Penile Lengthening: Before & After · Girth Enhancement: Before & After Non- Surgical Glans Enlargement: Before & After · Penoscrotal Webbing: Before & After.
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If there is need for further length, release of the suspensory ligament can be performed along with the suprapubic lipectomy If the buried penis is secondary to cicatrix post circumcision, which is more common in children but can present in adults, either Z-plasties or removal of the entire penile skin with skin grafting and vacuum assisted closure with a negative pressure wound dressing can be performed. Suction lipectomy, or liposuction, is considered inadequate to treat a buried penis unless it is used in conjunction with suprapubic lipectomy If no significant buried penis is present, but there is a moderate pubic fat pad, then liposuction may help to increase perceived penis length Rolle et al.
The penis is degloved and the neurovascular bundle is mobilized. After subtunical dissection, traction is applied to slide the distal penis away from the proximal shaft to perform the lengthening, the limit of which is the length of the urethra and neurovascular bundles 55 Figure 2. A prosthesis is then inserted into the tunical defects that are created by this technique.
The authors report an average penile lengthening of 3. The same group previously described this method of lengthening the penis with similar tunica incisions and subsequent pericardial grafting of the resulting tunical defect after lengthening, but felt that the grafting was time consuming and unnecessary A prosthesis is inserted into the tunical defects that are created by this technique. Perovic and Djordjevic describe a technique similar to sliding elongation, which they have used to treat short penises and congenital penile anomalies.
Their procedure involves separating the penis into the glans cap with neurovascular bundle dorsally, the corpora cavernosa, and the urethra ventrally. Thus, the corpora are separated completely from the surrounding structures. A space is created between the glans cap and the tip of the corpora cavernosa, on which an autologous rib cartilage graft is placed, and then the penis is reassembled 58 Figure 3. The cartilage is covered with the glans cap and the urethra and neurovascular bundles are sutured to the tunica.
This technique was performed on 19 patients with a short penis with an average increased length of 2—3 cm and 3—4 cm in 13 and 6 patients, respectively There was no evidence of cartilage extrusion, erectile dysfunction or urethral damage at a mean follow-up of 3. A The penis is degloved and the neurovascular bundle and corpus spongiosum are separated from the corpora cavernosa; B the glans cap is separated from the tip of the corpora cavernosa, and a space is created between these structures; C an autologous rib cartilage graft is placed, between the tip of the corpora cavernosa and the glans cap and the penis is reassembled.
Local, regional and free flap options exist to lengthen the penis.
Penile anatomy
These have typically been described for penile lengthening if the penis is shortened due to epispadias and exstrophy, where a lack of soft tissue and dorsal skin or tethering of the penis to the pubic bone from fibrous bands Kramer and Jackson describe the use of local rhomboid flaps, based laterally, for dorsal skin coverage combined with partial release of the corpora cavernosa from the pubic ramus in 10 patients.
These local flaps are necessary due to the lack of dorsal coverage once the corpora are released from the penis and advanced through an inverted V-shaped incision Figure 4. This technique is described for both congenital and acquired short penis. They state that most patients obtained a doubling in their penile length. Other local flap options are lateral superiorly based scrotal flaps that are rotated onto the dorsal penis Dorsal Z and W-plasties may also be performed as local skin flaps, but may bring hair bearing skin onto the penis Penile elongation using laterally based local rhomboid flaps to obtain length of the dorsal skin, as described by Kramer and Jackson, This technique is used if there is a need for further dorsal tissue after an inverted V-shaped incision is performed.
Men complaining of short penis need to be clinically assessed for evidence of true micropenis and screened for PDD. Patients should first be treated conservatively with testosterone therapy, PTD, and a psychiatric assessment if applicable. There are no current guidelines on the best surgical management for men requesting penile elongation.
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Multiple surgical techniques have been developed each with their own limitations and have been reviewed above. Further work in this field is required to devise the optimal surgical procedure with the smallest complication profile and the highest patient satisfaction. The authors would like to thank Alison Wong, MD for preparing the diagrams to supplement the surgical descriptions within this manuscript. The authors would also like to thank Dr.
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Gerald Brock, MD for his support in preparing this manuscript. Conflicts of Interest: The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Transl Androl Urol v. Transl Androl Urol. Jeffrey Campbell 1 and Joshua Gillis 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author. I Conception and design: J Campbell; II Administrative support: None; III Provision of study materials or patients: None; IV Collection and assembly of data: All authors; V Data analysis and interpretation: All authors; VI Manuscript writing: All authors; VII Final approval of manuscript: All authors.
Correspondence to: Jeffrey Campbell. Received Sep 20; Accepted Sep Copyright Translational Andrology and Urology. All rights reserved. Abstract Penile elongation surgery is less commonly performed in the public sector, but involves a collaborative approach between urology and plastic surgery. Micropenis, elongation, dysmorphophobia, surgery. Penile anatomy To fully understand limitations of small penis size and the surgical correction possibilities, we must review the relevant basic penile anatomy.
Penile length Normal penile length Accurate measurement of penile length is important for both clinical and academic purposes. Table 1 Etiology of micropenis. Open in a separate window. Penile dysmorphophobia The majority of men seeking penile elongation treatment have a normal penile size, which is functionally adequate for sexual activity and micturition 14 , Non-surgical management The idea of treating actual and perceived penile shortening with intervention is controversial. Testosterone In cases of true micropenis, the goal of treatment should be restoration of a functional penis size in order to improve body image and self-esteem, allow normal standing micturition and enable satisfying sexual intercourse.
