Increase In Penile Length Research Articles

(052) Penile Length Enhancement with Suspensory Ligament Release, Corporal Advancement, and Periosteal Stabilization

Abstract Introduction Penile shortening is a common complaint with multiple etiologies. To date, safe and efficacious options have been limited. Release of the penile suspensory ligament has been described for penile augmentation with a reported increase in penile length, However, a simple release of the suspensory ligament sacrifices the stability of the erect penis. We propose a novel technique of dividing the penile suspensory ligament while simultaneously advancing the corporal bodies and maintaining penile stability with periosteal anchoring of the corpora to the pubic symphysis. Objective We demonstrate a method to increase penile length by releasing the suspensory ligament while simultaneously performing corporal body advancement and anchoring of the corpora to the periosteum of the pubic symphysis. Methods An IRB protocol was submitted to the State University of New York at Buffalo IRB committee. The project was found to be IRB-exempt. A test procedure was performed on a male cadaver. A 3cm transverse infrapubic incision was made one fingerbreadth superior to the dorsal aspect of the penis. Scarpa’s fascia and the fundoform ligament were dissected to expose the suspensory ligament and dorsal phallus. Stretched penile length was measured. The suspensory ligament of the penis was released and the corporal bodies were advanced. A 2-0 Ethibond suture was placed through the periosteum of the inferior aspect of the pubic symphysis and tunica albuginea bilaterally in an intervascular manner. Stretched length was again measured with an increase of approximately four centimeters observed. Results In our cadaveric model, simultaneous penile suspensory ligament with corporal advancement and reattachment resulted in a four-centimeter increase in stretched penile length. Conclusions Simply releasing the suspensory ligament may lead to penile instability, scar tissue formation, and retraction of gained penile length. In this cadaveric model, we demonstrate suspensory ligament release with stabilization of the phallus is viable and may offer a method to increase stretched penile length. Disclosure No.

Treatment of penile curvature with aldehyde free bovine pericardium graft: an original and prospective evaluation of a cohort of patients with peyronie’s disease

Introduction: Peyronie´s disease (PD) is a common condition that can cause penile curvature and /or deformities and therefore affecting the male sexual function. The most effective treatment for clinically significative and stable penile curvature due to PD is the reconstructive surgery that involves techniques that do not shorten the penile length. Among the techniques that correct the curvature restoring the penile length, the incision and/or excision of the plaque, followed by the reconstruction of the defect with a graft remains as the gold standard. Although several materials have been used as a graft in the treatment of penile curvature due to PD, none have shown results good enough to be considered as the first choice. Herein, we aimed to evaluate the results of the surgical treatment of patients with penile curvature due to PD using a new biograft. Methodology: We performed the surgical management with graft technique in twelve men suffering from penile curvature due to PD. Penile curvature was measured before and one year after the reconstructive procedure. The graft of choice was the bovine pericardium graft segment treated with L-Hydro aldehyde-free technology. Erectile function was evaluated by the IIEF questionnaire and penis length was measured by a rigid rule during the pharmacological induced erection test. Results: The overall success rate of correction of the penile curvature was 90.9% and the patient’s satisfaction rate was 91.7%. No serious adverse events were found and erectile function impaired in 18.2%.There was an increase in penile length in 91.7% and this ranged from 0.7 to 3.0 cm. Conclusion: Correction of penile curvature due to Peyronie's disease using the technique of incision and/or excision of the plaque with the aldehyde-free bovine pericardium graft has high success rates in terms of both penile shaft rectification and patient satisfaction. L-hydro bovine pericardium graft is easy to handle surgically, allows a tight anastomosis and does not present serious postoperative complications. Furthermore, it can be used simultaneously with penile implants and appears to have a role in restoring penile length.

