Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome

Abstract

There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation (PA) using injectable hyaluronic acid (HA) gel. Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year. Penile size, erectile function, and psychological burden measured by the Index of Male Genital Image (IMGI), Index of International Erectile Function (IIEF), and Beliefs about Penis Size (BPAS), respectively, were assessed at the beginning and at 1, 3, 6, and 12 months postinjection. The volume of HA gel injected was 21.5 ± 3.7 ml. Compared to baseline data, flaccid penile girth and length significantly increased by 3.41 ± 0.95 cm ( P < 0.01) and 2.55 ± 0.55 cm ( P < 0.01) at the 1 st month postinjection, respectively. At the endpoint, despite attenuations, statistically significant improvements in flaccid penis size were still obtained, namely 2.44 ± 1.14 cm in girth ( P < 0.01) and 1.65 ± 0.59 cm in length ( P < 0.01). Similarly, erectile penile girth statistically increased by 1.32 ± 1.02 cm ( P < 0.01) at the 1 st month but were only 0.80 ± 0.54 cm bigger than baseline ( P < 0.01) at the endpoint. At the 1 st month, the average score of IMGI and the mean score of IIEF statistically increased by 46.2 ± 10.5 ( P < 0.01) and 7.6 ± 6.2 ( P < 0.01), respectively; the score of BAPS significantly decreased by 18.3 ± 4.5 ( P < 0.01). These alterations remained steady during follow-up. Considering the significant penile size improvement, lasting psychological benefit, and low complication rate, PA with HA might serve as an appropriate alternative for patients with SPS.

Commentary on “Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome”

“…Follow-up data were collected for 1 year (1 month, 3 months, 6 months, and 12 months) and included physical outcomes (flaccid and erect penile length and girth) and psychological measures (Index of Male Genital Image [IMGI], International Index of Erectile Function [IIEF], and Beliefs About Penis Size [BAPS] scales). 1 There was significant increase from baseline in both flaccid and erect length and girth measurements over all follow-up visits. The 1-month follow-up demonstrated the most pronounced increases in girth and length, at 3.41 ± 0.95 cm ( P < 0.01) and 2.55 ± 0.55 cm ( P < 0.01), respectively.…”

“…Current literature on this procedure is sparse, and the findings and experiences reported in Zhang et al . 1 are indeed promising in the context of SPS.…”

“…It is paramount to mention that the results reported herein by Zhang et al . 1 suggest that HA injections can be a safe and effective solution for patients with SPS. The positive physical outcomes, duration of such outcomes, and mild postoperative complications such as edema and subcutaneous bleeding are consistent with existing literature.…”

“…We read with special interest the study by Zhang et al . 1 regarding hyaluronic acid penile augmentation for patients with small penis syndrome (SPS). Utilization of hyaluronic acid (HA)-based injections as dermal filler has become increasingly popular in the past decade.…”

“…Traditionally, multiple strategies have been employed for esthetic penile augmentation, including HA injection as documented above, vacuum pumps, penile extenders, and various surgical interventions such as ligament dissection and dermal fat grafts. 1 In comparison to noninvasive treatments, HA injections are often considered longer-lasting and more convenient. Critically, the authors explained when compared to surgical penile augmentation procedures, HA injection is a less invasive treatment modality with lower morbidity.…”