The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia

Abstract

ObjectivesTo assess the use of an acellular collagen matrix (Pelvicol, Bard Medical, Covington, GA, USA), a successful agent for reconstructive surgery, for enhancing penile girth.Patients and methodsBetween June and December 2011, 18 patients (mean age 24 years, range 19–38) had their penis augmented with Pelvicol; the mean (range) penile circumference was 9.2 (7–13) cm before treatment. They were divided into two groups; the first (10 patients) had a Pelvicol sheet of 8 × 12 cm inserted through a V–Y suprapubic incision and wrapped around the shaft in a bilayer under the dartos fascia, but not covering the urethra, with division of the suspensory ligament. The second group of eight patients had the Pelvicol inserted through a subcoronal degloving incision and placed in one layer. The penile circumference was measured at 6 and 12 months after surgery. Patient satisfaction at 1 year after surgery was assessed as ‘poor’, ‘unsatisfied’, ‘moderately satisfied’, ‘highly satisfied’, or ‘excellent’.ResultsThe mean (range) increase in girth (circumference) was 2.8 (2–3.2) cm in group 1 and 1.7 (1.2–2) cm in group 2. In group 1, two patients were highly satisfied, four moderately satisfied and four unsatisfied; in group 2, three were moderately satisfied and five unsatisfied. Complications were common in both groups, with five patients in group 1 and three in group 2 developing severe penile oedema and ischaemic shaft ulcers. Removal of the graft was required in two patients in each group.ConclusionThis pilot study shows that Pelvicol is not an ideal option for enhancing penile girth, and the method of placement did not apparently influence the result.

Clinical applications of acellular dermal matrices: A review

“… 82 A pilot study assessing an acellular collagen matrix reported results varying by ADM insertion method, with a bilayer inserted through V-Y suprapubic incision producing greater circumference increases and patient satisfaction. 83 …”

“…One study reported that 60.3% of patients experienced erectile discomfort and 12.8% had no obvious augmentation effects when treated with ADM. 82 Reported complications include severe penile oedema, ischemic shaft ulcers, hematomas and wound infections. 82 , 83 Upon suturing the ADM to Buck’s fascia, micro-branches of the dorsal nerve of the penis may become covered and lead to less receptor threshold. 84 Additionally, a thick ADM may affect proprioception receptors in the deep tissue and on the skin surface, leading to abnormal temperature and pressure differences.…”

“…82 A pilot study assessing an acellular collagen matrix reported results varying by ADM insertion method, with a bilayer inserted through V-Y suprapubic incision producing greater circumference increases and patient satisfaction. 83 ADMs may contribute to improved erectile function and reduced premature ejaculation in penile augmentation patients. 81,84 One study followed 39 patients seeking treatment for ED, and after six months, flaccid girth increased >1 cm, erect girth by >2 cm and intravaginal ejaculatory latency time increased by 200 s on average.…”

Acellular dermal matrix in premature ejaculation

“…The ADM has been used with increased frequency over the last decade to assist during prosthetic breast reconstruction and other reconstructive surgeries. [ 20 – 22 ] ADM was also used for patients with penile augmentation and no major complications occurred in the patients received penile augmentation with ADM. [ 4 , 5 , 7 ] Alei et al used porcine dermal acellular grafts for penile augmentation in 69 candidates and followed for more than 1 year. They reported a 40% increase in penile girth during flaccidity, and 22% during erection with no major complications.…”

“…[ 4 ] With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible. Although a survey conducted by Tealab et al showed that penile augmentation by porcine acellular dermal grafts might negatively affect male sexual status (4 in 18 patients reported decreased penile sensation at 6-month visit), [ 5 ] penile enlargement by implantation of ADM was a safe and effective operation in most of the reports [ 4 , 6 ] and, no major complications occurred in the patients received penile augmentation by ADM. [ 7 ]…”