Penile Enhancement Research Articles

(283) Report of Newly Developed Penile Enhancement Surgery Using Midline Fixation Technique of Dermal Garft, Multi-layer Dissection Method, Multilayer Suture Lengthening and Minimal Skin Incision

Abstract Introduction Many physicians have tried to develop the surgical techniques to make safer and more effective results in penile enhancement surgery. Objective To accomplish better results of penile enhancement surgery, We aim to introduce newly developed more effective surgical techniques and safer processes in penile enhancement surgery. Methods 2023 Patients underwent penile enhancement surgeries. All patients adopted pre-pubic minimal skin incision with newly developed retractors. Allogenic dermal graft was fixed for girth enhancement. And midline fixation between penile skin inner surface and midline site of dermal graft was performed with surgifit 3.0. to accelerate the attachment of skin and graft. We use newly developed dissection technique with curved iris scissors and electro-cutting to dissect surgical plain between dartos and buck’s fascias. To perform lengthening procedure, fundiform ligament was dissected and pre-pubic dead space was approximated by multi-layer transverse suturing. Results Mean operation time was 46 min and mean incision length was 3.3 cm. Postoperative penile length after 3 months was elongated on average 2.7 cm. postoperative inflammation rate was 1.2% and no garfts failure was observed. Conclusions For more effective and safer penile enhancement and lengthening, multi-layer dissection technique, multi-layer suturing lengthening and mid-line fixation technique with minimal pre-pubic incision (4m penile surgery) are very useful. Disclosure No.

(216) Benefit of Closed Wound Drainage System with Negative Pressure in Penile Enhancement Surgery

Abstract Introduction Many patients have had penile enhancement surgery and the surgeon try to reduce postoperative complications including hemorrage, infection, wound dehiscence etc. we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Objective we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Methods We have experienced 500 penile enhancement surgery. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermal grafts which were fixed at the Buck's fascia. And we dissected fundi-form ligaments and sutured transversely pre-pubic dead space with PDS 2.0. In group 1, silastic drain were inserted in 250cases in order to drain postoperative bleeding and prevent inflammation. In group 2, the remain 250 cases adopted closed wound drainage system with negative pressure. Results In group 1, the wound infecton rate was 2.9% and no dermal graft infection was showed. In group 2, the wound infection rate was 0.6% and no dermal graft infection was appeared. Group 1 using closed wound drainage system with negative pressure is more effective than group 2 using silastic drain in order to reduce wound infection rate. Conclusions In penile augmentation surgery using Allogenic dermis, Using closed wound drainage system with negative pressure is safer than using silastic drain as postoperative drainage system. Disclosure No.

(110) Evaluation of Penile Anatomy with MRI

Abstract Introduction Penile enlargement interventions have become increasingly popular in recent years. The common lengthening procedure involves dividing the fundiform and suspensory ligaments to enable the outward movement of the concealed part of the penis. Nevertheless, the outcomes of these surgeries can vary, and clear patient selection criteria have yet to be established. Objective In this study, our objective was to assess penile anatomy using MRI and to identify penile anatomical variations that can aid in the selection of patients for penile enlargement surgeries. Methods We conducted a retrospective study to assess penile anatomy in the context of lengthening surgery. Pelvic MRIs taken for various reasons were evaluated, and the angle between the penile shaft and the symphysis pubis (a), as well as the distance from the pubis to the skin (b), were measured. Patients were categorized into three groups (I, II, III) based on the highest point of the penis relative to the symphysis pubis in the sagittal plane (Figure 1). Results A total of 519 pelvic MRIs were initially reviewed, and 344 met the protocol's eligibility criteria. The participants had a median age of 53 years (IQR 38-65) and a median body mass index of 26 (IQR 24-29). The median angle between the penile shaft and pubis was 23 degrees, with a pubis-skin distance of 38 mm. Age was significantly correlated with the angle between the penile shaft and pubis (r=0.61, p<0.01). Patient distribution across the groups based on penis highest point and pubis location was as follows: 36.1% in Group I, 47.4% in Group II, and 16.5% in Group III. Additionally, a significant positive correlation existed between BMI and suprapubic fat thickness (r=0.65, p<0.01). The analysis unveiled noteworthy variations in penile anatomy, suprapubic fat distribution, peno-pubic angle, and the anchoring point of the fundiform ligament to the penis. Some penises also displayed an S-shaped anatomy. Figure 2 visually illustrates the range of observed penile anatomical variations. Conclusions Our study revealed a significant variability in penile anatomy. The distinctions among patients should be carefully considered when planning any penile enhancement intervention. Disclosure No.

