Penile Length Measurements Research Articles

Penile length after penile implant surgery is determined by stretched penile length before surgery.

While various treatment modalities exist, penile prosthesis (PP) implantation offers a permanent solution for patients that do not respond to or are not suitable for other treatment options for erectile dysfunction. The aim of this study was to establish stretched penile length before surgery as a reliable determining factor of penile length after penile implant surgery. For this study, data on penile length before and after PP surgery from three European centers was analyzed. Penile length measurements were conducted preoperatively and postoperatively in different conditions using standardized techniques. Only virgin cases were included and a complete case analysis was performed. The outcome of this study was the comparison of stretched penile length before and the inflated penile length after PP surgery. Data on penile length before and after PP of 361 patients was analyzed. Preoperative stretched penile length was equal to postoperative inflated penile length in 33% of patients. The absolute mean difference between pre-surgery stretched and postoperative inflated lengths was 1.1cm. No correlation was found between implanted cylinder length and postoperative penile length. Additionally, the choice of implant type did not significantly affect postoperative penile length outcomes. Our findings confirm the reliability of preoperative stretched penile length as a tool for proper patient counseling before PP surgery. Although our study is overpowered, our results show that preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery. By providing clinicians with a tool for patient counseling, our findings contribute to enhancing satisfaction and quality of life outcomes in patients undergoing PP implantation. Preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery.

Advancing Precision in Penile Length Measurement: Evidence-based Synthesis of Stretched Penile Length INdicator Technique (SPLINT).

The purpose of this study was to synthesize evidence and propose a technique for estimation of stretched penile length (SPL) applicable to children. This review has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, and Scopus databases were queried on penile length (PL) measurement techniques in humans published from 1990 onward. The devices and the techniques used for PL measurement, state of the penis, the habitus of the participants, proximal and distal landmarks for measurement, handling the foreskin and pubic pad of fat, optimal stretching of the penis, and other factors (including the environment) which should be accounted for in the technique were identified from the study cohort (90895 participants across 145 included studies). PL has been represented through flaccid (33.79%), stretched (81.3%), and erect (12.41%) PLs as well as the greatest corporeal length (1.4%). Following devices have been used to measure the PL in the study cohort: rulers [54.68%], calipers [9.7%], measuring tapes [14.5%], coloured measuring strips [2.06%], spatulas/tongue depressors [11.03%], FitKit, syringe [1.4%], cotton swab (and ruler), titan cylinders, slide gauge and ultrasonography [1.37%]. The factors relevant to SPL measurement have been incorporated into the proposed SPL INdicator Technique (SPLINT) which is essentially a holistic extension of the "Conventional PL Measurement" technique. There is a wide range of heterogeneity in the technique for estimation of PL across the study cohort; the underlying factors have been identified along with the respective variables, and the SPLINT for SPL has been described.

Penile Length and Circumference among Adult Egyptians

Abstract Background accurate measurement of penile length is important for both clinical and academic purposes. For this reason, a standard practice for measurement has been defined to maintain consistency. Rather than measuring a flaccid penis, which offers limited clinical significance, stretched penile length (SPL) measurement is considered best practice for adult men as it most closely replicates normal erect penile length. Aim of the Work to assess the stretched penile length and penile circumference in a sample of physically normal Egyptian men and to determine the penile anthropometry-somatometric parameters relationship. Patients and Methods The current study demonstrated that the mean stretched penile length of this sample of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1; which are consistent with the results of previous studies done in Egypt and with studies done within the same geographical region. There were significant positive correlations between penile measures and height, weight, and BMI with no significant correlations between penile measures and age. Our study results revealed as well that there was no significant difference between age grades regarding penis length and penis circumference. The previous correlations agree with most of the studies except for BMI which remains controversial whether it has positive or negative correlation with the penile anthropometry. Results revealed that alcohol use and smoking were significant factors that decrease penis length and circumference. This could be attributed to the associated erectile dysfunctions revealed in previous studies to be found in smokers and alcohol drinkers, in addition to the findings that postulate that erectile dysfunction could shorten the penile measurements. Nonetheless, further studies are needed to clarify these associations. Conclusion Concern over penile size is not uncommon. The results of this study help to establish a reference range for male genital size among adult Egyptian men, which should be helpful for andrologists in counselling patients. As evident from the current study, the mean stretched penile length of Egyptian men was 13.0 ±1.9 cm and the flaccid penile circumference was 9.3±1.1 with significant positive correlations between penile measures and height, weight, and BMI. Moreover, penile anthropometry was significantly lower in smokers and alcohol users.