(130) Increasing Penile Length and Girth in Healthy Men Using a Novel Protocol: The P-Long Study

Abstract Introduction Various therapies have been utilized to increase penile length and girth, with some exhibiting significant adverse event profiles, including fillers, fat transfers, suspensory ligament ligation, and silicon augmentation. Our team sought to evaluate a novel combination therapy to enhance penile characteristics using platelet-rich plasma (PRP) as a source of autologous growth factors, penile traction for lengthening, a vacuum erection device for girth enhancement, and nitric oxide precursor supplements to augment penile vascular smooth muscle function. Objective To evaluate the safety and efficacy of combination therapy with PRP, traction, vacuum device, and nitric oxide boosting nutritional supplements to increase penile length, girth, and function in healthy men. Methods A prospective, non-randomized study was designed (NCT04231422) to evaluate the efficacy of combination therapy in healthy men aged 20-55 with baseline normal erectile function and no penile pathology. Penile length and girth measurements were obtained using at-home photography of an erect penis with maximal tumescence. Measurements were obtained at baseline and at monthly intervals x 6 months. PRP (a modified P-Shot ® Procedure) was administered in the right and left corpora under ultrasound guidance once a month for six months using PureSpin double spin system (60cc blood drawn). Centrifuge technical data show an average platelet recovery of 84% and an average concentration of 6.6 times that of the whole blood sample. Using this data, the injection of 10cc of PRP, assuming a starting platelet count of 250K/microliter, would contain approximately 1.65 billion platelets. Subjective erectile function was assessed with a 5 point Likert Scale. RestoreX traction device was utilized for 20 minutes, twice daily, and a Dr Joel Kaplan vacuum erection device was applied with 5-10 mmHg pressure x 12 minutes (1 min x 2, 5 min x 2). Oral nitric oxide boosting supplementation was with AFFIRM, consisting of 3 gm L-Citrulline and 1 gm beet extract. Results A total of 32 men have been enrolled, with 16 having complete data available for review. The 6-month mean increase in the size of the erect penis was 0.85 inches in length (95% CI: 0.75 to 0.94, p-value < 0.01) (range 0.5-1.44) with a linear increase in size. The 6-month mean increase in circumference was 0.47 inches (95% CI: 0.37 to 0.57, p-value <0.01) (range 0.2-0.75). Mean age was 32 and mean baseline erect penile length was 5.70 and girth was 5.25. All 16 participants reported better penile rigidity with erections. No adverse events were reported. Conclusions Results from a pilot study using a novel combination therapy (P-Long Protocol) in healthy men demonstrated increases in penile length, girth, and subjective rigidity improvement compared to baseline with no adverse effects. External validation is warranted. The P-Long Protocol does not require any synthetic injectables or foreign bodies. It does not preclude additional augmentation procedures. The slope of the growth curve indicates possible continued growth with additional treatments. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: BTL Inc.

PENIS GROWTH RESPONSE TO HORMONAL THERAPY IN CHILDREN WITH MICROPENIS AT HASAN SADIKIN HOSPITAL

Objective: This study aims to determine the response of penis growth to testosterone injection. Material & Methods: The study was conducted on all cases of micropenis from January 2016 to December 2020. Each subject who met the criteria for micropenis received 25 mg of intramuscular testosterone ester injection, in 4 doses with an interval of 1 week. Evaluation is done at the beginning, before administration of testosterone, then an evaluation is carried out for each patient before testosterone injection until 1 week after the 4th injection. Penis measurement is done by fully stretched length measurement. Results: There were 62 patients who met the criteria for micropenis. The average age of patients with micropenis when they first came was 5.9 years. The patient's mean initial penile length was 2.13 cm. There was an increase in penis length of 32% in the first injection, 28% after the second injection, 18% after the third injection and 14% after the fourth injection. The average length of the penis at the first, second, third and fourth injections was 2.53 cm, 3.24 cm, 3.65 cm and 4.01 cm, respectively. At the end of treatment, there was an average increase in penile length of 75.8% compared to the beginning of treatment. Conclusion: In conclusion, it can be said that testosterone therapy in micropenis patients gave a good response in terms of increasing penile length by 75.8% and increasing the average from 2.13 cm to 4.01 cm.

Gonadotropin administration to mimic mini-puberty in hypogonadotropic males: pump or injections?

