Purpose of Review
The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues.
Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings.
Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.
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Papers of particular interest, published recently, have been highlighted as: • Of importance
Welliver C. Erectile dysfunction: patient evaluation, investigations. AUA Core Curriculum. 2020.
Mulhall JP, Luo X, Zou K, Stecher V, Galaznik A. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA. Int J Clin Pract. 2016;70:1012–8. https://doi.org/10.1111/ijcp.12908.
Goldstein I, Goren A, Li VW, Tang WY, Hassan TA. Epidemiology update of erectile dysfunction in eight countries with high burden. Sex Med Rev. 2020;8:48–58. https://doi.org/10.1016/j.sxmr.2019.06.008.
Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. AUA guidelines: Erectile Dysfunction. 2018.
Osterberg EC, Maganty A, Ramasamy R, Eid JF. 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. https://doi.org/10.1038/ijir.2013.50.
Deveci S, Martin D, Parker M, Mulhall JP. Penile length alterations following penile prosthesis surgery. Eur Urol. 2007;51:1128–31. https://doi.org/10.1016/j.eururo.2006.10.026.
Habous M, Giona S, Tealab A, Aziz M, Sherif H, Abdelwahab O, et al. Penile length is preserved after implant surgery. BJU Int. 2019;123:885–90. https://doi.org/10.1111/bju.14604.
Habous M, Muir G, Soliman T, Farag M, Williamson B, Binsaleh S, et al. Outcomes of variation in technique and variation in accuracy of measurement in penile length measurement. Int J Impot Res. 2017;30:21–6. https://doi.org/10.1038/s41443-017-0013-3.
Xie D, Nicholas M, Gheiler V, Perito D, Siano L, Kislinger I, et al. A Prospective Evaluation of Penile Measures and Glans Penis Sensory Changes after Penile Prosthetic Surgery. Transl Androl Urol. 2017;6:529–33. https://doi.org/10.21037/tau.2017.05.34.
• Wang R, Howard GE, Hoang A, Yuan JH, Lin HC, Dai YT. 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. https://doi.org/10.1038/aja.2009.35This was one of the first papers to show an overall decrease in penile length post operatively after 3-piece IPP placement.
• Saavedra-Belaunde JA, Clavell-Hernandez J, Wang R. Epidemiology regarding penile prosthetic surgery. Asian J Androl. 2020;22:2–7. https://doi.org/10.4103/aja.aja_124_19This is an up to date review of the epidemiology of men undergoing penile prosthetic surgery and common conditions today that lead to the development of ED.
Munding MD, Wessells HB, Dalkin BL. Pilot study of changes in stretched penile length 3 months after radical Retropubic prostatectomy. Urology. 2001;58:567–9. https://doi.org/10.1016/s0090-4295(01)01270-5.
Kim KS, Bae WJ, Kim SW, Lee MY. Experience with AMS 700 LGX Penile Prostheses for Preserving Penile Length in Korea. BMC Urol. 2019. https://doi.org/10.1186/s12894-018-0425-5.
Lee KCJ, Brock GB. Strategies for maintaining penile size following penile implant. Strategies for Maintaining Penile Size Following Penile Implant. 2013;2:67–73. https://doi.org/10.3978/j.issn.2223-4683.2013.01.05.
Wallen JJ, Madiraju SK, Wang R, Henry GD. Implementation of length expanding inflatable penile prosthesis is not sufficient to prevent postsurgical penile shortening. Asian Journal of Andrology. 2018;21:98–100. https://doi.org/10.4103/aja.aja_77_18.
Wilson SK, Levin L, Wang R. Make It as Long as You Can, Doc. Concomitant Surgical Treatments with Penile Implant to Enhance Penile Size. International Journal of Impotence Research. 2020. https://doi.org/10.1038/s41443-020-0306-9.
Canguven O, Talib RA, Campbell J, Young LD, El Ansari W, Al-Ansaria A. Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? A randomized controlled trial. Andrology. 2016;5:103–6. https://doi.org/10.1111/andr.12258.
Köhler TS, Pedro R, Hendlin K, Utz W, Ugarte R, Reddy P, et al. A pilot study on the early use of the vacuum erection device after radical Retropubic prostatectomy. BJU Int. 2007;100:858–62. https://doi.org/10.1111/j.1464-410x.2007.07161.x.
Gontero P, Di Marco M, Giubilei G, Bartoletti R, Pappagallo G, Tizzani A, et al. A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’. BJU Int. 2009;103:793–7. https://doi.org/10.1111/j.1464-410x.2008.08083.x.
Levine LA, Rybak J. Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study. J Sex Med. 2011;8:2112–7. https://doi.org/10.1111/j.1743-6109.2011.02285.x.