(229) A Pilot Study of a Novel PRP Protocol to Increase Penile Length, Girth, and Function

Abstract Introduction A study of a novel PRP protocol to increase penile length, girth, and function Intro: Various solutions have been utilized to increase penis size, including fillers, fat transfers, traction devices, suspensory ligament ligation, and silicon augmentation. None of these improve length, girth, function and are completely safe. PRP is an autologous source of growth factors. The RestoreX is a well-studied traction device. Vacuum erection devices provide a stimulus for circumferential penile growth. Nitric Oxide boosters improve blood flow and nighttime erections. Objective The P-Long Study aims to find a safe and reproducible way to increase the length, girth, and function of a normal male penis. Methods The study is IRB approved and patient consented. Inclusion criteria: healthy men aged 20 to 55 with normal erectile function (SHIM greater than 22) and no Peyronie’s Disease, previous penile interventions, or congenital penile issues. Measurement of penile length and girth were performed by the patient on an erect penis during self-stimulation at full tumescence with standard protocol and measuring instruments (transparent rigid ruler and flexible tape measure) and documented with digital images. No PDE-5 inhibitors or Trimix were used. Measurements were taken at baseline and once a month for six months. PRP 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 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. Traction with RestoreX 20 minutes bid and suction with Joel Kaplan penis pump (pressure 5-10 for 12 minutes bid (1 minute x 2 and 5 minutes x 2.) Nitric Oxide boosting supplement (trade name AFFIRM) with a dose of 3 gm L-Citrulline and 1 gm beet extract (nitrate). Results 29 men have completed treatment. The mean age was 32 and mean baseline erect penile length was 5.70 and girth was 5.25. Erect penis length was 0.805 inch greater after six months from baseline (N=29, paired t-test t=13.641 p value=0.000). Circumference was 0.469 inch greater (N=29, paired t-test t=13.498 p value=0.000). Using a Likert scale, all participants reported better erectile function. Conclusions The P-Long Protocol is potentially a safe way to improve erect penile length 0.81 inches and girth 0.47 inches over a period of six months and subjectively improve function in a healthy penis. The P-Long Protocol does not require any synthetic injectables or foreign bodies or extensive penile traction. The P-Long Protocol ultrasound-guided PRP injection can be taught to urologists and sexual medicine practitioners. It does not preclude additional augmentation procedures and is potentially an acceptable first option for men interested in penile enhancement. This study provides a guide for expectations for growth for men using the protocol. 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: AFFIRM Science.

(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.

(347) Prediction of Post-operative Sexual Satisfaction after Penile Prosthesis Implantation (With and Without Penile Lengthening Procedures) Using Preoperative Penile Length Measurements

Abstract Introduction `- Penile prosthetic devices are the gold standard treatment of medication-resistant erectile dysfunction, however penile length reduction was reported as one of the main post operative disturbing complaints - Many lengthening procedures during penile prosthesis implantation (PPI) were described to increase postoperative sexual satisfaction. Objective `- To predict post-operative sexual satisfaction after PPI (with or without penile lengthening procedure) using preoperative penile length measurements. Methods `- This study was conducted in our urology department as prospective RCT, in the period between August 2018 till April 2020 - It included 61 male patients with organic ED who are candidates for PPI. - Patients were randomized to 2 groups; group A included 31 patients who underwent suspensory ligament release via penopubic Z-plasty, dorsal phalloplasty, suprapubic lipectomy, +/− ventral phalloplasty (in case of high scrotal insertion); group B included control patients who underwent PPI only via penoscrotal incision. - Measurement of preoperative and postoperative (after 3 months) penile lengths were done, including; the flaccid, visible stretched and functional stretched penile lengths. - Assessment of patients’ sexual satisfaction was done using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score adapted to penile prosthetic implant. - Patients with EDITS scores of 60-80 were considered satisfied, and those with EDITS scores of 80-100 were considered very satisfied. - Receiver operating curve (ROC) analysis was done to detect cutoff value for the preoperative stretched penile lengths (functional & visible) that are predicted to aid the patient to reach a postoperative satisfaction of EDITS ≥90 in each group. Results `- The mean preoperative measurements showed no statistically significant difference between the two groups. - However, the mean postoperative measurements after 3 months demonstrated a statistically significant difference between the two groups. - The mean values of both overall EDITS and the EDITS resting state and malleability scores were higher in group A (91.92 ± 7.22 and 7.38 ± 0.78) Vs. (79.55 ± 15.55 and 5.32 ± 1.12) in group B (p < 0.001) - For EDITS satisfaction level, the percentage of the very satisfied patients [≥ 80] in group A (89.7%) was significantly higher than in group B (64.3%) (p= 0.045) - Also, for the EDITS resting state and malleability satisfaction level, the percentage of the very satisfied patients in group A (55.2%) was significantly higher than in group B (0.0%) (p < 0.001) - ROC curve was done for both groups In group A: - Functional stretched penile length: AUC 0.815 with a cutoff value of 12.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value = 0.013) - Visible stretched penile length: AUC 0.795 with a cutoff value of 10.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value =0.020) In group B: - Functional stretched penile length: AUC 0.927 with a cutoff value of 14.50 cm yielding a 77.8% sensitivity and 94.7% specificity (p value < 0.001) - Visible stretched penile length: AUC 0.892 with a cutoff value of 12.50 cm yielding a 66.7% sensitivity and 94.7% specificity (p value <0.001). Conclusions `- Preoperative measurement of functional and visible penile lengths can be of value in predicting post-operative sexual satisfaction after PPI (with or without concurrent penile lengthening procedures). Disclosure No