Newborns with congenital hypogonadotropic hypogonadism (CHH) have an impaired postnatal activation of the gonadotropic axis. Substitutive therapy with recombinant gonadotropins can be proposed to mimic physiological male mini-puberty during the first months of life. The aim of this study was to compare the clinical and biological efficacy of two treatment modalities of gonadotropins administration during mini-puberty in CHH neonates. Multicenter retrospective analytical epidemiological study comparing two treatments, pump vs injection, between 2004 and 2019. Clinical (penile size, testis size, testicular descent) and biological parameters (serum concentrations of testosterone, anti-Müllerian hormone (AMH) and Inhibin B) were compared between the two groups by multivariate analyses. Thirty-five patients were included. A significantly higher increase in penile length and testosterone level was observed in the injection group compared to the pump group (+0.16 ± 0.02 mm vs +0.10 ± 0.02 mm per day, P = 0.002; and +0.04 ± 0.007 ng/mL vs +0.01 ± 0.008 ng/mL per day, P = 0.001). In both groups, significant increases in penile length and width, testosterone, AMH, and Inhibin B levels were observed, as well as improved testicular descent (odds ratio of not being in a scrotal position at the end of treatment = 0.97 (0.96; 0.99)). Early postnatal administration of recombinant gonadotropins in CHH boys is effective in stimulating penile growth, Sertoli cell proliferation, and testicular descent, with both treatment modalities.

Effect of Preoperative Androgen Stimulation on Penile Size and Postoperative Complication Rate in Patients with Hypospadias: A Systematic Review and Meta-Analysis.

To systematically review and evaluate the beneficial effects of preoperative androgen stimulation (PAS) on penile length, glans width, and postoperative complications in patients with hypospadias using meta-analysis. A comprehensive search of the published literature between 1980 and 2022 was done on PubMed, Embase, Google Scholar, Scopus, Web of Science, and Proquest. Studies of patients with 5-alpha reductase deficiency, differentiation sex disorder, or micro-penis without hypospadias were excluded. The full-text screening, quality assessment, and data acquisition were done independently by two reviewers. Meta-analysis was done to quantify the penile growth and postoperative complications. The initial literature search yielded 2,389 records, wherein 32 studies were eligible for the systematic review and meta-analysis. Preoperative testosterone stimulation increased the penile length and glans width by 9.34 mm (95% CI: 6.71-11.97) and 3.26 mm (95% CI: 2.50-4.02), respectively. A longer penis at the baseline led to greater length gain following treatment (1 mm longer at the baseline was likely to gain 0.5 mm more). However, the increase in penile length was not associated with the severity of hypospadias. While the treatment did not affect the overall complication rate, the postoperative fistula risk was lower in those receiving PAS (RR=0.52, 95% CI: 0.30-0.91, p=0.02). The beneficial effects of PAS on increasing the penile length and glans width were again confirmed. More gain of penile length was expected in the larger penis at baseline. There are no reported increased postoperative complications in association with PAS.

Parenteral testosterone therapy’s effect on penile size before hypospadias surgery

Objectives: The purpose of this study was to see the effect of parenteral testosterone injection on penile length, glans diameter, and diameter at the base of the penis in hypospadias patients before surgery. Material and Methods: The study was conducted from September 2019 to March 2021. This study comprised a total of 20 hypospadias patients. At a dose of 2 mg/kg body weight, an injection testosterone propionate was administered deep intramuscularly in three doses with a 3-week gap before reconstructive surgery. Before surgery, the penile length, glans diameter, and penile diameter at the base of the penis were all measured. Results: The mean increase in penile length, glans diameter, and diameter at the base of penis following parenteral testosterone therapy was 1.07 ± 0.23 cm (P < 0.001), 1.01 ± 0.46 cm (P < 0.001), and 0.92 ± 0.12 cm (P < 0.001), respectively. All three measurements were statistically significant. Conclusion: Intramuscular testosterone increased penis size, glans diameter, and penile diameter without causing any notable side effects. Development of fine pubic hair, acne, and aggressiveness is minor adverse effects.

Penile lenghthening original technique using a pubo-cavernous spacer. Long term results from a series of over 200 patients.