Welliver C, Kottwitz M, Ahmad AE, Wilson SK, Köhler TS. Manufacturers’ data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol. 2015;34:993–8. https://doi.org/10.1007/s00345-015-1705-2.
Chung PH, Siegel JA, Tausch TJ, Klein AK, Scott JM, Morey AF. Inflatable penile prosthesis as tissue expander: what is the evidence? Int Braz J Urol. 2017;43:911–6. https://doi.org/10.1590/s1677-5538.ibju.2016.0528.
Negro CLA, Paradiso M, Rocca A, Bardari F. Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures. Asian Journal of Andrology. 2015;18:114–7. https://doi.org/10.4103/1008-682x.154311.
Caso JR, Myers MD, Wiegand L, Rodriguez A, Hann S, Carrion R. Phalloplasty and penile implant surgery. Current Urology Reports. 2009;10:475–7. https://doi.org/10.1007/s11934-009-0075-y.
Hakky TS, Suber J, Henry G, Smith D, Bradely P, Martinez D, et al. Penile Enhancement Procedures with Simultaneous Penile Prosthesis Placement. Adv Urol. 2012. https://doi.org/10.1155/2012/314612.
Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. ORIGINAL RESEARCH—SURGERY: 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. https://doi.org/10.1111/j.1743-6109.2007.00551.x.
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. https://doi.org/10.1016/j.jsxm.2019.02.001.
Baumgarten AS, Beilan JA, Shah BB, Loeb A, Bickell M, Parker J, et al. Suprapubic fat pad excision with simultaneous placement of inflatable penile prosthesis. J Sex Med. 2019;16:333–7. https://doi.org/10.1016/j.jsxm.2018.12.005.
Borges F, Hakim L, Kline C. ORIGINAL RESEARCH-SURGERY: surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via Infrapubic approach. J Sex Med. 2006;3:550–3. https://doi.org/10.1111/j.1743-6109.2006.00232.x.
Shaeer O, Shaeer K, El-Sebaie A. ORIGINAL RESEARCH-SURGERY: 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. https://doi.org/10.1111/j.1743-6109.2005.00105.x.
• 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’. The Journal of Sexual Medicine. 2012;9:2389–95. https://doi.org/10.1111/j.1743-6109.2012.02675.xPaper reviews a novel “Sliding technique” for prosthesis placement in Peyronie’s disease.
Egydio PH, Kuehhas FE. The multiple-slit technique (MUST) for penile length and girth restoration. J Sex Med. 2018;15:261–9. https://doi.org/10.1016/j.jsxm.2017.11.223.
Wilson SK, Mora-Estaves C, Egyido P, Ralph D, Habous M, Love C, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144–8. https://doi.org/10.1016/j.urology.2017.06.020.
Fang A, Wang R. Nondegloving technique for Peyronie′s disease with penile prosthesis implantation and double dorsal-ventral patch graft. Asian Journal of Andrology. 2018;20:90–2. https://doi.org/10.4103/aja.aja_42_17.
• Clavell-Hernández J, Wang R. Penile Size Restoration With Nondegloving Approach for Peyronie’s Disease: Initial Experience. The Journal of Sexual Medicine. 2018;15:1506–13. https://doi.org/10.1016/j.jsxm.2018.07.003Paper reviews a novel non- degloving surgical method for penile prothesis placement with graft in Peyronie’s disease.
Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast titan inflatable penile prosthesis. J Sex Med. 2015;12:1298–304. https://doi.org/10.1111/jsm.12833.
Pryor MB, Carrion R, Wang R, Henry G. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast titan prosthesis. Asian Journal of Andrology. 2016;18:754–8. https://doi.org/10.4103/1008-682x.163266.
Benevides MD, Carson CC. Intraurethral application of Alprostadil in patients with failed inflatable penile prosthesis. J Urol. 2000;163:785–7. https://doi.org/10.1097/00005392-200003000-00019.
Mulhall JP, Jahoda A, Aviv N, Valenzuela R, Parker M. The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ. BJU Int. 2004;93:97–9. https://doi.org/10.1111/j.1464-410x.2004.04564.x.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Interest
Conflict of Interest
Run Wang, MD, FACS – Consultant for Boston Scientific, Coloplast, and Teleflex.
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Chang, C., Wang, R. A Review on Penile Length and Girth Issues in Penile Prosthetic Surgery. Curr Urol Rep 22, 16 (2021). https://doi.org/10.1007/s11934-021-01032-2
- Erectile dysfunction
- Penile shortening
- Penile length
- Penile girth
- Penile prosthesis