Penile prosthesis lengthening

Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie's disease, refractory erectile dysfunction, and.
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In all, 14 patients 9. Among the patients, Men affected by PD typically experience a variety of penile deformities, such as penile axis deviation, penile shortening, penile narrowing or the hinge effect 3 , and these deformities can interfere with the induction of an erection and the ability to participate in sexual intercourse. A reduction in penile length is encountered not only in PD but also in several other conditions, as mentioned above.

Many surgical techniques have been used to correct the underlying curvature caused by the fibrotic changes in the tunica albuginea of patients with PD 1 - 3. However, the reduction in penile length is not addressed and dealt with, as the primary focus of these techniques is correcting the penile axis.


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Unfortunately, any plication technique that aims to correct the underlying penile deviation by assimilating the longer side of the curvature to the shorter side will ultimately cause additional shortening. This surgically induced penile shortening will further reduce penile length, thereby aggravating the physical and psychological challenges that these patients face.

Interestingly, any additional length loss due to the surgical correction of PD significantly concerns the affected patients, irrespective of the magnitude of the loss Among patients with severe PD, those with significant penile shortening and ED are candidates for more invasive surgical procedures, beyond routine plication or grafting.

In these patients, simply straightening the penile axis may not adequately address the their needs, as inadequate rigidity may persist and continue to impede sexual intercourse. However, patients with severe PD, severe ED, complex anatomical deformities and a shortened penis exhibit significant improvement after penile prosthesis implantation 3 , 21 , In addition, we think that any patient with severe ED and significant penile length reduction is a candidate for a more invasive surgical approach to treating the ED and the loss of length.

The literature on penile lengthening techniques with concomitant prosthesis implantation, indicate promising results. In that study, patients reported an overall satisfaction rate and the rate of satisfaction with penile length gain of In addition, the mean sd , range functional length gain was 3.

In addition, the mean range length gain was 3. Extended operative time is a potential risk factor for penile prosthesis infection; therefore, extended procedures should be avoided to reduce the risk of infection of the implant Using our modified technique, malleable implants can be inserted through the tunical defects that are created when applying the sliding technique. However, when an inflatable penile prosthesis is used, additional bilateral proximal corporotomies should be performed to introduce the cylinders, thereby eliminating the need for an additional skin incision.

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As we do not spend time suturing the graft to the tunica albuginea, our modified technique can be performed in a shorter period, with a lower risk of prosthesis infection. However, there is no doubt that eliminating the need to suture the graft to the tunica albuginea saves time. Among patients with PD, surgical correction of the underlying penile curvature without grafting is a safe and viable procedure. Djordjevic and Kojovic 31 have recently reported their results for penile prosthesis implantation malleable, 49 patients; inflatable, 13 and tunica albuginea incision without grafting in the treatment of PD with ED.

Their results confirm our experience and validate the fact that tunica albuginea incision with concomitant penile prosthesis implantation does not require grafting, as Buck's fascia and the NVB are sufficient to cover the resulting defects. In addition, while haematoma and bulging or herniation of the prosthesis cylinders through the incision sites might be possible complications of this modified sliding technique, we did not observe any of these complications.

Haematoma formation is something that is highly expected, because the spongy tissue of the corpora cavernosa is not covered completely and meticulous haemostasis is not possible. Furthermore, it has to be pointed out that the haematoma is only superficial and laminar. We did not experience any prolonged healing or any delay in reinitiating sexual activity after this type of surgery. According to our experience, the recovery time is very similar to that of circular incision and grafting 16 , However, these disadvantages should be kept in mind if one is thinking about this type of surgery.

We think that the use of an oversized reservoir may prevent this type of complication. Finally, we think that all patients must be informed preoperatively that the restoration of their original penile length is limited by the elasticity of their NVB, which may be affected by the structural alterations caused by the fibrotic changes in the tunica albuginea in patients with PD. This avoids unrealistic patient expectations and ensures higher patient satisfaction. The indentations in the penile shaft can be counteracted by the longitudinal tunical incisions, as described above.

One limitation of the present study was the few inflatable prostheses that were implanted; this is related to the higher associated costs borne by the patient , due to government restriction and reimbursement issues for inflatable penile prosthesis. Nevertheless, we were able to demonstrate that our modified technique was a safe and effective approach, even for inflatable penile prostheses.

In addition, the use of only the IIEF questionnaire to evaluate patient satisfaction may be viewed as a limitation of the present study, as patient satisfaction with the treatment outcome is most accurately evaluated using the EDITS questionnaire In conclusion, our modified sliding technique is a safe and effective procedure to restore penile length and girth, as the elimination of grafting reduces the operative time, consequently decreasing the cost of surgery and potentially also the risk of infection.

Therefore, any patient with severe ED who is a candidate for penile prosthesis implantation should be evaluated for subjective penile length reduction before the surgery, as penile prosthesis implantation with concomitant penile length and girth restoration is associated with higher patient satisfaction. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries other than missing content should be directed to the corresponding author for the article. Volume , Issue 6. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

If the address matches an existing account you will receive an email with instructions to retrieve your username. Sexual Medicine Free Access. Paulo H. Make an appointment. Visit now. Explore now. Choose a degree.

Does a penile prosthesis (implant) affect the size of the penis?

Get updates. Give today. Clinical Trials. Find trials By condition, treatment or drug name Search tips. Overview Participation eligibility Participating Mayo Clinic info. See eligibility criteria Inclusion Criteria Men undergoing placement of a penile prosthesis Must be the first time a penile prosthesis is implanted Undergoing implantation of a 3-piece inflatable penile prosthesis Exclusion Criteria Prior ischemic priapism Any prior penile prosthesis surgeries Any prior penile surgeries other than circumcision Undergoing malleable penile prosthesis or Ambicor device.

Study statuses change often. Correspondence Address: None, Conflict of Interest: Implantation of an inflatable penile prosthesis IPP is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis.

Does a penile prosthesis (implant) affect the size of the penis? | ISSM

The AMS LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February to April AMS LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.

Users Online: Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice.

Penile lengthening and widening without grafting according to a modified ‘sliding’ technique

J Urol ; The role of penile prosthetic surgery in the modern management of erectile dysfunction. Postgrad Med J ; Implantation of model AMS penile prosthesis: Penile length alterations following penile prosthesis surgery. Eur Urol ; Early experience with the controlled girth and length expanding cylinder of the American Medical Systems Ultrex penile prosthesis.