MP62-02 MULTI-INSTITUTIONAL SAFETY AND EFFICACY OUTCOMES WITH THE PENUMA PENILE IMPLANT

You have accessJournal of UrologyCME1 Apr 2023MP62-02 MULTI-INSTITUTIONAL SAFETY AND EFFICACY OUTCOMES WITH THE PENUMA PENILE IMPLANT Alexandra Siegal, Shirin Razdan, Bhavik Shah, Bryan Kansas, Laurence Levine, Michaela Sljivich, and Robert Valenzuela Alexandra SiegalAlexandra Siegal More articles by this author , Shirin RazdanShirin Razdan More articles by this author , Bhavik ShahBhavik Shah More articles by this author , Bryan KansasBryan Kansas More articles by this author , Laurence LevineLaurence Levine More articles by this author , Michaela SljivichMichaela Sljivich More articles by this author , and Robert ValenzuelaRobert Valenzuela More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penuma is a soft silicone penile sleeve implant FDA cleared for cosmetic augmentation and correction of penile deformities. Since its FDA clearance, approximately 5,000 Penuma devices have been implanted. The increasing popularity of the implant is accompanied by concerns over patient safety. Possible risks and complications include infection or erosion requiring removal of the implant, hematoma, seroma, prosthesis displacement, and persistent flaring proximal to the coronal sulcus requiring revision. Over time, the surgical method to implant Penuma has evolved, most notably with the use of a scrotal lateral incision in lieu of an infrapubic incision. Our objective is to provide the first set of multi-institutional data on safety and efficacy outcomes in patients undergoing Penuma penile implant surgery across multiple high implant surgeons. METHODS: We performed a retrospective analysis of men undergoing Penuma implant between November 2020 and October 2022 with four surgeons, each from a separate geographically diverse academic hospital. Peri- and post-operative adverse events such as unsatisfactory cosmetic outcomes requiring revision as determined by physician follow up and patient questionnaires were noted. Penile length and girth measurements were made pre- and post-operatively. RESULTS: 228 male patients underwent Penuma implant surgery. Mean age was 42.2 +/- 10.2 years. Mean BMI was 28.7 +/- 4.1. Our patient population was very healthy (4% hyperlipidemia, 2% smokers, 1% diabetes, 1% cardiovascular disease). Patients added an average of 4.4 +/- 2.3 cm to their penile length (54% increase) and an average of 3.6 +/- 1.3 cm to their girth (39% increase) (p<0.01). Complications rates were: infection 0.8%, seroma 2.3%, and erosion 6.6%. Complication rates of infection and seroma were lower and erosion rates were higher than those previously reported in a single-center review. 5.7% reported unsatisfactory cosmetic results that resulted in revision – all had persistent flaring of the Penuma at the coronal sulcus. These cases may be revised under local anesthesia. Based on questionnaires, all revisions had satisfactory outcomes. CONCLUSIONS: This is the first study to characterize the long-term safety of the Penuma penile implant across multiple surgeons and institutions. The Penuma can be used to safely enhance flaccid penile length and girth in patients who desire cosmetic augmentation or with retractile penis and other deformities. When cosmetic complications occur, corrections may be completed easily and with low risk. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e861 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Siegal More articles by this author Shirin Razdan More articles by this author Bhavik Shah More articles by this author Bryan Kansas More articles by this author Laurence Levine More articles by this author Michaela Sljivich More articles by this author Robert Valenzuela More articles by this author Expand All Advertisement PDF downloadLoading ...

