Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results

Li, Chi‐Ying; Kayes, Oliver; Kell, Phillip D.; Christopher, Nim; Minhas, Suks; Ralph, David

doi:10.1016/j.eururo.2006.01.020

Cited by 108 publications

(77 citation statements)

References 8 publications

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“…[21] Although the author supports the use of local tissues to fill the advancement gap to additionally maintain advancement, some authors have published their experience inserting small testicular prostheses as spacers with no better results. [22] In our practice performing suspensory ligament release, skin flap advancement together with simultaneous girth enlargement using fat grafts is the most satisfactory approach to increase penis size. This composite technique generates real volume increase which results in a better perceptual outcome for the patient.…”

Section: Resultsmentioning

confidence: 99%

Composite augmentation phalloplasty: personal experience after 275 patients

Monreal¹

2015

Plast Aesthet Res

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Aim: To report the author's experience in augmentation phalloplasty by studying a retrospective series of patients who underwent fat grafting for girth enhancement or a composite technique based on suspensory ligament release plus fat grafting performed simultaneously. Methods: The author analyzed retrospectively the outcomes of 275 augmentation phalloplasty procedures performed in 259 patients until November 2013. Of these, 127 correspond to girth augmentation with fat grafting and 148 to composite augmentation phalloplasty (girth augmentation with fat grafting and length improvement by suspensory ligament release). In 16 patients girth and length enhancement were performed in two separate procedures. Results: Of this 259 patients, 87 underwent postoperative follow-up for at least 12 months and 160 patients underwent follow-up for at least 6 months. The average increase in circumference at 6 months was 1.7 cm (1.57 cm at 12 months) and the average increase in length of 3.2 cm (3.1 cm at 12 months). Twenty-two patients showed minor complications that were treated without sequelae and without influencing the final result. Conclusion: By judicious use of currently available techniques, it is possible to achieve stable increases in penis size. The use of composite techniques provides better final results than the use of individual techniques performed alone due to the increase of the actual volume of the penis. An adequate informed consent is essential in all patients due to the unrealistic expectations expressed by the majority of them.

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Section: Resultsmentioning

confidence: 99%

Composite augmentation phalloplasty: personal experience after 275 patients

Monreal¹

2015

Plast Aesthet Res

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“…The rate of poorly satisfied patients has been reported to be as high as 62%. 5 Similarly, Li et al 12 noted that despite an adequate penile length gain, the satisfaction rates were low (35% overall and 27% in the dysmorphophobic group). Other investigators published more favorable outcomes with 88%-91% of patients experiencing an improvement of self-esteem and functional status.…”

Section: Discussionmentioning

confidence: 99%

“…4 Others proposed the insertion of a silicon buffer. 12 In our opinion, the penis extender device for penile traction is a preferable option because of its relatively low cost (approximately J100), its adjustability to any penile size, its ease in wear and the fact that high motivation is not a prerequisite for its success.…”

Section: Discussionmentioning

confidence: 99%

Is V–Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique

Mertziotis¹,

Kozyrakis²,

Bogris³

2013

Asian J Androl

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Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length ,7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P50.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P50.453). Hypertrophic scars were observed in 18 men (51%) in the former group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P50.007 and ,0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size. INTRODUCTIONFor centuries, penile size has been a source of major concern and anxiety to the male population. Despite that in the majority of men, penile length is within the normal range, the concern regarding its size may lead to low self-esteem, sexual dysfunction and even psychiatric disorders. The psychiatric term 'penile dysmorphophobia' has been introduced to describe the abnormal perception of penile size, although it has normal dimensions.The majority of patients who request penile augmentation are dysmorphophobic rather than micropenile men.1,2 However, augmentation phalloplasty is not always successful and occasionally leads to penile shortening.3,4 Moreover, the reported satisfaction rates are often poor, which is most likely because the formation of even small hypertrophic scars or keloids for these patients can reduce their inclination for surgery. Therefore, detailed counseling regarding the postoperative results and surgical complications is of utmost importance.5 Several penile augmentation surgical techniques have been proposed, and the most widely performed is the incision of the suspensory ligament (ligamentolysis) combined with V-Y plasty.

