The impact of diabetes mellitus on penile length in men undergoing inflatable penile prosthesis implantation

Advanced Penile Length Restoration Techniques to Optimize Penile Prosthesis Placement Outcomes

INTRODUCTION

The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical techniques as well as preoperative and postoperative protocols have been reported to preserve and possibly enhance penile length in someone undergoing penile prosthesis surgery.

OBJECTIVES

This article presents a description of as well as the authors' experience with presurgical protocols, intraoperative techniques, and postsurgical protocols that allow for preservation or enhancement of penile length for patients who undergo inflatable penile prosthesis insertion.

METHODS

An extensive, systematic literature review was performed using PubMed searching for key terms including penile lengthening, inflatablepenile prosthesis, penile girth, buried penis, and penile enhancement. All articles with subjective and/or objective penile length outcomes were reviewed.

RESULTS

Several preoperative treatment protocols were found for penile length preservation and enhancement, which included use of a vacuum erection device as well as traction therapy. Intraoperative techniques included cavernosal sparing, channeling without dilatation, circumferential penile degloving, ventral phalloplasty, suprapubic lipectomy, liposuction, suspensory ligament release, sliding technique, modified sliding technique, multislice technique, and aggressive implant sizing. Postoperative protocols included early device inflation and cycling. Table 1 summarizes and compares the various preoperative, intraoperative, and postoperative strategies identified during literature review with their corresponding reported length gain.

CONCLUSIONS

Many preoperative, intraoperative, and postoperative surgical techniques can be performed by high-volume implanters to improve one's perceived or true penile length. In the hands of experienced, high-volume implanters, these techniques can be very meaningful for patients undergoing penile prosthesis insertion, particularly those who are concerned with penile length. Shah B, Kent M, Valenzuela R. Advanced Penile Length Restoration Techniques to Optimize Penile Prosthesis Placement Outcomes. Sex Med Rev 2020;XX:XXX-XXX.

Acquired Buried Penis in Adults: A Review of Surgical Management

INTRODUCTION

Acquired buried penis (ABP) is a urologic condition that has significant morbidity and negative effect on quality of life, including but not limited to sexual function, hygiene, micturition, and self-image. This disease process is characterized by a wide degree of variability and severity that requires a patient-specific approach and significant flexibility on the surgeon's behalf.

AIM

To review and present the current evaluation and surgical management of this rare and complex patient population.

METHODS

A structured review of the English language literature from 1970 to June 2018 was performed using the PubMed and MEDLINE medical databases. Queried terms included "buried penis," "concealed penis," "hidden penis," "adult buried penis," "cicatricial penis," "trapped penis," "inconspicuous penis," "scrotoplasty and obesity," "penile release," "penile skin graft," "penile reconstruction," and "pubic lift." Papers were individually reviewed for their utility and applicability to the management of adult ABP. Manuscripts focusing on pediatric patients were excluded.

MAIN OUTCOME MEASURE

Current surgical management options for adult ABP are heterogenous but focus on preserving shaft length while improving cosmesis and voiding function.

RESULTS

Surgical versatility remains critical for successful outcomes. However, recent advances in surgical techniques for correction of adult ABP focus on the use of skin grafting to cover the shaft, along with lipectomy and/or scrotoplasty to further aid penile exposure. Collaboration with multiple surgical services is often required to achieve optimal outcomes.

CONCLUSION

ABP is a complex urologic condition with equally complex surgical treatment options. Care must be taken when planning a surgical intervention, and support from plastic or general surgery may be required. However, with careful selection, surgical correction frequently leads to significant improvement in function and quality of life. Smith-Harrison LI, Piotrowski J, Machen GL, et al. Acquired Buried Penis in Adults: A Review of Surgical Management. Sex Med Rev 2020;8:150-157.