We report our long experience in the surgical treatment of patients requesting penile lengthening by suspensory ligament release and placement of a custom-made soft silicone pubo-cavernous spacer. The aim was to show that with this surgical technique the results obtained are maintained over time. It is crucial to achieve postoperative satisfaction of these patients who show fragility and self-esteem problems. From 1999 to 2020, we treated 245 patients with congenital or acquired penile brevity. We carefully analysed the preoperative and postoperative (at 6, 12, 24 and 48 months) penile size of the patients to evaluate whether this technique could allow the long-term maintenance of aesthetic results. We also assessed preoperative erectile function and we focused on the psychological aspects to avoid surgery in patients with dysmorphophobia. This original technique involves the section of the suspensory ligament and the implantation of a silicone spacer between the pubic symphysis and the corpora cavernosa. This spacer is conformed to the patient anatomy and maintains the relationship between the anatomical structures unchanged over time. Sexual self-esteem and patient satisfaction were assessed with the APPSSI questionnaire. The mean increase in penile length was about 2.5 cm in flaccid state and 1.9 cm in stretched state. There were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction was noted. These results persisted at 6, 12, 24 and 48 months without significant differences. Over 80% of patients stated that they were completely satisfied with the results obtained. This satisfaction remained stable along follow up. The section of the suspensory ligament and the implant of the soft silicone spacer provide real penis elongation with satisfactory results that persist over time. This technique avoids the frequent complication of short-term shortening due to the scar adhesions of the edges of the dissected ligament. The high aesthetic satisfaction of patients is stable at controls at 6, 12, 24 and 48 months.

The modified Devine's procedure for the management of concealed penis in children: an experience of 131 cases.

With the current study, we aimed at describing our experience of surgical management of concealed penis using the modified Devine's procedure. Medical records of all patients undergoing surgical management of concealed penis using the modified Devine's procedure from January 2019 to June 2021 were retrieved. Penile length was measured before and after the procedure. Parental satisfaction on the penile size, morphology, voiding status and hygiene was measured using a 5-point Likert's scale. A total of 131 patients were included. The mean age of the patients was 8.56 ± 2.75 years. The mean BMI of the patients was 24.17 ± 1.78 kg/m2. The patients were followed up to a mean of 15 ± 3 months. The duration of the surgery was 89.93 ± 16.85 minutes. There was a statistically significant increase in penile length from 1.8 ± 0.64 cm to 5.02 ± 1.11 cm after the procedure (p < 0.01). There was a statistically significant improvement in satisfaction status of all domains at 6, 12 and 24 weeks as compared to pre-operative levels. The modified Devine's technique is a simple and effective surgical technique for management of concealed penis in children producing predictable results and excellent parental satisfaction. The low rate of complications and good cosmetic outcomes lend support to its use in clinical practice.

HF01-17 PENILE STRETCHING PRACTICES THROUGH TIME AND CULTURE

You have accessJournal of UrologyCME1 May 2022HF01-17 PENILE STRETCHING PRACTICES THROUGH TIME AND CULTURE John Sigalos, Sriram Eleswarapu, and Jesse Mills John SigalosJohn Sigalos More articles by this author , Sriram EleswarapuSriram Eleswarapu More articles by this author , and Jesse MillsJesse Mills More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002541.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The medical literature suggests there is benefit to penile stretching and traction therapy in Peyronie’s disease, after prostatectomy to prevent shortening, erectile dysfunction prior to placement of an inflatable prosthesis, and for men concerned about penile length. We seek to present the historical practices regarding penile stretching and traction therapies. METHODS: Literature review via PubMed, Google scholar, and archive.org for books, journal articles, texts, and historical discussion detailing the practice of penile stretching and traction practices throughout history. RESULTS: Margaret Mead in her studies of Polynesian males described a woven device of plant fiber that was used to help men to stretch their penises. Working in a similar fashion to a Chinese finger trap, the penis is inserted into one end of the device while a weighted object is hung from the other end. The Cholomec tribe from Peru and some African tribes have used the direct hanging of weights on to their penises in attempts to increase penile length. This method of traction does not increase girth. Direct use of weights hanging from the penis has been shown to decrease girth and cause tissue damage. Certain Holy Men from the Sadhu tribes in India have practiced penile stretching via hanging stones from their penises using grass or lianas. Egyptian pharaohs as well may have used weights to increase penile length. The most prominently featured technique of penile stretching is the Arabic jelqing method. Jelqing is still practiced by some to this day, and it involves a regimented milking or massaging of the semi-erect penis from base to tip repeatedly. The man then stops jelqing prior to ejaculation so that the process can be restarted. Jelqing has not been rigorously studied in the medical literature, however one British physician reported on use of jelqing for penile length gain in the 1970s. Richards' study reported on 30 men, who followed a regular program of jelqing three months. According to Richards, 87 percent of the participants experienced increases in penile length with an average 1 inch increase in the length of their penises and a 1 inch increase in girth. A similar milking and exercise method has been used by Sudanese practioners to achieve increased penile size. CONCLUSIONS: There is a long-standing use of penile stretching and traction practices across many cultures and historical time points. Only recently has the medical literature begun to elucidate best practices and objective benefits that men have been seeking for many years. Source of Funding: John Sigalos has received funding from H H LEE Research Program via LB Research and Education Foundation in support of this work © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e217 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sigalos More articles by this author Sriram Eleswarapu More articles by this author Jesse Mills More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD28-12 MODIFIED TEP: A NOVEL WAY TO OPTIMIZE PENILE GIRTH AND LENGTH ENHANCEMENT POST IPP

