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The Role of Penile Lengthening Procedures at the Time of Penile Implant Surgery

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Penile Implant Surgery
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Abstract

The management of loss of penile length and end-stage erectile dysfunction represents a challenge for reconstructive andrologists, as penile size is one of the main determinants of patients’ satisfaction after surgery. Different strategies for simultaneous length restoration and penile prosthesis (PP) implantation have been described so far with satisfactory results. Furthermore, adjuvant strategies, such as prepubic V-Y plasty, suspensory ligament release, suprapubic lipectomy, and ventral phalloplasty, could be offered to maximize final outcomes and improve patients’ satisfaction rates.

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References

  1. Tran H, Goldfarb R, Ackerman A, Valenzuela RJ. Penile lengthening, girth, and size preservation at the time of penile prosthesis insertion. Sex Med Rev. 2017;5(3):403–12.

    Article  PubMed  Google Scholar 

  2. Smith JF, Walsh TJ, Conti SL, et al. Risk factors for emotional and relationship problems in Peyronie’s disease. J Sex Med. 2008;5:2179–84.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Egydio PH, Kuehhas FE. Penile lengthening and widening without grafting according to a modified “sliding” technique. BJU Int. 2015;116:965–72.

    Article  CAS  PubMed  Google Scholar 

  4. Dillon BE, Chama NB, Honig SC. Penile size and penile enlargement surgery: a review. Int J Impot Res. 2008;20:519–29.

    Article  CAS  PubMed  Google Scholar 

  5. Haliloglu A, Baltaci S, Yaman O. Penile length changes in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. J Urol. 2007;177:128–30.

    Article  PubMed  Google Scholar 

  6. Park KK, Lee SH, Chung BH. The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: a single-center, prospective, open-label, observational study. J Sex Med. 2011;8:3214–9.

    Article  CAS  PubMed  Google Scholar 

  7. Whelan P, Levine LA. Additional procedures performed at time of penile prosthesis implantation: a review of current literature. Int J Impot Res. 2020;32(1):89–98.

    Article  PubMed  Google Scholar 

  8. Kueronya V, Miernik A, Stupar S, et al. International multi-centre psychometric evaluation of patient-reported outcome data for the treatment of Peyronie’s disease. BJU Int. 2015;115(5):822–8.

    Article  PubMed  Google Scholar 

  9. Gaffney CD, Pagano MJ, Weinberg AC, et al. Lengthening strategies for Peyronie’s disease. Transl Androl Urol. 2016;5(3):351–62.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Reddy AG, Alzweri LM, Gabrielson AT, et al. Role of penile prosthesis in priapism: a review. World J Mens Health. 2018;36(1):4–14.

    Article  PubMed  Google Scholar 

  11. Munding MD, Wessells HB, Dalkin BL. Pilot study of changes in stretched penile length 3 months after radical retropubic prostatectomy. Urology. 2001;58(4):567–9.

    Article  CAS  PubMed  Google Scholar 

  12. Akin Y, Sahiner IF, Usta MF. The impact of diabetes mellitus on penile length in men undergoing inflatable penile prosthesis implantation. Turk J Urol. 2013;39:161–4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kadono Y, Machioka K, Nakashima K, et al. Changes in penile length after radical prostatectomy: investigation of the underlying anatomical mechanism. BJU Int. 2017;120:293–9.

    Article  PubMed  Google Scholar 

  14. Frey A, Pederson C, Lindberg H, et al. Prevalence and predicting factors for commonly neglected sexual side effects to external-beam radiation therapy for prostate cancer. J Sex Med. 2017;14:558–65.

    Article  PubMed  Google Scholar 

  15. Deveci S, Martin D, Parker M, et al. Penile length alterations following penile prosthesis surgery. Eur Urol. 2007;51:1128–31.

    Article  PubMed  Google Scholar 

  16. Lever J, Frederick DA, Peplau LA. Does size matter? Men’s and women’s views on penis size across the lifespan. Psychol Men Masc. 2006;7:129–43.

    Article  Google Scholar 

  17. Montorsi F, Rigatti P, Carmignani G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50.

    Article  CAS  PubMed  Google Scholar 

  18. Wang R, Howard GE, Hoang A, et al. Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection. Asian J Androl. 2009;11:411–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Osterberg EC, Maganty A, Ramasamy R, et al. Pharmacologically induced erect penile length and stretched penile length are both good predictors of post-inflatable prosthesis penile length. Int J Impot Res. 2014;26:128–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sellers T, Dineen M, Salem EA, et al. Vacuum preparation, optimization of cylinder length and postoperative daily inflation reduces complaints of shortened penile length following implantation of inflatable penile prosthesis. Adv Sex Med. 2013;3:14–8.

