained through the evaluation of anamnestic data. The study was divided into two steps. The preliminary data consist in the creation of a form for the evaluation of the bleeding score based on literary data. Subsequently, the first step was put on a retrospective study on 163 patients who underwent aesthetic surgery from January 2013 to July 2017. In the second step, the bleeding score was introduced in clinical practice, submitting the form to 223 patients operated on from September 2017 to September 2018. Retrospective results showed that patients with a low bleeding index had no hemorrhagic complications. One patient of three with a medium-high bleeding score showed a hemorrhagic complication in the postoperative course. The prospective study showed that in three patients with an index between 4 and 7, the level II panel analysis confirmed a medium risk of incurring bleeding episodes during or after the surgery. One patient in 223 obtained a bleeding index of 9: This patient was not operated on and he was sent to the reference center for further investigation. This routine will help to recognize, manage, and prevent hemorrhagic complications of aesthetic surgery.Level of Evidence V 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 www.springer.com/00266.
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Affiliation(s)
- Sergio Marlino
- Plastic Surgery, Health Park, Naples, Italy
- Plastic Surgery, Clinica Grimaldi, San Giorgio a Cremano, Italy
| | - Barbara Cagli
- Dipartimento di Chirurgia Plastica, Campus Biomedico, Rome, Italy
| | | | - Andrea Boccia
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" di Napoli, Naples, Italy.
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.
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Casavantes L, Lemperle G, Morales P. Penile Girth Enhancement With Polymethylmethacrylate-Based Soft Tissue Fillers. J Sex Med 2016; 13:1414-1422. [PMID: 27461963 DOI: 10.1016/j.jsxm.2016.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION An unknown percentage of men will take every risk to develop a larger penis. Thus far, most injectables have caused serious problems. Polymethylmethacrylate (PMMA) microspheres have been injected as a wrinkle filler and volumizer with increasing safety since 1989. AIM To report on a safe and permanently effective method to enhance penile girth and length with an approved dermal filler (ie, PMMA). METHODS Since 2007, the senior author has performed penile augmentation in 752 men mainly with Metacrill, a suspension of PMMA microspheres in carboxymethyl-cellulose. MAIN OUTCOME MEASURES The data of 729 patients and 203 completed questionnaires were evaluated statistically. RESULTS The overall satisfaction rate was 8.7 on a scale of 1 to 10. After one to three injection sessions, average girth increased by 3.5 cm, or 134% (10.2 to 13.7 cm = 134.31%). Penile length also increased by weight and stretching force of the implant from an average of 9.8 to 10.5 cm. Approximately half the patients perceived some irregularities of the implant, which caused no problems. Complications occurred in 0.4%, when PMMA nodules had to be surgically removed in three of the 24% of patients who had a non-circumcised penis. CONCLUSION After 5 years of development, penile augmentation with PMMA microspheres appears to be a natural, safe, and permanently effective method. The only complication of nodule formation and other irregularities can be overcome by an improved injection technique and better postimplantation care.
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Affiliation(s)
| | - Gottfried Lemperle
- Division of Plastic Surgery, University of California-San Diego, San Diego, CA, USA
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Abstract
In our contemporary postmodern society, a modified perception of the human body is accompanied by an increasing demand for body shaping procedures. The treatment needs to be effective but it is just as important that they are safe and can be easily integrated into the daily working and routine schedule. While the options for minimally invasive volume addition are largely limited to injectable implants based on hyaluronic acid or autologous fat, a multitude of options are available for volume reduction. Before deciding on the method of choice, the following needs to be considered: which indications need to be treated, the extent of the reduction in volume and how much pain and possible undesired reactions the patient is prepared to accept.
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Affiliation(s)
- N Krüger
- Rosenpark Research, Wilhelminenstraße 13, 64283, Darmstadt, Deutschland.
| | - S Lübberding
- Rosenpark Research, Wilhelminenstraße 13, 64283, Darmstadt, Deutschland
| | - G Sattler
- Rosenpark Research, Wilhelminenstraße 13, 64283, Darmstadt, Deutschland
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Siebert T, Chaput B, Vaysse C, Meresse T, Chavoin JP, Garrido I, Grolleau JL. The latest information on Macrolane™: Its indications and restrictions. ANN CHIR PLAST ESTH 2014; 59:e1-e11. [DOI: 10.1016/j.anplas.2013.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 01/13/2023]
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