Functional Penile Length After Penile Plication: “Empha-sizing” What Matters

ObjectiveTo reassess penile length changes after penile plication (PP), we defined a novel measurement of functional penile length (FPL) and compared preoperative and postoperative measurements. PP reduces penile curvature in Peyronie's Disease (PD) patients, but is traditionally thought to reduce overall penile length. However, the literature on PD lacks a standardization for penile length measurement techniques, leading to high inter-study variability. MethodsA prospectively maintained database of PD patients who underwent PP from 2018-2021 was queried. FPL was obtained by measuring the erect penis from the base of the pubis to the tip of the glans, as a straight line disregarding any curvature. Intraoperative assessment of FPL was performed before incision and immediately after surgical correction. ResultsOf 28 patients included, the average age was 59, average SHIM was 17, and average PDQ was 9. Curvature was unidirectional in 16 patients (57%) and bidirectional in 12 (43%). Dorsal curvature was most common (71%). The average curve severity was 37 ± 8.6 degrees. Mean FPL pre-operatively was 11.1 ± 1.4 cm and 12.5 ± 1.3 cm post-operatively. This represented an average 12.8% ± 6.6% increase in FPL following plication. All 28 patients reported subjective improvement in their curvature. ConclusionFunctional penile length is a useful primary surgical outcome when describing post-operative expectations for penile plication. We report an increase in FPL achieved for PD treated with PP despite conventionally being considered a shortening procedure. This can be an invaluable tool for preoperative counseling and setting expectations for penile length.

Outcomes of a Single Center's Initial Experience With the Penuma® Penile Implant

ObjectiveTo provide new data, techniques, and safety and efficacy outcomes in patients undergoing Penuma penile implant surgery at a large tertiary care center. MethodsWe performed a retrospective analysis of men undergoing Penuma implants between November 2020 and January 2022 with a single surgeon at a tertiary hospital. Measurements of penile length were made both pre- and postoperatively. Adverse events including infection and unsatisfactory cosmetic outcomes requiring revision were recorded. We also provide detailed technique descriptions of Penuma implantation and revision. Outcomes include measurements of incidents of peri and post-operative adverse events and penile length and girth pre- and post-operatively. Results49 male patients underwent Penuma implant surgery. Mean age was 40.2 ± 8.9 years. Mean BMI was 28.2 ± 4.5. All but 2 patients were nonsmokers and only 2 had comorbidities (diabetes). Preoperative mean flaccid length was 8.1 ± 1.9 cm. Postoperative mean length was 12.3 ± 1.9 cm. Patients added an average of 4.9 ± 2.9 cm to their penile length, a 52% increase (P < .01). Average follow up time was 6 months. Among the complications were 1 case of infection and 2 cases of erosion. There were 4 cases of persistent flaring of the Penuma; 3 required revision surgery, all with a good cosmetic outcome. ConclusionThe Penuma implant can be used to safely enhance flaccid penile length and girth in patients with retractile penis or other cosmetic deformities. Should complications occur, they are mainly cosmetic and can be easily corrected with low risk.

External phallopexy: A revisited technique and algorithm for simple management of buried penis

IntroductionBuried penis (BP) is a distressing condition for both the child and his caregivers. A lot of techniques are available for the management of such condition. External phallopexy represents a simple technique designed for selected cases. This study aimed at reexploring the technique of “3 stitches phallopexy” in the context of correction of selected cases with BP, validating a prospectively designed algorithm for BP management, and detecting the parental satisfaction and possible complications of this technique. MethodsThis was a prospective study performed over a 2 years’ period on cases diagnosed with BP. Patients were excluded if they have previous urethral repair e.g., hypospadias or epispadias, BP with normal penopubic angle, micropenis, and insufficient skin coverage after phallopexy simulation test. A questionnaire with 0–12 points score was used for assessment of satisfaction by caregivers. Results28 cases were included, with a mean age at the procedure of 5.03±2.6 years. The mean BMI was 15.25±1.1. The intraoperative flaccid penile length measurement was 4.74±1.62 cm, and the mean gained extra-length with phallopexy simulation test was 1.8±0.63 cm. The mean operative time was 20±7 minutes. No wound infection was noted. 2 cases were concerned about the stitch marks at the penopubic junction skin. No recurrence of symptoms was reported after at least 6 months (mean11±4 months) follow up. The mean preoperative satisfaction score was 4.7±1.2, while at the 6 months follow up visit it rose to 10.8±0.67. ConclusionsExternal phallopexy represents a simple technique for managing buried penis, with minimal complications during follow up period and satisfactory cosmetic outcome.

Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction

BackgroundMost of the published literature addressing the satisfaction postinflatable penile implant (IPP) placement includes non-validated surveys. AimThe study aims to report the survey outcomes of the English version of The QoLSPP and to evaluate the different factors that could influence these results. MethodsPatients who underwent inflatable penile implant placement from January 2017 to December 2019 received a survey by phone and had a visit scheduled no sooner than 27 months after surgery. In the clinic, they were inquired about the penile size and underwent measurements of postoperative penile length and diameter. The survey responses were rated from zero to 5 following QoLSPP, and answers ≥3 were considered positive. An evaluation of the factors influencing the quality-of-life score of patients post-IPP placement was performed. Variables included age (<60, 60–70, >70), BMI classification, Charlson Comorbidity Index, diabetes diagnosis, implant type (AMS 700CX vs Titan), ED etiology, revisions, postoperative time in months (<30, 30–40, >40) and preoperative vs postoperative penile dimensions in those who attended the clinic. OutcomesThe primary outcome was to obtain accurate patient-reported satisfaction after inflatable penile implantation. ResultsWithin the timeframe, 542 patients underwent first-time IPP placements. Of that group, 322(n) completed the surveys, and 109 patients attended the clinic to compare preoperative vs postoperative dimensions. Of note, 67 (61.4%) and 54 (49.4 %) demonstrated enlargement in length and diameter, respectively. Conversely, 12 (11%) and 4 (3.7%) experienced a shortening in length and girth. We found 66 (60.5%) patients who complained about a penile size decrease after the intervention. The survey had a positive response in 93.1% of the cases. There were no statistically significant differences in positive responses concerning the variables investigated. The subpopulation analysis of the penile-sized group neither showed response variations. Clinical implicationsThe investigation allowed a better understanding of patient-reported satisfaction post-IPP placement. Strengths & LimitationsThe performance of all the procedures in a high-volume center by a single surgeon limits its generalization. ConclusionThe overall results after IPP surgery are positive in most patients who underwent the procedure and the variables investigated did not influence the overall outcomes of the QoLSPP survey in the study.Luna E, Rodriguez D, Barrios D, et al. Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction. J Sex Med 2022;19:1472–1478.

Does knowing pre-operative penile length influence patient satisfaction post penile prosthesis surgery

ABSTRACT Introduction Patients may undergo penile prosthesis surgery (PPS) as a treatment option for erectile dysfunction (ED). Those who undergo PPS commonly complain of penile shortening after implantation. Furthermore, previous research has shown a decrease in penile length following inflatable penile prosthesis surgery compared to intracavernosal injection at 12 months. Objective Therefore, we conducted a prospective, multicenter cohort study to determine whether knowledge of pre-operative penile length measurement influences post-operative treatment satisfaction and satisfaction with penile length. Methods The cohort included a total of 102 patients undergoing PPS from August 2017 to December 2019. Study group participants underwent pre-operative penile length measurement (n=49) while the control group (n=53) did not undergo pre-operative measurement. Intra-operative and 6-week post-operative penile length measurements were later obtained in both groups. Six months post-operatively, patients were asked to complete the validated 14 item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire to assess both overall treatment satisfaction and satisfaction with penile length. Chi-square analysis was performed to determine whether a difference in satisfaction existed between the two groups. Results We observed high patient satisfaction scores in both groups when using the EDITS questionnaire. Mean scores for overall treatment satisfaction were 3.57 and 3.53 (on a scale from 0 to 4) in the study and control group respectively. Mean scores for satisfaction with penile length were 4.08 and 4.11 (on a scale from 1 to 5) in the study and control group. There was no difference in overall satisfaction of treatment between those who knew their pre-operative length and those who did not (p=0.483). We also found no difference in satisfaction of post-operative penile size between both groups (p=0.645). Moreover, 59% of the combined cohort believed their overall sexual satisfaction was affected by penile length, with no difference between both groups (p=0.463). We observed no significant decrease in mean penile length from pre-surgical intraoperative measurement to 6-week post-operative measurement (0.42 cm and 0.21 cm in study and control group, respectively) with no statistical difference between groups (p=0.251). Conclusions The study suggests that knowledge of pre-operative penile length does not influence 6-month post-operative satisfaction in patients who have PPS. Therefore, performing pre-operative measurement in clinic solely for the purpose of informing the patient may be unnecessary. Current interventions aimed at conserving penile length may be effective at maintaining patients’ satisfaction with their penile length. The effects of other factors such as partner satisfaction, sex therapy, time after PPS, and the use of malleable versus inflatable penile prosthetic should be investigated in future studies. Disclosure Work supported by industry: no.