(180) Unveiling Consumer Interest and Regional Disparities: Comparative Analysis of Online Search Trends for Penile Aesthetic Procedures

Abstract Introduction In recent years, the introduction of Penuma, an implantable silicone penile sleeve, offers urologists a tool in the cosmetic enhancement of the penis, specifically for individuals who are concerned regarding the perceived size of their penis, with buried penis, and with mild to moderate penile curvature. With the increasingly widespread adoption of Penuma, it is crucial to understand how public interest in Penuma compares to other related interventions such as hyaluronic acid injections. Objective To assess the online search interest over time for Penuma and other penile enhancement terms on a national and regional scale. Methods Google Trends data from 2018 to March 2021 were utilized to analyze online traffic for the search terms “Penuma”, “penile implant”, “penile girth”, “HLA injection”, and “penis injection”. Trendlines were generated to assess the changes in search interest over time. The highest search interest locations were identified for each term. Results While online searches for Penuma increased between 2018 through 2021, interest in Penuma has since been in decline (Figure 1). While interest in penile implants remained higher than Penuma throughout the study period, Penuma remained a more popular term compared to other cosmetic treatments including penile injections and HLA injections. In terms of regional disparities, the highest search interest for Penuma was observed in San Antonio, TX, while penile girth searches were highest in OKC, OK. Penile implant searches were prominent in Mobile, AL, and Birmingham, AL. Notably, HA injection searches peaked in New York, NY, and penis injection searches were most prevalent in Los Angeles, CA. Conclusions This study highlights the dynamics of online search interest of Penuma in relation to other penile enhancement terms. While general interest in penile implants and penile girth surpasses that of Penuma, regional disparities in search patterns are evident. The findings emphasize the need for further research to understand the factors driving these disparities and the implications for consumer decision-making in different regions. Such insights can assist healthcare professionals and policymakers in tailoring educational initiatives and resource allocation to meet the diverse needs and preferences of individuals seeking penile enhancement procedures. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(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.

(050) Safety and Efficacy of Hyaluronic Acid Injections Using the UroFill™ Technique for Penile Girth Enhancement

Abstract Introduction Penile girth enhancement (PGE) has gained significant popularity and is in high demand among individuals seeking to improve their sexual experiences and self-confidence. Perception of penile length and girth are integral components of the male psyche. Unfortunately, current treatment options for motivated patients looking to enhance penile girth fall short of patient and clinical expectations. While the safety of penile augmentation methods has been a subject of debate, hyaluronic acid (HA) fillers have demonstrated proven efficacy and safety, offering potential solutions for those interested in PGE. Advancements in the field of penile cosmetics with HA has led to the development of the UroFill™ patented technique for PGE. Objective To assess the safety and efficacy of injecting HA using the UroFill™ technique for PGE. Methods We performed a retrospective analysis of men undergoing penile girth enhancement with FDA-approved HA fillers between October 2021 and March 2023. Patients completed a series of validated questionnaires including the COPS-P, IIEF, and BAPS. Peri- and post-procedure adverse events were closely monitored. Physician follow-up appointments and patient questionnaires were utilized to identify and document these events. The determination of unsatisfactory cosmetic outcomes and the need for revision was made by the treating physician in consultation with the patient. The UroFill™ standardized technique was employed for all injections. Results A total of 300 men (mean age: 37, range 21-80) received treatment using the UroFill™ standardized technique. 4,879 injections were performed over this time. Mean injection volume was 16.5 cc (range: 4-78cc) of HA once treatment had been completed. The study observed an average of 3.85 injection sessions (range: 1-44 sessions) and 5.25 post-injection modeling sessions (range 0-55) per patient. After receiving HA dermal fillers, patients experienced local injection site reactions such as bruising, tenderness, swelling, and erythema. These events were generally mild in intensity, and no patient reported bruising lasting longer than 7 days. None of the patients in this cohort required removal of filler. Adverse reactions were limited to 8 cases of localized skin infections which were successfully treated with conservative antibiotic therapy. All localized skin infections were a result of premature sexual intercourse or shaving in the area following injection. Patients reported high levels of satisfaction with 272/300 (91%) reporting “completely satisfied” or “mostly satisfied”. Mean filler retention was 90% after 12 months. Conclusions This study provides evidence that the UroFill™ standardized technique for penile girth enhancement using HA fillers is both safe and efficacious. With no instances of filler removal and successful management of adverse reactions, the safety profile of HA fillers is further supported. These findings reinforce HA’s potential for sustainable penile enhancement. It is essential these procedures be performed in the described fashion by qualified urological professionals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, UroFill.

