1
|
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.
Collapse
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;
| |
Collapse
|
2
|
Falcone M, Bettocchi C, Carvalho J, Ricou M, Boeri L, Capogrosso P, Cocci A, Corona G, Gül M, Hatzichristodoulou G, Jones TH, Kadioğlu A, Kalkanli A, Martinez-Salamanca JI, Milenkovic U, Morgado LA, Russo GI, Serefoğlu EC, Tharakan T, Verze P, Minhas S, Salonia A. European Association of Urology Guidelines on Penile Size Abnormalities and Dysmorphophobia: Summary of the 2023 Guidelines. Eur Urol Focus 2023:S2405-4569(23)00197-9. [PMID: 37709592 DOI: 10.1016/j.euf.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
CONTEXT Recommendations regarding the management of penile size abnormalities and dysmorphophobia are important in guiding evidence-based clinical practice. OBJECTIVE To present a summary of the 2023 European Association of Urology sexual and reproductive health evidence-based recommendations for the management of penile size abnormalities and dysmorphophobia. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a strength of recommendation were assigned for each recommendation according to the evidence identified. The evidence cutoff date for the 2023 guidelines is June 1, 2022. EVIDENCE SYNTHESIS Well-structured studies reporting high level of evidence, with standardized PROMS were deficient on penile size abnormalities and dysmorphohobia. A shared definition for short penis/micropenis was also lacking. Categorisation of penile abnormalities according to congenital, acquired, and dysmorphophobic aetiology is deemed compulsory. A detailed medical and psychosexual history and precise measurements of penile size are essential in the diagnostic pathway. Patients with normal penile size who are seeking penile augmentation should be referred for psychological evaluation for potential dysmorphophobic disorders. Penile length and girth enhancements can be achieved via a multitude of treatments, but a personalised management plan is crucial for satisfactory results. Endocrinological therapies, when indicated, are effective in the prepubertal setting only. Vacuum therapy has a limited evidence base in treatment protocols, although acceptable outcomes have been reported for penile traction therapy. Surgical techniques to enhance penile length and girth have limited evidence and should only be proposed after extensive patient counselling. CONCLUSIONS Management of penile abnormalities and dysmorphophobia is a complex issue with considerable ethical concerns. The adoption of a structured diagnostic and therapeutic pathway is crucial, as recommended in the guidelines. PATIENT SUMMARY Requests for medical/surgical treatments to increase penis size have increased dramatically worldwide. Several conservative and surgical treatments are available. However, few patients receive clear information on the benefits and possible harms of these treatments. These guidelines aim to provide a structured path to guide both physicians and patients in the selection of appropriate treatment(s) to increase penis size.
Collapse
Affiliation(s)
- Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Carlo Bettocchi
- Department of Andrology and Male Genitalia Reconstructive Surgery, University of Foggia, Foggia, Italy
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Miguel Ricou
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Murat Gül
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | | | - T Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioğlu
- Department of Urology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - L Afonso Morgado
- Urology Service, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, Porto University, Porto, Portugal
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoğlu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|