A longitudinal long-term observation study on sexual function and satisfaction rates in men with partial penectomy for penile cancer in a prospectively clinical database

ABSTRACT Introduction Organ-preserving partial penectomy provides a reasonable oncological approach in managing early-stage penile cancer with preservation of normal urinary function and many men can retain some aspects of sexual domains. However, there is limited published data regarding the longer-term sexual outcomes and satisfaction rates in men who remain sexually active in the context of penile cancer survivorship. Objective To evaluate sexual outcomes and satisfaction rates in sexually active men who underwent partial penectomy at a minimum 36-month follow-up study. Methods A prospective database on men treated with penile cancer was set up in 2011 following ethics approval. All men with pre-existing normal erectile function (EF) as defined by the International Index of Erectile Function (IIEF-5) score of 21 and above, and have a stable active sexual lifestyle were included in this study. Patient demographics including EF and sexual satisfaction scores based on IIEF questionnaire, erection hardness scores (EHS) and Brief Sexual Function Inventory (BSFI), use of erectile agents, and sexual satisfaction outcomes were recorded and compared between preoperative vs. 36 months postoperative. Results Of a total of 85 men with partial penectomy identified over the 10-year period, 44 men reported normal EF preoperatively and were in a stable sexual relationship. Six men underwent subsequent completion penectomy during that time while 3 men were lost to follow-up, and only 25 men were identified to be sexually active. Of these, 4 men can achieve satisfactory spontaneous erection for sexual intercourse, while 18 men take regular phosphodiesterase type-5 inhibitor drugs, and 3 men use intracavernosal injections. The median patient age was 54 (38-70) years, and the median follow-up was 44 (38-118) months. The mean penile length measurements were 4.2cm and 6.8cm in flaccid and erect states. Two-thirds of patients maintained the same frequency and level of sexual desire as before surgery and 36-month postoperative, and 80% continued to have ejaculation and orgasm every time they had sexual intercourse. Deterioration in both IIEF-5 and EHS scores were reported in 80% of patients at the 36 months review with lower sexual domains scores in BMSFI recorded in 72% of patients especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). Multivariate analysis using logistic regression confirmed that older age (OR 1.18, 95% CI 1.02-1.21, p&amp;lt;0.01), shorter penile length (OR 0.45, 95% CI 0.38-0.69, p&amp;lt;0.01) and quality of erection (OR 1.23, 95% CI 1.10-1.41, p&amp;lt;0.01) were significantly associated with lower sexual satisfaction rates. Conclusions While most sexually active men retained the ability to have sexual intercourse following partial penectomy, many required erectile aids and reported clinical deterioration in sexual function and overall satisfaction rates at 36 months. Disclosure Work supported by industry: no.

3D-printed phantoms to quantify accuracy and variability of goniometric and volumetric assessment of Peyronie’s disease deformities

Characterization of Peyronie’s disease (PD) involves manual goniometry and penile length measurement. These techniques neglect volume loss or hourglass deformities. Inter-provider variability complicates accuracy. Using 3D-printed models, we aimed to evaluate measurement accuracy and variability and establish computational assessment workflows. Five digital phantoms were created: 13.0 cm cylinder, 13.0 cm hourglass cylinder, 15.0 cm cylinder with 40° angulation, 12.0 cm straight penis, and 12.9 cm PD penis with 68° angulation and hourglass. Lengths, volumes, and angles were determined computationally. Each phantom was 3D-printed. Ten urology providers determined lengths, angles, and volumes with measuring tape, goniometer, and volume calculator. Provider versus computational measurements were compared to determine accuracy using t-tests or Wilcoxon rank-sum tests. No significant differences were observed between manual assessment of length of penile models and designed length in penile models. Average curvature angles from providers for bent cylinder and PD phantoms were 38.3° ± 3.9° (p = 0.25) and 57.5° ± 7.2° (p = 0.006), respectively. When assessing for volume, hourglass cylinder and bent cylinder showed significant differences between designed volume and provider averages. All assessments of length, angle, and volume showed significant provider variability. Our results suggest manual measurements suffer from inaccuracy and variability. Computational workflows are useful for improved accuracy and volume assessment.