Penile enhancement: men who want more

Penile enhancement, while indicated for men with penile abnormalities, is controversial for men who are simply dissatisfied with the size or appearance of their penis. A multidisciplinary approach to evaluate men for penile enhancement is key to appropriate management, and patients need to be made fully aware of the likely outcomes and risks of procedures on offer, not all of which are fully supported by clinical evidence.

(532) An Innovative Combination of Penile Corporeal Girth Enhancement and Erection Restoration

Abstract Introduction It has been controversial in penile venous surgery for erection restoration and penile enhancement across three centuries thus far. Objective Based on the De Novo penile fibro-vascular assembly, we report an anatomy-physiology-based combination of a physiological penile corporeal diameter expansion and erection restoration surgery in recent decades. Methods From 2012 to 2022, intractable impotence and subjective micropenis prompted 23 men to seek penile venous stripping (PVS) and factual penile enhancement (TPE). All patients received dual cavernosography demonstrating penile venous anatomy and veno-occlusive dysfunction. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins after every emissary's vein was double ligated 0.3 cm apart closest to the outer tunica with a 6-0 nylon suture. In addition, the para-arterial veins were just segmentally ligated. In TPE, a longitudinal incision was performed bilaterally over 3 and 9 O'clock positions along the pendulous penis. Every tunic defect was then water-tight sutures with a 7x3 cm rectangle venous stripe as an inner tunica bilaterally, subsequently covered with a piece of 7x3 venous wall, fascia tense lata, or a controlled tissue integration material sheet for surrogating the outer layer bilaterally. On penile girth and glans penis, the diameter was measured preoperatively and postoperatively in six months when a cavernosography was conducted, if available. Radio-opacity was used to compare the femoral cortex and the penile crus on preoperative and postoperative cavernosography. Additionally, the abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) was used to confirm improvement preoperatively and postoperative follow-up yearly either by telephone or INTERNET. Results The average follow-up period was 5.3±0.8 years. The operation time was 7.2±1.8 hours. The material of outer patches was fascia tense lata (n=3), Surgifrom (n=6), penile vein (n=8), internal spermatic vein (n=3), and cephalic vein (n=3). The radiopacity was unexceptionally enhanced postoperatively. It was a significant difference between the preoperative and postoperative IIEF-5scores (9.7±2.8 vs. 20.8±2.3; P<0.01). The EHS improved at least one scale. The diameter of the glans and distal penile shaft is increased from 2.78±0.33 cm and 3.41±0.41 cm (n=18) to 2.98±0.32 cm and 3.49±0.31 cm, respectively. Although the satisfaction rate is only 70.0% (16/23), the intracorporeal retention and erection quality improvement were unexceptional. Conclusions This novel combination strategy of factorial penile enhancement and erection restoration is feasible. However, it requires a more significant sample size and longer-term follow; the surgery technology is conspicuously challenging. Disclosure No

