Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review

Schifano, Nicolò; Çakır, Ömer; Castiglione, Fabio; Montorsi, Francesco; Garaffa, Giulio

doi:10.1038/s41443-021-00444-5

Cited by 13 publications

(10 citation statements)

References 71 publications

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“…Penile morphometric changes represent one of the main factors, which typically may have a strong impact on the satisfaction levels after every PPI surgery. 24,25 Discussing this issue in the pre-operative setting becomes particularly important in those patients having ED secondary to Peyronie's disease. Indeed, these patients almost invariably experience post-operative penile shrinkage because of the natural history of the disease and because of the changes introduced intraoperatively, and especially so when plication or grafting are needed in addition to the PPI to correct complex deformities.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings confirmed that overall QoL and satisfaction scores after PPI were high, although the best outcomes were achieved by patients implanted for ED secondary to Peyronie's disease. Penile morphometric changes represent one of the main factors, which typically may have a strong impact on the satisfaction levels after every PPI surgery 24,25 . Discussing this issue in the pre‐operative setting becomes particularly important in those patients having ED secondary to Peyronie's disease.…”

Section: Discussionmentioning

confidence: 99%

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Which patient may benefit the most from penile prosthesis implantation?

et al. 2022

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Background Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. Aim We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. Materials and methods Data from a national multi‐institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (http://www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients’ baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re‐assessed at 1‐year follow‐up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. Results Follow‐up data were available for 285 patients (median age 60 years; interquartile range: 56–67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1‐year follow‐up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60 vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post‐operative complications (10% vs. 14%) than those with lower quality of life score (all p > 0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1 year after surgery (p = 0.02). Patients treated for Peyronie's disease (odds ratio: 2.62; p = 0.01; 95% confidence interval: 1.20–5.74) were more likely to report better outcomes after accounting for age, post‐operative complications, and surgical volume. Conclusion Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self‐image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction af...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which patient may benefit the most from penile prosthesis implantation?

et al. 2022

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“…The appearance of the penis and the males' sexual performance are intimately connected with the self-confidence of men in modern society [1], and it is not surprising that patients seeking medical help for penile girth enhancement (PGE), premature ejaculation (PE) and Peyronie's disease (PD) are on the rise more recently. In this era of growing emphasis on minimally invasive procedures, the popularity of soft tissue fillers has grown, with a renewed interest in their andrological applications.…”

Section: Introductionmentioning

confidence: 99%

“…Penile size concerns cause even patients with average-sized penises to seek penile augmentation [1], even though this field remains a controversial topic in reconstructive andrology. A variety of surgical and non-surgical strategies have been developed to address the increasing demand from these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Even though there is initial evidence [2] that levels of penile lengthening can be obtained through non-invasive strategies, effective enhancement of the length of the penis is mainly obtained through invasive surgery. Meanwhile, the demand for procedures to enlarge genital girth has increased significantly, even though a major concern is that penile girth enhancement is primarily performed for aesthetic purposes, unlike penile lengthening [1]. Although fillers have been comprehensively investigated for their use in other areas of the body, their applications in the penis pose different challenges due to the different anatomy and the larger amount of filler needed for the penis, thus requiring dedicated clinical studies.…”

Section: Introductionmentioning

confidence: 99%

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The Application of Hyaluronic Acid Injections in Functional and Aesthetic Andrology: A Narrative Review

Schifano

Capogrosso

Antonini

et al. 2023

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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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