You have accessJournal of UrologyCME1 May 2022PD28-12 MODIFIED TEP: A NOVEL WAY TO OPTIMIZE PENILE GIRTH AND LENGTH ENHANCEMENT POST IPP Shirin Razdan, Ariel Zisman, and Robert Valenzuela Shirin RazdanShirin Razdan More articles by this author , Ariel ZismanAriel Zisman More articles by this author , and Robert ValenzuelaRobert Valenzuela More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Three piece penile prosthesis (IPP) surgery is the gold standard surgical treatment of erectile dysfunction. As this procedure is associated with penile shortening in inexperienced hands, many techniques created by experienced surgeons exist in the literature to optimize penile length and ensure proper cylinder sizing. Here we present our data on a modification of the existing tunica expansion procedure (TEP) for penile length restoration. METHODS: A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients’ charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP were analyzed. The modification entails alternating between vertical and horizontal scoring of the tunica albuginea, with vertical scoring contributing to increased penile length and horizontal scoring contributing to increased penile girth. Endpoints were average increase in prosthesis length as well as average increase in girth. RESULTS: A total of 23 patients from the larger cohort underwent modified TEP. All patients underwent IPP placement via scrotal approach. In patients undergoing vertical modification of TEP (n=15), average increase in length of distal corpora was 2.8cm. This was measured using Furlow before and after penile degloving with TEP. In patients undergoing horizontal TEP (n=8), average increase in girth was 1.6cm. This was measured at midphallus pre-procedure and after full inflation of prosthesis. There were no reported complications for these 23 cases. CONCLUSIONS: In men undergoing IPP placement, modification of the already existing TEP can allow for measurable increase in penile length and girth of almost 3 and 2cm respectively. This is an important technique within the arsenal of the prosthetic urologist to ensure cosmesis post IPP placement is optimized. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e503 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Ariel Zisman More articles by this author Robert Valenzuela More articles by this author Expand All Advertisement PDF DownloadLoading ...

Auxetic Expansion of the Tunica Albuginea for Penile Length and Girth Restoration Without a Graft: A Translational Study.

IntroductionSeveral conditions can cause penile length and girth loss. Surgical techniques have been used to restore these penile alterations in patients with severe erectile dysfunction during penile prosthesis implantation. One technique uses multiple small incisions in a mesh pattern (similar to a skin mesh) with satisfactory curvature correction without using a graft, however, this technique does not allow simultaneous increase in penile length and girth.AimTo identify a new surgical technique that increases both the length and girth at the same place on the corpora cavernosa (CC), allowing a simultaneously longitudinal and transverse increase of the tunica albuginea.MethodsA sheet with a star-shaped perforation was created using a mathematical model to allow a longitudinal and transversal increase in the material. Two previously published penile model simulators, with and without deformity, were used to test the mechanical modification of this incision pattern in the CC.Main Outcome MeasureThe effect of the incisions pattern on the geometry of the CC simulator.ResultsThe star-shaped incision (auxetic) simultaneously increased the length, girth, and volume of the CC simulator. This auxetic technique could correct any penile deformity, re-establishing the original penile anatomy. The new auxetic incision is only a conceptual and experimental technique awaiting clinical evidence.ConclusionThe data presented here show that the auxetic technique successfully increases both the length and girth at the same place on the CC simulators, opening a new potential solution to correct challenging cases of complex penile deformities and to restore volume loss.Miranda A, Auxetic Expansion of the Tunica Albuginea for Penile Length and Girth Restoration Without a Graft: A Translational Study. Sex Med 2021;9:100456.

Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys?

Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Penile Prosthesis Placement with Immediate Buried Penis Correction: A Retrospective Chart Review

Introduction: We present a case report on six patients who underwent a combined approach to improve the cosmetic appearance and functional performance of their buried penis. Aim: To report our combined approach to improve both buried penis and erectile dysfunction. Methods: In one surgery, we performed: a malleable penile prosthesis, ventral phalloplasty, and penile suspensory ligament release followed by a suprapubic lipectomy. Results: Postoperatively, all patients had an increase in penile length and were able to achieve successful penetrative intercourse. The average difference between the pre-operational and post-operational flaccid length of our six patients was 3.5 cm ± 1.38 (range, 1.9 to 5.08 cm). Conclusion: This case series serves as successful examples of using a combined approach in one stage to not only improve the cosmetic appearance of a buried penis but also address erectile dysfunction.

The use of collagen fleece (TachoSil) as grafting material in the surgical treatment of Peyronie's disease. A comprehensive narrative review.

Grafting for the treatment of Peyronie's disease (PD) can be performed with autologous grafts, allografts, xenografts and synthetic grafts, with all available materials presenting their own characteristics. Still, there is a current arising interest in the use of collagen fleece (TachoSil) as grafting material. We generated an extensive literature review, aiming to assess the use of TachoSil in the treatment of PD. TachoSil is currently indicated in men with PD and preserved erectile function for defect closure after partial plaque excision or incision. In addition, it is indicated for residual curvature correction during penile prosthesis implantation (PPI) in patients with PD and severe erectile dysfunction. Our literature search identified 12 studies evaluating the role of TachoSil for PD surgical treatment. We presented the surgical procedure of TachoSil grafting for the treatment of complex penile curvatures with or without simultaneous PPI and summarized the available evidence on the matter. Identified studies suggest that TachoSil is considered highly effective, reliable and safe in patients with PD. Moreover, it displays favorable properties compared to other grafting materials. It should be stressed that, despite some limitations of available data, TachoSil presents key strengths, which include easy application, decreased operative times, no risk of damaging the implant during PPI, preservation or increase in penile length, fewer cases of penile hypoesthesia, low risk of other adverse events, additional hemostatic effects and low cost. Still, randomized trials comparing TachoSil with different grafting materials are necessary to establish its efficacy.

Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie\u2019s disease in a multicenter clinical study

In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie’s Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0–15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications.

Central precocious puberty: A case report

Precocious puberty is the onset of physical and hormonal signs of pubertal development before the age of 9 years in males and 8 years in females. A 2-year 9-month-old Indian male child was brought to the hospital with complaints of excessive growth of pubic hair and increase in penile length for 2 months. On local examination of the genitalia, pubic hair was ++, his penile length was 9 cm, and testicular volume was >4 mL. The Sexual Maturity Rating score was A1P2T4. Serum testosterone levels – 592.76 mmol/L; serum luteinizing hormone – 2.18 IU/L; and serum follicle-stimulating hormone – 4.69 IU/L. His X-ray of the left wrist showed bone age >6 years. Magnetic resonance imaging of the brain showed an ill-defined, T2-hyperintense mass involving the right half of the tuber cinereum. A diagnosis of central precocious puberty due hypothalamic hamartoma was made. During the course of his admission, he was given injection leuprodex 3.75 mg intramuscularly once in 28 days. He was discharged with a plan to follow-up on outpatient basis.

Hot spots in fetal human penile and clitoral development

To better understand how the human fetal penis and clitoris grows and remodels, we undertook an investigation to define active areas of cellular proliferation and programmed cell death spatially and temporally during development of human fetal external genitalia from the indifferent stage (8 weeks) to 18 weeks of gestation. Fifty normal human fetal penile and clitoral specimens were examined using macroscopic imaging, scanning electron microscopy and immunohistochemical localization for the cellular proliferation and apoptotic markers, Ki67 and Caspase-3, respectively. A number of hot spots of cellular proliferation characterized by Ki67 localization are present in the penis and clitoris especially early in development, most notably in the corporal body, glans, remodeling glanular urethra, the urethral plate, the roof of the urethral groove and the fully formed penile urethra. The 12-fold increase in penile length over 10 weeks of growth from 8 to 18 weeks of gestation based on Ki67 labelling appears to be driven by cellular proliferation in the corporal body and glans. Throughout all ages in both the developing penis and clitoris Ki67 labeling was consistently elevated in the ventral epidermis and ventral mesenchyme relative to the dorsal counterparts. This finding is consistent with the intense morphogenetic activity/remodeling in the ventral half of the genital tubercle in both sexes involving formation of the urethral/vestibular plates, canalization of the urethral/vestibular plates and fusion of the urethral folds to form the penile urethra. Areas of reduced or absent Ki67 staining include the urethral fold epithelium that fuses to form the penile tubular urethra. In contrast, the urethral fold mesenchyme is positive for Ki67. Apoptosis was rarely noted in the developing penis and clitoris; the only area of minimal Caspase-3 localization was in the epithelium of the ventral epithelial glanular channel remodeling.