(220) Penile Enhancement Supplements: The Only Thing Getting Bigger is Demand & False Hope

Abstract Introduction Penile dysmorphophobia is common, with up to 20% of men reporting dissatisfaction with their genital size. The global market for Sexual Enhancement Supplements is estimated at $300 Million in the year 2020 and is projected to reach $608 Million by 2027 in the US alone. Evidence for efficacy is minimal, and purported claims are hyperbolic. Objective We sought to assess penile elongation internet offerings, quantify cost, ingredients, and risk and investigate scientific literature of product ingredients when available. Methods Three online marketplaces (Amazon, Google market, and Walmart) were queried for dietary supplements available without a prescription to improve penile size. Product labels were reviewed to compile penile size-related claims and active ingredients. The one-course (60-day) cost of treatment and consumer star rating were assessed. MEDLINE, Web of Science, and Google Scholar were queried with labeled ingredients to assess the scientific evidence from published and lay sources. Results A total of 84 dietary supplements claimed either increased penile length, girth, enhanced sexual performance, or a combination thereof. Of these 84 products, 90 ingredients were listed. The Mean 60-day cost was $52 (range of $12–$222). The median score by consumers in the markets with a possibility of star rating was 3.5 (range 2.4-4.2) with obvious repetitive and self-promotional tactics. Unsurprisingly, no scientific evidence supporting change in penile size was found for any products in our search. Actual described physiologic activity from active ingredients included were described as antidepressant, lipid and glucose lowering/metabolizing, blood pressure effecting, anti-inflammatory, renally protective, cognitive function effecting, antioxidant, and several ingredients weakly enhancing erectile activity. Renal failure, warnings against long-term use, heart problems, neuropathy, blood pressure effects, fertility toxicity, bleeding, liver disease, and numerous interactions with diabetes, blood thinning, immunosuppressant, and PDE5 medications were found for the ingredients. Conclusions Dietary supplements claiming to enhance penile size contained ingredients with conflicting or no scientific evidence to support their claims. Several ingredients were dangerous. Clinician awareness of these sham “solutions” and their continued mass consumption highlight the magnitude of misinformation, unrealistic expectations, shame, and enhancement desperation regarding penile size in the male public psyche. Disclosure No

(102) Complications of the Penuma Penile Implant for Genital Enhancement

Abstract Introduction The Penuma penile implant (PPI) is a subcutaneous silicone implant intended to increase penile length and girth. Only one case report and one case series of four patients have been published on the complications of PPIs. Objective To report a single center experience treating complications of the PPI both prior to and after implant removal. Methods Patients with a prior history of PPI surgery treated at our center were identified between 2012 and 2022. Demographic data, implant date, complications leading to explant, postoperative course, and functional outcomes were recorded. Our protocol is to wait 6 months after explant prior to scar excision (SE)/revision should disabling capsular contraction develop. Results A total of 13 patients were evaluated at our institution. Median age at time of implant was 36 (26-54) years. The median duration of implant was 3 months (range 3 days-33 months). Mean follow-up was 21.6 months. The most common complication leading to explant was distal lateral protrusion of the implant at the coronal margin causing patient and partner discomfort which occurred in 8 patients. Other reasons for explant were skin erosion, infection, decreased sensation, ventral curvature, and penile shortening each occurring in 1 patient. Adverse sensation changes occurred in 2 patients after implant. Following explant 9 (69%) patients developed disabling dorsal curvature, 8 (62%) patients had penile shortening, 3 (23%) had infections, 2 (15%) had de novo sensation changes, 2 (15%) had erectile dysfunction, and 1 (8%) had right lateral curvature. Curvature occurred because of capsule contraction following explant. Of those with disabling curvature, 6 (67%) underwent scar excision (SE), 1 is awaiting scar maturation for SE, 1 more is considering SE for disabling curvature, and 1 has elected not to undergo further surgery. In patients who underwent SE, severe scarring was noted superficial to the neurovascular bundles. All patients who have undergone SE had improvement in curvature and were able to have functional erections. Conclusions PPI for cosmetic penile enhancement can be associated with a variety of complications leading to device removal. Subsequent to explant, capsular contraction can result in disabling curvature and penile shortening which can be managed successfully with SE. Disclosure No