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“…60 Surgically the division of the suspensory ligament, providing lengthening of the free portion of the shaft, provides little satisfaction for the patient. 61 A 'sliding technique' from Rolle et al, published in 2012, also addresses severe shortening of the penis due to Peyronie's disease. Two separate transverse incisions with posterior dilatation of the corpora cavernosa, the insertion of the prosthesis and added suture of two grafts seems promising, with an increase in length close to 3 cm.…”

Section: Penile Prosthesismentioning

confidence: 99%

Recent surgical advances in Peyronie’s Disease

Gaspar¹,

Dias²,

Martins³

et al. 2016

Acta Med Port

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RESUMOIntrodução: A doença de Peyronie, uma doença fibrótica da túnica albuginea do pénis tem estado associada a encurtamento peniano e a algum grau de disfunção eréctil. Afeta a qualidade de vida do doente, levando a stress psicológico, mental e físico. A deformidade peniana perturba a vida sexual do doente, levando a episódios de depressão, disfunções sexuais e a ansiedade associada ao ato sexual. A etiologia da doença de Peyronie permanece por esclarecer. Material e Métodos: A pesquisa na literatura foi efetuada nas bases de dados da Medline, Embase e Cochrane no mês de Janeiro de 2015 no sentido de identificar artigos relacionados com a doença de Peyronie, nomeadamente o tratamento cirúrgico, técnicas, resultados bem como tratamentos complementares. Publicações que não envolvessem humanos não foram consideradas. Identificámos artigos originais, artigos de revisão e editoriais acerca do assunto em questão. Todos os artigos publicados na língua inglesa foram selecionados para screening. Os critérios de elegibilidade para inclusão envolveram a relevância associada ao tema. Resultados: Existe uma variedade de deformidades penianas associada com a doença de Peyronie que ainda não têm uma solução não cirúrgica que seja eficaz. Apresentamos uma atualização das técnicas cirúrgicas atuais bem como o algoritmo de tratamento associada a esta doença. Discussão: Todos os tratamentos cirúrgicos têm como objetivo a correção da curvatura, a preservação da função eréctil e do comprimento peniano, bem como o de minimizar a morbilidade. Conclusão: Até à data não existem estudos de medicina baseada na evidência que determinem o melhor tratamento cirúrgico para a doença de Peyronie. Após o diagnóstico, a reconstrução cirúrgica deve ter como objetivo um pénis funcional, com uma retificação da sua curvatura que permita o acto sexual. Palavras-chave: Induração Peniana; Pénis/cirurgia; Procedimentos Cirúrgicos Urológicos Masculinos; Prótese de Pénis. ABSTRACT Introduction:Peyronie's disease, a fibrotic disorder of the tunica albuginea of the penis, has been associated with penile shortening and some degree of erectile dysfunction. It affects patient's quality of life, leading to severe psychological, mental, and physical stress. Penile deformation hampers sexual life leading to depression, lack of sexual confidence, loss of sexual function and performance anxiety. Peyronie's disease etiology is yet to be known. Material and Methods: Literature search was conducted in Medline, Embase, and Cochrane databases in January 2015 in order to identify papers related to Peyronie's disease, concerning evolving surgical management, technique, outcomes as well as ancillary treatments. Publications not concerning humans were not considered. We identified original articles, review articles, and editorials addressing the subject. All articles published in the English language were selected for screening. The eligibility criteria for inclusion were based on relevance concerning the subject. Results:The variety of penile deformities associated with P...

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Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results

Cited by 108 publications

References 8 publications

Composite augmentation phalloplasty: personal experience after 275 patients

Composite augmentation phalloplasty: personal experience after 275 patients

Is V–Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique

Recent surgical advances in Peyronie’s Disease

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