Penile traction therapy with the new device 'Penimaster PRO' is effective and safe in the stable phase of Peyronie's disease: a controlled multicentre study.

To evaluate the efficacy and safety of a new penile traction device (PTD), 'Penimaster PRO', in a group of patients with stable Peyronie's disease (PD) compared with a non-intervention group in a multicentre study. A total of 93 patients with chronic stable PD (without erectile dysfunction, with no significant pain, and with a unidirectional curvature of at least 45° being stable for > 3months) were recruited and followed for a 12-week period. Of these patients, 47 were randomly assigned to the Penimaster PRO group (PG) and 46 to the non-intervention group (NIG). Patients were asked to apply the PTD 3-8h a day for 12 consecutive weeks, with specific instructions regarding the progressive increase of traction force applied to the penis over time. The primary outcome of the study was the change in the degree of curvature measured in the fully erect state after intracavernosal injection of alprostadil at baseline, 1, 2 and 3months. Other variables, such as the type of curvature, stretched penile length (SPL), Peyronie's Disease Questionnaire (PDQ) scores, erectile function domain of the International Index of Erectile function (IIEF-EF) score and adverse events (AEs) were also assessed in each visit. Forty-one patients in the PG and 39 in the NIG completed the study. There was an overall reduction in curvature of 31.2° (P < 0.001) at 12weeks compared to baseline in the PG, representing a 41.1% improvement from baseline, which significantly correlated with the number of daily hours the device was applied in a dose-dependent manner. Those patients using the device < 4h/day experienced a reduction of 15°-25° (mean 19.7°, 28.8% improvement; P < 0.05), while patients using the device > 6h/day experienced greater curvature reduction, ranging from 20° to 50° (mean of 38.4°, 51.4% improvement; P < 0.001). In contrast, no significant changes in curvature were observed in the NIG. Furthermore, SPL increased significantly in the PG compared to baseline and compared with the NIG, ranging from 0.5 to 3.0cm (mean 1.8cm; P < 0.05). The IIEF-EF score also improved in patients in the PG (by a mean of 5 points). Mild AEs occurred in 43% of patients, such as local discomfort and glans numbness. The use of the Penimaster PRO PTD, a non-invasive treatment, should be offered to patients with stable PD for 3 consecutive months before performing any corrective surgery, as this provided a significant reduction in the curvature, an increase in penile length and a significant improvement of the symptoms and bother induced by PD.

A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery.

BackgroundWith better designed devices and lower infection rates, satisfaction with inflatable penile prosthesis (IPP) placement is increasingly high. However, dissatisfaction is still present and there is disagreement regarding length and sensation changes after the IPP placement. The aim of this study was to evaluate changes in penile length, girth and sensitivity after IPP placement.MethodsFrom August 2012 to January 2013 all patients undergoing “de novo” IPP surgery were invited to participate in this study. Eighty six patients met inclusion criteria while 62 agreed to participate in this observational study. A week before surgery, penile length and circumference, and glans/elbow biothesiometer readings were recorded 15 minutes after Trimix induced erection. Same measures were taken at postoperative week 6 and month 6.ResultsAmperage from Glans biothesiometer readings showed statistically significant shorter readings than elbow biothesiometer preoperatively, 6 weeks and 6 months after surgery (P<0.001 each). No significant sensory difference in the glans penis after IPP was noted. However, compared to preoperative Trimix induced erections, penile length and circumference were greater after IPP placement (P=0.04 and P=0.001, respectively).ConclusionsWe observed statistically significant increase in penile length and girth after IPP placement without significant changes in sensory conduction.