(540) Aesthetic Penile Augmentation Procedures: A Comprehensive and Current Perspective

Abstract Introduction Society has perpetuated the misconception that penis shape and size are a marker of masculinity and sexual ability. Unfortunately, many men experience small penis anxiety syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average in length and girth. In these situations, patients who have received proper psychological evaluation may choose to pursue clinical procedures to augment their penis. There is a lack of consensus on current approaches for aesthetic penile augmentation in patients with small penis anxiety. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists. Objective We aim to provide a updated review of aesthetic penile augmentation procedures that are available for physicians to discuss with this unique patient population. Our review focuses on procedures and techniques that have been of interest in the scientific literature over the last five years. Methods A PubMed literature review was performed to identify articles published between 2015-2021 on penile aesthetic augmentation procedures. Relevant prospective studies, retrospective studies, and systematic reviews were included, while abstracts and opinion papers were excluded. Search terms included “penis”, “penile,” “augmentation,” “enhancement,” “aesthetic,” “girth,” and “length.” Results After thorough psychological counseling, patients with small penis syndrome may choose to undergo penile augmentation. Augmentation procedures range from invasive to non-invasive. Surgical solutions include grafts and flaps, suspensory ligament release, and suprapubic lipectomy. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). Noninvasive solutions include external devices such as vacuum pumps and traction devices. Conclusions In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. While there are a multitude of treatment options with varying degrees of invasiveness, there is no standardized recommendation for patients who are pursuing penile enhancement. Our review of the literature summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures. Disclosure No

MP79-18 QUALITY OF ONLINE MEDICAL INFORMATION ABOUT PENILE AUGMENTATION TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP79-18 QUALITY OF ONLINE MEDICAL INFORMATION ABOUT PENILE AUGMENTATION TREATMENT Jeffrey Lee, Chiya Abramowitz, Dhaval jivanji, Elie Kaplan-Marans, and Jacob Khurgin Jeffrey LeeJeffrey Lee More articles by this author , Chiya AbramowitzChiya Abramowitz More articles by this author , Dhaval jivanjiDhaval jivanji More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , and Jacob KhurginJacob Khurgin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is estimated that more than half of adult men in the United States express concerns about their penis size. With lack in available scientific data, the American Urological Association (AUA) and International Society for Sexual Medicine (ISSM) currently do not recommend any treatment options for penile augmentation. Nonetheless, many online resources speak on this topic and may be providing patients with inaccurate information. Therefore, we aimed to assess the quality of online educational information regarding treatment options for penile augmentation. METHODS: A Google search was performed using the terms “penile augmentation”, “penile enlargement”, and “penile enhancement”. The first 100 webpages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with pay walls were excluded from analysis. The quality of the website was assessed by presence of Health on the net (HON) code certification and by the DISCERN instrument. Two independent reviewers scored each webpage and inter-rater reliability calculated. Websites were categorized by the type of resource. RESULTS: After applying the exclusion criteria, a total of 69 websites were included in the data analysis. There were 9 (12.7%) websites with HON code certification. The mean DISCERN score was 38.2 out of 80, which is considered “poor” quality. Inter-rater reliability of the DISCERN score was 0.76. Webpages with HON code certification had a higher mean DISCERN score (52.7 versus 36.1, p<0.0001). Of the 45 commercial webpages, cosmetic and plastic surgeons (48.9%) comprised the larger proportion whereas urologists (42.2%). There was no significant difference in the DISCERN scores of commercial websites by urologists (n=19) compared to commercial websites by all other medical specialties (n=26) (34.9 versus 34.4, p=0.80). CONCLUSIONS: Overall, the quality of online patient education regarding penile augmentation is poor. Websites with HON certification were seen to have better quality of health information. Although regulation of online material is difficult, promotion of accurate information from the AUA or ISSM can help improve online content for patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Lee More articles by this author Chiya Abramowitz More articles by this author Dhaval jivanji More articles by this author Elie Kaplan-Marans More articles by this author Jacob Khurgin More articles by this author Expand All Advertisement PDF downloadLoading ...