Does knowing pre-operative penile length influence patient satisfaction post penile prosthesis implantation?

Patients who undergo penile prosthesis implantation as treatment for erectile dysfunction commonly complain of penile shortening after implantation. We conducted a study to determine whether knowledge of pre-operative stretched penile length measurement influences patient satisfaction. This prospective study consisted of 149 patients undergoing inflatable penile prosthesis (IPP) implantation from August 2017 to December 2019. Study group participants underwent pre-operative stretched penile length measurement in clinic while the control group did not. Six months post-operatively, patients completed a modified 14-item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire to assess overall satisfaction and penile length satisfaction. A total of 102 patients were eligible for final analysis (49 in study group, 53 in control). Mean scores for overall treatment satisfaction were 3.57 and 3.53 (scale from 0 to 4) in the study versus control group, respectively (p = 0.483). Mean scores for satisfaction with penile length were 4.08 and 4.11 (scale from 1 to 5) in the study vs. control group (p = 0.645). The study suggests that knowledge of pre-operative stretched penile length does not influence post-operative satisfaction after penile prosthesis implantation. Therefore, performing pre-operative measurements in clinic solely for informing the patient may be unnecessary. Current interventions aimed at conserving penile length may be effective at maintaining satisfaction with penile length.Trial Registration- This trial is registered and approved by the IRB committee at our institution, ID: HSC-MS-19-0320.

Stretched penile length at birth: a systematic review.

Micropenis is an endocrinological condition that is habitually observed at birth. Diagnosis is made by measuring the stretched penile length, a method established 80 years ago. Discrepancies in the normative data from recent studies raise the need for a current revision of the methodology. The aims of this systematic review were to compare the different normative data of SPL at birth, to examine the methodological aspects of the technique and to evaluate the independent variables that may be involved. Searches were performed using MEDLINE, EMBASE, Scielo, the Cochrane Library and Web of Science. A combination of the relevant medical terms, keywords and word variants for "stretched penile length", "penile length", "penile size", "newborn" and "birth" were used. Eligibility criteria included normative studies that used the stretched penile length (SPL) measurement on a population of healthy, full-term newborns during the first month of life. The outcomes studied included characteristics of the studies, methodological aspects and independent variables. We identified 49 studies comprising 21,399 children. Significant discrepancies are observed between the different studies. Methodological aspects seem to be consistent and similar. The main independent variables appear to be ethnic group and gestational age. Main limitations were the absence of studies of entire world regions such as Europe or South America, and the heterogeneity of the ethnic background that complicates the analysis. It seems advisable to suggest the creation of customized reference charts for each specific population instead of resorting to the classic cut-off points.

Obesity Is Strongly Associated With Low Testosterone and Reduced Penis Growth During Development.

Growth of male genitalia represents an important marker of sexual development. Testicle size is the primary measure and little is known regards penile length changes during puberty. This work aims to assess penis growth and testosterone levels in obese vs normal-weight children and adolescents, to evaluate a possible influence of obesity on genital development in boys, and to establish a new method for measuring penis length that allows comparison of normal-weight and overweight boys. We assessed anthropometric and genital development in 1130 boys from birth to age 20 years. Testosterone levels were also measured. A new method for penile length measurement was employed to minimize errors when comparing obese and nonobese children. Penis length was measured with a gentle, painless, straight positioning on a centimetric ruler without stretching, which is doable from the first years of life until the end of adolescence. Penis length and testosterone are strongly related in children during puberty. Penile length growth is significantly decreased (by about 10%) in obese boys when compared to normal-weight boys, with concomitantly reduced testosterone levels, across puberal phases. Childhood obesity represents an important determinant of lower testosterone level and reduced penis development. A new method should be employed to improve penis measurement in normal-weight and overweight/obese boys. The possible significance of these observations for adult genital development and reproductive potential will require large longitudinal studies.

Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft

Background/aimWe aimed to evaluate the effectiveness and safety of penile plaque incision and buccal mucosa grafting in patients with stable-phase Peyronie's disease (PD). MethodsThis was a prospective evaluation of patients with stable-phase PD who were treated by plaque incision and buccal mucosa grafting. Preoperative evaluation included International Index of Erectile Function Questionnaire (IIEF-5), measurement of erect penile length, and penile Doppler ultrasound during prostaglandin-induced erection. At 3- and 24-month follow-up visits, penile length and residual curvature were measured along with penile Doppler ultrasound and IIEF5 questionnaires. Patient and sexual partner satisfaction were also assessed at 24-month-visit. ResultsThe study was completed with 20 patients (mean age 46.5 ± 9.9 years). Dorsal curvature was the most frequent site of curvature (45%). The median curvature at preoperative evaluation was 45°(range 40-90°). The postoperative median curvatures were 5°(5-10, IQR) and 7°(5-10, IQR) at 3- and 24-month postoperatively, respectively. Success rate was 95% at 3-month and 90% at 24-month. There was no significant penile shortening. The mean IIEF-5 score was 17.5 ± 2.2 at preoperative evaluation. The median IIEF-5 scores were calculated as 20.1 ± 2.2 and 21.3 ± 2.2 at 3-month and 24-month visits, respectively (p<0.0001). Compared with baseline IIEF-5 score, both postoperative IIEF-5 scores were significantly higher. There was no de novo erectile dysfunction. There were no serious complications during and after the surgery. Ten percent of patients were poorly satisfied with the results of the surgery. ConclusionCorporoplasty with buccal mucosa graft led to excellent structural and functional results and patient satisfaction.Ainayev Y, Zhanbyrbekuly U, Gaipov A, et al. Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft. J Sex Med 2021;18:1308–1316.

Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review

BackgroundPenile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements. AimTo review the methodology used to report data in studies evaluating penile length and provide a detailed recommendation in conducting future high-quality research. MethodsThe MEDLINE database was searched for randomized clinical trials and open-label prospective or retrospective studies. OutcomesThe panel reviewed the modality of data reporting on these specific areas: patients’ age and assessment, patient position, type of measurement instrument used, penile length technique description, examination conditions, and actual examiner. ResultsOverall, 70 studies investigating penile length were selected; among these, 72.85% included at least 50 patients: 16 prospective studies, 5 randomized clinical trials, and 49 retrospective cross-sectional studies. Amongst all studies, 90% reported to measure penile length by health care practitioners in clinical settings. Penile length was assessed in all 70 studies, whereas penile girth was measured in 57.14% of patients. A semi-rigid ruler was the most commonly used measurement aid to assess penile length/girth in 62.86% of studies. Penile measurements were reportedly obtained: (i) stretched state, 60%; (ii) flaccid state only, 52.68%; and (iii) during erection, 27.43%. All studies investigating the penile length in an erect state were simultaneously assessing penile length in the flaccid state. About 90% of studies investigated penile length in adults, whereas 10% were conducted in adolescents. Clinical ImplicationsThe use of shared methodology to assess penile length in both adults and adolescents allows more accurate and standardized measurements. Strength & LimitationsA systematic review of the published literature allowed proper data interpretation in order to provide accurate recommendations. Main limitations of the study relied on a relatively limited number of databases for the identification of potentially eligible studies. ConclusionThe methodology used in studies measuring penile length should be precise and standardized in order to provide accurate data to both clinicians and researchers.Cakir OO, Pozzi E, Castiglione F, et al. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2020;XX:XXX–XXX.

Nose size indicates maximum penile length

BackgroundIn a previous report, we investigated whether the size of male genitalia similarly exposed to serum testosterone during aging could change with age and found that penile length almost stopped increasing during adolescence and decreased in older males. In this report, to determine what factors other than age are related to penile length, we performed a multivariate analysis of the relationships between stretched penile length (SPL) and other measurements of genital organs, nose size, height and body weight in 126 adults in their 30s–50s.ResultsThe most highly correlated factor with SPL was flaccid penile length (r = 0.565, P < 0.0001). The next highest correlation was nose size (r = 0.564, P < 0.0001). The penile stretched rate correlated with FPL (r = − 0.690, P < 0.0001) but not with SPL or penile circumference.ConclusionsThe fact that nose size is related to SPL indicates that penile length may not be determined by age, height or body weight but has already been determined before birth.