    Article  Google Scholar 

  21. Barrett-harlow B, Clavell-hernandez J, Wang R. New developments in surgical treatment for penile size preservation in Peyronie’s disease. Sex Med Rev. 2019;7:156–66.

    Article  PubMed  Google Scholar 

  22. Hatzichristodoulou G, Osmonov D, Kübler H, Hellstrom WJG, Yafi FA. Contemporary review of grafting techniques for the surgical treatment of Peyronie’s disease. Sex Med Rev. 2017;5:544–52.

    Article  PubMed  Google Scholar 

  23. Hatzichristodoulou G. Grafting techniques for Peyronie’s disease. Transl Androl Urol. 2016;5:334–41.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Moncada I, Martinez-Salamanca JI, Jara J, et al. Inflatable penile prosthesis implantation without corporeal dilation: a cavernous tissue sparing technique. J Urol. 2010;183:1123–6.

    Article  PubMed  Google Scholar 

  25. Zaazaa A, Mostafa T. Spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile prosthesis implantation. J Sex Med. 2019;16:474–8.

    Article  PubMed  Google Scholar 

  26. Weinberg AC, Pagano MJ, Deibert CM, et al. Sub-coronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med. 2016;13:270–6.

    Article  PubMed  Google Scholar 

  27. Yavuz U, Ciftci S, Ustuner M, et al. Surgical treatment of erectile dysfunction and Peyronie’s disease using malleable prosthesis. Urol J. 2015;12:2428–33.

    PubMed  Google Scholar 

  28. Safarinejad MR. Re: Surgical treatment of erectile dysfunction and Peyronie’s disease using malleable prosthesis. Urol J. 2015;12:2434–5.

    PubMed  Google Scholar 

  29. Yafi FA, Hatzichristodoulou G, DeLay KJ, et al. Review of management options for patients with atypical Peyronie’s disease. Sex Med Rev. 2017;5:211–21.

    Article  PubMed  Google Scholar 

  30. Rolle L, Falcone M, Ceruti C, et al. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the “sliding” technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117:814–20.

    Article  CAS  PubMed  Google Scholar 

  31. Do F, Matter C, Kozacioglu Z, Degirmenci T, Gunlusoy B, Kara C, et al. Effect of tunical defect size after Peyronie’s plaque excision on postoperative erectile. Urology. 2012;80:1051–5.

    Article  Google Scholar 

  32. Wilson SK, Delk JR. A new treatment for Peyronie’s disease: modeling the penis over an inflatable penile prosthesis. J Urol. 1994;152:1121–3.

    Article  CAS  PubMed  Google Scholar 

  33. Perito P, Wilson SK. The Peyronie’s plaque “scratch”: an adjunct to modeling. J Sex Med. 2013;10:1194–7.

    Article  PubMed  Google Scholar 

  34. Austoni E, Colombo F, Romanò AL, Guarneri A, Kartalas Gou-mas I, Cazzaniga A. Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie’s disease: a 5-year experience and long-term follow-up on 145 operated patients. Eur Urol. 2005;47:223–9.

    Article  PubMed  Google Scholar 

  35. Zucchi A, Silvani M, Pecoraro S. Corporoplasty with small soft axial prostheses (VIRILIS I®) and bovine pericardial graft (HYDRIX®) in Peyronie’s disease. Asian J Androl. 2013;15:275–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Perovic SV, Djinovic RP. Current surgical management of severe Peyronie’s disease. Arch Esp Urol. 2010;63(9):755–70.

    Article  PubMed  Google Scholar 

  37. Hatzichristodoulou G. The PICS technique: a novel approach for residual curvature correction during penile prosthesis implantation in patients with severe Peyronie’s disease using the collagen fleece TachoSil. J Sex Med. 2018;15:416–21.

    Article  PubMed  Google Scholar 

  38. Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical technique for complex cases of Peyronie’s disease with implantation of penile prosthesis, multiple corporeal incisions, and grafting with collagen fleece. J Sex Med. 2019;16(2):323–32.

    Article  PubMed  Google Scholar 

  39. Rigaud G, Berger RE. Corrective procedures for penile shortening due to Peyronie’s disease. J Urol. 1995;153:368–70.

    Article  CAS  PubMed  Google Scholar 

  40. Sansalone S, Garaffa G, Djinovic R, Egydio PH, Vespasiani P, Miano R, et al. Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie’s disease, refractory erectile dysfunction, and severe penile shortening. J Sex Med. 2012;9:316–21.

    Article  PubMed  Google Scholar 

  41. Egydio PH, Kuehhas FE, Sansalone S. Penile length and girth restoration in severe Peyronie’s disease using circular and longitudinal grafting. BJU Int. 2013;111(4 Pt B):E213–9.

    Article  PubMed  Google Scholar 

  42. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, et al. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012;9:2389–95.

    Article  PubMed  Google Scholar 

  43. Egydio PH, Kuehhas FE, Valenzuela RJ. Modified Sliding Technique (MoST) for penile lengthening with insertion of inflatable penile prosthesis. J Sex Med. 2015;12(5):1100–4.

    Article  PubMed  Google Scholar 

  44. Egydio PH, Kuehhas FE. The Multiple-Slit Technique (MUST) for penile length and girth restoration. J Sex Med. 2018;15(2):261–9.

    Article  PubMed  Google Scholar 

  45. Egydio PH. An innovative strategy for non-grafting penile enlargement: a novel paradigm for tunica expansion procedures [published online ahead of print, 2020 Jul 4]. J Sex Med. 2020:S1743-6095(20)30646-9.

    Google Scholar 

  46. García Gómez B, Romero Otero J, Díez Sicilia L, Jiménez Alcaide E, García-Cruz E, Rodríguez AA. Ischemic gangrene of the glans following penile prosthesis implantation. Case Rep Urol. 2013;323574:2013.

    Google Scholar 

  47. Wilson SK, Mora-Estaves C, Egydio P, Ralph D, Habous M, Love C, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:1448.

    Article  Google Scholar 

  48. Vandeput JJ, Tanner JC, Boswick J. Implementation of parameters in the expansion ratio of mesh skin grafts. Plast Reconstr Surg. 1997;100:653–6.

    Article  CAS  PubMed  Google Scholar 

  49. Srinivas B, Vasan S, Mohammed S. Penile lengthening procedure with V-Y advancement flap and an interposing silicone sheath: a novel methodology. Indian J Urol. 2012;28:340–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Baumgarten AS, Beilan JA, Shah BB, et al. Suprapubic fat pad excision with simultaneous placement of inflatable penile prosthesis. J Sex Med. 2019;16:333–7.

    Article  PubMed  Google Scholar 

  51. Li CY, Kayes O, Kell PD, et al. Penile suspensory ligament division for penile augmentation: indications and results. Eur Urol. 2006;49:729–33.

    Article  PubMed  Google Scholar 

  52. Shaeer O, Shaeer K, El-Sebaie A. Minimizing the losses in penile lengthening: “V-Y half-skin half-fat advancement flap” and “T-closure” combined with severing the suspensory ligament. J Sex Med. 2006;3:155–60.

    Article  PubMed  Google Scholar 

  53. Borges F, Hakim L, Kline C. Surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via infrapubic approach. J Sex Med. 2006;3:550–3.

    Article  PubMed  Google Scholar 

  54. Ce H, Vorstman B, Teasley D, Winslow B. Hidden penis release: adjunctive suprapubic lipectomy. Ann Plast Surg. 1987;19:131–4.

    Article  Google Scholar 

  55. Shaeer O. Supersizing the penis following penile prosthesis implantation. J Sex Med. 2010;7:2608–16.

    Article  PubMed  Google Scholar 

  56. Vollstedt A, Gross MS, Antonini G, et al. The infrapubic surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:620–7.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pestana IA, Greenfield JM, Walsh M, et al. Management of “buried” penis in adulthood: an overview. Plast Reconstr Surg. 2009;124:1186–95.

    Article  CAS  PubMed  Google Scholar 

  58. Adham M, Teimourian B, Mosca P. Buried penis release in adults with suction lipectomy and abdominoplasty. Plast Reconstr Surg. 2000;106:840–4.

    Article  CAS  PubMed  Google Scholar 

  59. Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med. 2007;4:1494–9.

    Article  PubMed  Google Scholar 

  60. Caso JR, Myers MD, Wiegand L, et al. Phalloplasty and penile implant surgery. Curr Urol Rep. 2009;10:475–7.

    Article  PubMed  Google Scholar 

  61. Gupta NK, Sulaver R, Welliver C, Kottwitz M, Frederick L, Dynda D, et al. Scrotoplasty at time of penile implant is at high risk for dehiscence in diabetics. J Sex Med. 2019;16:602–8.

    Article  PubMed  Google Scholar 

  62. Chung E. Penile reconstructive surgery in Peyronie disease: challenges in restoring normal penis size, shape, and function. World J Mens Health. 2018;36

    Google Scholar 

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Preto, M., Garaffa, G. (2022). The Role of Penile Lengthening Procedures at the Time of Penile Implant Surgery. In: Miranda, E.P., Mulhall, J.P. (eds) Penile Implant Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-82363-4_9

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  • DOI: https://doi.org/10.1007/978-3-030-82363-4_9

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