COMPLICATIONS AFTER PENIS ENHANCEMENT WITH HYALURONIC ACID: A LITERATURE REVIEW

Introduction. The penis is a symbol of the primal sense of male fertility and sexual activity, which affects the sense of male personality and the ability to satisfy a partner. Some patients experience discomfort, even if their penis is within the normal size range from an anatomical point of view. The reason for the spread of penis enlargement procedures is related to the feeling of masculinity that the appearance of the genitals can give a man, as well as a changed perception of his body. Penis enlargement procedures are becoming more and more common among men who seek to achieve a more desirable aesthetic of their male organ. In addition, penis enlargement methods remain a controversial issue, as they do not have clear indications and can cause complications. Materials and methods. This study reviewed the literature on complications after penile enhancement with hyaluronic acid (HA). To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine), and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, we manually searched for relevant references in the found texts. Results. The use of HA injections for penis enlargement in men shows a low rate of complications both in the early- and long-term period after the procedure. In a small percentage of patients, early and expected side effects included swelling, bruising, subcutaneous nodules, and infections. In this work, radical ways of their correction are proposed for all types of complications, which makes the use of HA safe and effective for penis enlargement. Conclusions. Nowadays, there is a lack of high-level evidence-based information on complications after HA injections. Due to the growing demand for these procedures, the issue of their safety is relevant. According to the available statistics, the overall incidence of complications after HA injections is spontaneous without further side effects. If complications are detected, the prognosis after treatment is satisfactory. As a result, there are no standardized surgical protocols and recommendations for penile enhancement with hyaluronic acid in the world.

Penile Girth Enhancement Using Amniotic Membrane in a Rabbit Model: A stereological study.

This study aimed to evaluate the efficacy of penile girth enhancement (PGE) using amniotic membrane (AM) as a graft in a rabbit model. Additionally, quantitative histological data of the structure of the penis were obtained by stereological studies. This study was conducted at the Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. In this study, 20 adult male rabbits of similar age and weight were allocated to two groups: sham surgery and surgery+AM. Both groups underwent surgery in which a longitudinal I-shaped midline incision was made in the tunica albuginea on the dorsal surface of the penis. The surgery+AM group underwent PGE using AM as a graft. The penile length and mid circumference were measured using a vernier caliper before and two months after the surgery. The mean total volume and diameter of the penis significantly increased in the surgery+AM group (P <0.03 and P <0.04, respectively). On stereological evaluation, a significant increase in the mean volumes of the tunica albuginea and corpora cavernosa was observed in the surgery+AM group compared to the sham group (P <0.01 and P <0.03, respectively). Additionally, the mean volume densities of the collagen bundles, muscle fibres, cavernous sinuses, and the total number of fibroblasts and smooth muscle cells increased in the surgery+AM group compared to the sham group (P <0.05 each). No infections, bleeding or other complications were observed. The use of AM as a graft is a method that shows promising results for material use in penile enhancement. Thus, it may be considered for PGE in the future.

Revelations on Men Who Seek Penile Augmentation Surgery: A Review.

Men with normal penis size sometimes mistakenly believe they have below average penile dimensions and often seek out treatment. Many men suffer from significant anxiety regarding this perceived defect. In this review, we evaluate the current literature of psychological, medical, and surgical treatment options for men with a complaint of a small penis. To review the current practice for treatment of men presenting for penile augmentation surgery. A literature review was conducted, using PubMed to identify current studies regarding penile enhancement. Search terms included "penile enhancement," "small penis anxiety," "small penis syndrome," "body dysmorphic disorder," and "penile augmentation." The literature consistently reveals that men who seek out penile augmentation surgery usually have normal penile dimensions. There are limited published data on the practice of penile lengthening surgery or procedures to increase penile girth. New techniques have expanded on suspensory ligament release, such as tissue grafting and flaps. Structured psychological counseling continues to be the recommended initial standard of care for these men. Many social forces have increased the perception among men that their penis size is inadequate. This increases anxiety and can lead to psychological disorders such as Penile Dysmorphic Disorder and Small Penis Syndrome. Men who undergo penile enhancement are often not satisfied with the results and may develop complications. Soubra A, Natale C, Brimley S, et al. Revelations on Men Who Seek Penile Augmentation Surgery: A Review. Sex Med Rev 2022;10:453-460.