Traction devices Penile traction devices PTD have been explored both as an independent strategy to help with penile elongation and as an augment to surgery. Surgical management Penile augmentation Different types of injectable materials have been used for penile augmentation including liquid silicone, polyacrylamide, hyaluronic acid and mineral-oil 35 - Suspensory ligament release As discussed, the suspensory ligament anchors the penis to the pubic symphysis and while providing support, acts as the mobile point for the penis during erection.
V-Y advancement Penile elongation using a dorsal V-Y incision in the congenital or acquired short penis was first described over 40 years ago. Figure 1. Suprapubic lipectomy Suprapubic lipectomy has been performed to increase perceived penis length, particularly for patients with a buried penis. Figure 2. Penile disassembly Perovic and Djordjevic describe a technique similar to sliding elongation, which they have used to treat short penises and congenital penile anomalies.
Figure 3. Flap reconstruction Local, regional and free flap options exist to lengthen the penis. Figure 4. Conclusions Men complaining of short penis need to be clinically assessed for evidence of true micropenis and screened for PDD. Acknowledgements The authors would like to thank Alison Wong, MD for preparing the diagrams to supplement the surgical descriptions within this manuscript.
Footnotes Conflicts of Interest: References 1. The inconspicuous penis in children. Nat Rev Urol ; Surgical anatomy of the penis in hypospadias: Urology ; Johnson P, Maxwell D.
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Fetal penile length. Ultrasound Obstet Gynecol ; The development of the fetal penis--an in utero sonographic evaluation. Hughes IA. The testes: Sperling MA. Pediatric Endocrinology. Philadelphia, PA: Saunders; ; Sex determination and disorders of sex development according to the revised nomenclature and classification in 46,XX individuals.
Hormones Athens ; 9: Endocrinology of fetal development. Williams Textbook of Endocrinology. Sounders, ; Grumbach MM. A window of opportunity: J Clin Endocrinol Metab ; Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15, men. BJU Int ; Penile length in the flaccid and erect states: J Urol ; A Cohort Study. Sex Med ; 3: Aaronson IA. Wiygul J, Palmer LS. ScientificWorldJournal ; Position paper: Management of men complaining of a small penis despite an actually normal size.
J Sex Med ; Penile length is normal in most men seeking penile lengthening procedures.
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Int J Impot Res ; American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; Relationship between self-discrepancy and worries about penis size in men with body dysmorphic disorder. Body Image ; Wylie KR, Eardley I. Penile size and the 'small penis syndrome'. Fox C. Sizing up the man: Sexologies ; S1, S Penile Dysmorphic Disorder: Development of a Screening Scale.
Arch Sex Behav ; Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sized penis?
Eur Urol ; Congenital hypogonadotropic hypogonadism and micropenis: J Pediatr ; Early determination of androgen-responsiveness is important in the management of microphallus. Lancet ; 2: Transdermal dihydrotestosterone therapy and its effects on patients with microphallus. Penile growth in response to hormone treatment in children with micropenis. Indian J Urol ; Topically applied testosterone and phallic growth. Its effects in male children with hypopituitarism and microphallus.
Am J Dis Child ; The effect of prepubertal androgen exposure on adult penile length. The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: J Sex Med ; 8: A pilot phase-II prospective study to test the 'efficacy' and tolerability of a penile-extender device in the treatment of 'short penis'.
FastSize Medical Extender for the treatment of Peyronie's disease. Expert Rev Med Devices ; 5: Effect of penile-extender device in increasing penile size in men with shortened penis: Oderda M, Gontero P. Non-invasive methods of penile lengthening: Penile traction therapy for treatment of Peyronie's disease: J Sex Med ; 5: Levine LA, Rybak J.
Traction therapy for men with shortened penis prior to penile prosthesis implantation: Panfilov DE. Augmentative phalloplasty. Aesthetic Plast Surg ; A critical analysis of penile enhancement procedures for patients with normal penile size: Coleman SR. Facial recontouring with lipostructure.
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Clin Plast Surg ; Hand rejuvenation with structural fat grafting. Plast Reconstr Surg ; Human adipose stem cells: Plast Reconstr Surg ; Current practice in autologous fat transplantation: Ann Plast Surg ; Autologous human fat grafting: Try the Metashred diet from Men's Health.
While Rapaport and many of his colleagues don't perform penile enhancements, there are certified surgeons who do. It's vital to make sure the procedure is happening in an accredited facility, and with a similarly certified anesthesiologist. One huge red flag to look for is whether or not the facility has a hour help line. After a surgery there's a risk of infection, and Rapaport said any patient feeling unwell or exhibiting other symptoms like shortness of breath or fever must have a lifeline to call immediately—and not one that will tell them to tie their penis back together with popsicle sticks.
For patients who may be on a tight budget, Rapaport recommended calling the nearest university teaching hospital. There, fully competent resident doctors in training for a specific field often perform operations under the full supervision of board-certified plastic surgeons for lower rates. Your penis is, arguably, one of the most important organs in your body. If you're going to have work done, make sure you do it right.
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