REMOVED: The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement.

IntroductionThere are limited options for cosmetic penile enhancement and the correction of structural penile deformities.AimWe present the Augmenta, an innovative, technologically advanced subcutaneous elastomer-silicone cosmetic penile implant (CPI), as evaluated by objective structural changes in a cadaveric model.MethodsFive fresh male cadaver pelves were utilized in this preclinical setting. Placement of a subcutaneous elastomer-silicone CPI was performed via a penoscrotal approach. Penile circumference was measured at the base and distal shaft before and after implant placement. Penile length was measured from the pubic bone to the tip of the glans penis before and after implantation of Augmenta.Main Outcome MeasureObjective outcomes included changes in penile circumference and shaft length in both the flaccid and erect state, both before and after CPI placement.ResultsIn 5 cadaver models, implantation of the Augmenta CPI increased flaccid penile shaft base circumference from an average of 8.7 cm to 12.0 cm after implantation (39.1% increase, P < .001). Flaccid distal circumference increased from 7.3 cm to 10.3 cm (41.8% increase, P = .020). During the erect state, penile base circumference increased from an average of 12.5 cm to 13.7 cm (6.3% increase, P = .273), while distal erect circumference changed from an average of 11.3 cm to 12.4 cm (9.7% increase, P = .298). Nonstretched flaccid shaft length increased from an average of 12.1 cm to 14 cm (15.2% increase, P = .073).Clinical ImplicationsThe Augmenta CPI could serve as alternative option for men seeking cosmetic penile enhancement.Strengths and LimitationsLimitations include a small number of cadavers which do not completely reproduce living physiologic function and the use of a single technical approach. However, a consistent and standardized surgical approach reduces operator-dependent outcomes. Another strength is the use of fresh human cadavers that most closely represent live models.ConclusionIn a cadaveric model, the Augmenta CPI demonstrates enhancements in penile girth in both the flaccid and erect state. The unique honeycomb technology, the embedded polyester mesh, and the antimicrobial hydrophilic coating of the Augmenta CPI may provide an advantage to currently available CPIs. Clinical trials will be needed to demonstrate both the safety and feasibility. Clavell-Hernández J, Tatem AJ, Lipshultz LI, et al. The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement. Sex Med 2021;9:100447.

The perils of penile enhancement: case report of a fulminant penile infection

BackgroundPenile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support.Case presentationA 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission.ConclusionThis is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.

Penile shortening complaints in males with erectile dysfunction: a narrative review on penile lengthening procedures during penile prosthesis surgery.

Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate 'normal' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient’s overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were “penile lengthening”, “penile enhancement”, “penile girth”, “inflatable penile prosthesis” and “glans augmentation”. Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.

Penile Reconstruction after Polymethilmetacrylate Injection

Rising number of aesthetic procedures in men directed to enhance genitalia has alerted the medical community due to several complications related to them. Most of those procedures are performed in an office under local anesthesia using different kind of substances, most of them known to be harmful for humans; still, patients seek those procedures as a “safe” way to meet their goals. We present a reconstruction case due to Polymethilmetacrylate injection for penile enhancement.

Non-invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review.

To systematically review the literature in order to investigate the efficacy and safety of surgical and non-invasive penile enhancement procedures for aesthetic and therapeutic purposes. A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty-nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie's disease and erectile dysfunction. Twenty-five studies evaluated non-invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non-invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing. The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications.