Penile Lengthening Research Articles

A Proof of Concept Top Evaluate a Novel Penile Lengthening Protocol

A Proof of Concept Top Evaluate a Novel Penile Lengthening Protocol

Anti-lysyl oxidase combined with a vacuum device induces penile lengthening by remodeling the tunica albuginea.

This study aimed to explore whether and how anti-lysyl oxidase (anti-LOX) combined with a vacuum device (VD) could promote penile lengthening and to evaluate the effect on erectile function. This study was performed on four groups of adult rats: control, anti-LOX, VD (negative pressure value of −300 mmHg), and anti-LOX + VD. Penile length was measured by a modified VD method and verified on exposed length data. Intracavernous pressure (ICP) and maximum ICP/mean arterial pressure (MAP) ratio were recorded to assess erectile function. For corpus cavernosum, LOX activity and concentrations of pyridinoline, desmosine, hydroxyproline, and elastin were analyzed; transmission electron microscope and Hart's elastin staining were performed to monitor microstructural changes. Anti-LOX and VD significantly lengthened the penis by 10.8% (3.75 mm) and 8.2% (2.48 mm) compared with the control group, respectively, while anti-LOX + VD achieved the longest penile size (40.58 ± 0.40 mm) which was 17.4% longer than the control group (34.58 ± 0.54 mm). After 1-week washout, no penile retraction was observed. Meanwhile, exposed penile length data confirmed that the penis in the anti-LOX + VD group was also significantly longer. Anti-LOX inhibited LOX activity to reduce pyridinoline level, which led the penile tunica albuginea remodeling. However, it had no effect on hydroxyproline, desmosine, and elastin levels. Moreover, anti-LOX had no impact on erectile function, which was determined by ICP and ICP/MAP ratio. These results suggest that anti-LOX elongates the penis by reducing pyridinoline, which induces tunica albuginea remodeling. This lengthening effect was more obvious when combined with a VD. All procedures had no impact on erectile function.

Utility of Skin Grafting and Tissue Expansion in Penile Reconstruction for the Exstrophy-Epispadias Complex

ObjectiveTo describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex patients using either local skin from tissue expansion (TE) or extragenital skin with a skin graft (SG) and report their respective outcomes. MethodsAn institutionally approved database of exstrophy-epispadias complex patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of TE and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length. ResultsA total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%). ConclusionTE and SG are useful techniques in providing soft tissue coverage following penile lengthening. TE is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extragenital skin (SG) is recruited.

The concealed penis: the "two-corner" surgical technique.

Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing. From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the "two corners" technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed. Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients. The "two-corners" technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.

Penile lengthening and the treatment options available

Penile lengthening can restore normal functioning length and improve a patient's quality of life. Determining the underlying pathology is central to guiding choice of treatment, which will vary depending on individual patient circumstances.

Strategies and current practices for penile lengthening in severe Peyronie's disease cases: a systematic review.

Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile function, plaque incision/excision (PIG/PEG) are advisable in order to maximize penile length, despite the risk of postoperative erectile dysfunction (ED), recurrent curvature, or penile shortening. For men with PD deformities associated to a certain degree of ED several lengthening techniques associated to penile prosthesis (PPI) implantation can be considered. Because of the potential postoperative complications, the indication must be balanced between patient's risk factors and surgeon's experience. Furthermore, adjuvant surgeries, such as prepubic V-Y plasty, suspensory ligament release, suprapubic lipectomy, and ventral phalloplasty, can be performed simultaneously or in a staged fashion to maximize the outcomes. Restoration a decent penile length in the case of a severe PD represents a real challenge for reconstructive surgeons. We present a systematic review of the literature on the current practices for penile lengthening in severe PD, providing the reader with a practical overview on the existing surgical strategies and their surgical and functional outcomes.

Surgical and Non-surgical Penile Elongation Techniques

To summarize data on lengthening treatments from PubMed-indexed scientific publications. Several surgical techniques achieve penile lengthening when combined with penile prosthesis (PP) implantation, including the sliding, incision/excision and grafting, and multiple incision techniques. Other factors associated with greater length with PP include use of AMS 700 LGX devices, new length measurement technique, immediate activation, and regular device cycling. Among non-surgical therapies, penile traction achieves lengthening in most studies, while vacuum therapies demonstrate milder improvements. Other treatments either have failed to demonstrate consistent benefits or have mixed data, including isolated incision/excision and grafting, scrotoplasty, lipectomy/escutcheonectomy, suspensory ligament release, placement of cylindrical silicone (Penuma), or penile injections with silicone, hyaluronic acid, or other similar materials. Although multiple surgical and non-surgical therapies exist for penile lengthening, most have limited data available. Additionally, injection and surgical treatments can result in severe complications in some cases.

Marcel D. Waldinger January 17, 1955–May 1, 2019

Peyronie’s disease (PD) is a debilitating condition that affects a sizable number of men worldwide. Current treatment options consist of oral therapy, intralesional injections, and surgery. Penile stretching has been used as a treatment for PD, including penile traction therapy (PTT) and vacuum erection devices (VEDs), with numerous trials completed or underway.To present and summarize the current literature on penile stretching for the treatment of PD.Using PubMed, we performed a literature review of studies from January 1990 through July 2018 that focused on penile stretching for PD management. PTT and VED were included in the search criteria.Penile curvature correction was effective, and stretched penile length was improved.PD therapies that use penile stretching as a mechanical intervention to alter tissue characteristics were studied. PTT has been successful in primary penile lengthening and curvature correction in the acute phase of PD. PTT also improved length retention in men undergoing plication and incision/grafting procedures. Combination of PTT and intralesional injection therapy for PD treatment requires further investigation. There are fewer studies investigating VEDs and their role in PD management, but initial small trials suggest a role in curvature correction and penile lengthening.Penile stretching is an effective therapy for PD. Data from limited trials suggest a role for PTT and VEDs in the management of PD, although further research is needed.Cowper MG, Burkett CB, Le TV et al. Penile Stretching as a Treatment for Peyronie’s Disease: A Review. Sex Med Rev 2019;7:508–515.

Surgical Technique for Complex Cases of Peyronie’s Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece

IntroductionPatients with Peyronie’s disease (PD) and erectile dysfunction (ED) concomitant with shortening or other malformations benefit from prosthesis implantation and penile lengthening procedures. AimTo evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening. MethodsFrom February 2015–May 2018, 43 consecutive patients with complex PD were treated using this technique. Implantation of a penile prosthesis (malleable or inflatable [IPP]) together with multiple relaxing tunica albuginea incisions and grafting with a self-adhesive collagen-fibrin fleece (TachoSil, Baxter Healthcare) was performed in all patients by a single surgeon (J.I.M.S.). Main Outcome MeasurePenile length and curvature correction, operative time, and incidence of postoperative complications were recorded as outcome measures. Functional outcomes were measured with questionnaires (International Index of Erectile Function-5, Erection Hardness Score, modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, PD Questionnaire) before and 3 and 6 months after surgery. ResultsWith a median follow-up of 21 months (range 10–31), mean postsurgical penile lengthening was 2.5 (range 1–5) cm, with an improvement in the Bother domain of the PD Questionnaire of 4.4 (range 2–5) points. The average operative time was 86.7 and 71.6 minutes for the IPP and malleable penile prosthesis procedure, respectively. No glans ischemia was recorded; however, 1 IPP infection and 1 delayed distal corporeal erosion were recorded. Hematoma or bruising was observed in 23.2% of patients. The modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was completed by 39 (90.7%) patients. Overall, 89.7% would recommend this surgery. Patient satisfaction with straightness and length was 94.9% and 82.1%, respectively. Clinical ImplicationsThe described technique helps restoration of penile length and erectile function in patients with complex PD. Strengths & LimitationsThe strength of the study is that it offers a simple, easy-to-apply technique for surgeons to correct shortening and other malformations in patients with ED and complex PD. The study is limited by the small number of patients, the short follow-up period and the performance of the technique by a single high-volume implanter. ConclusionThe implantation of a penile prosthesis (malleable or inflatable) together with multiple incisions of the plaque/tunica albuginea and grafting with a collagen fleece is a safe and efficient treatment for patients with complex PD in addition to ED and significant shortening.Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical Technique for Complex Cases of Peyronie’s Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece. J Sex Med 2019;16:323–332.

Additional procedures performed at time of penile prosthesis implantation: a review of current literature

Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie's Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. We sought to identify the results of available literature regarding the additional procedures performed at the time of penile prosthesis implantation that provide defined surgical outcomes rather than merely describe surgical techniques. Surgical outcomes to procedures provide more realistic clinical outcome for readers than simply the description of novel techniques or expert opinions. We performed a review of the MEDLINE database to identify additional procedures performed in conjunction with penile prosthesis placement. Many procedures are described in review articles, however, with limited data regarding their outcomes. The included articles must describe additional procedures performed in conjunction with penile prosthesis placement. Perioperative office techniques and management were included if it changed the surgical technique. All abstracts obtained through search criteria were reviewed. Only articles written in English, on human subjects with documented surgical results and relevant articles were included in this study. After a thorough literature search, a total of 24 articles were identified. Penile lengthening procedures at the time of penile prosthesis comprise most of the literature on this subject. Lengthening procedures are as simple as Peyronie's plaque excision and grafting to complex sliding and lengthening procedures requiring complete neurovascular bundle and partial urethral mobilization. Additionally, aggressive cylinder sizing and prolonged postoperative cycling at home are also described. Glanulopexy may be necessary when malpositioning of the glans is present. Other options such as scrotoplasty are also available options for those patients with scrotal webs. Notably there is a paucity of published literature regarding girth enhancement, buried penis repair, hernia repair, and vasectomy at time of penile prosthesis placement. There are numerous procedures that can be performed in the same operative setting as penile prosthesis. Although the procedures do have a common goal to provide optimal postoperative natural appearance, length, straightness, girth and function, the techniques employed must be tailored to each patient as there is not a one-procedure fits all in this patient population.

Penile Stretching as a Treatment for Peyronie's Disease: A Review.

Peyronie's disease (PD) is a debilitating condition that affects a sizable number of men worldwide. Current treatment options consist of oral therapy, intralesional injections, and surgery. Penile stretching has been used as a treatment for PD, including penile traction therapy (PTT) and vacuum erection devices (VEDs), with numerous trials completed or underway. To present and summarize the current literature on penile stretching for the treatment of PD. Using PubMed, we performed a literature review of studies from January 1990 through July 2018 that focused on penile stretching for PD management. PTT and VED were included in the search criteria. Penile curvature correction was effective, and stretched penile length was improved. PD therapies that use penile stretching as a mechanical intervention to alter tissue characteristics were studied. PTT has been successful in primary penile lengthening and curvature correction in the acute phase of PD. PTT also improved length retention in men undergoing plication and incision/grafting procedures. Combination of PTT and intralesional injection therapy for PD treatment requires further investigation. There are fewer studies investigating VEDs and their role in PD management, but initial small trials suggest a role in curvature correction and penile lengthening. Penile stretching is an effective therapy for PD. Data from limited trials suggest a role for PTT and VEDs in the management of PD, although further research is needed. Cowper MG, Burkett CB, Le TV etal. Penile Stretching as a Treatment for Peyronie's Disease: A Review. Sex Med Rev 2019;7:508-515.

AB041. Anti-Lysyl oxidase combined with vacuum aspiration induce penile lengthening by tunica albuginea remodeling

BackgroundThe penile length is from the pubis to the end of glan of the stretched penis, which is mainly defined by the dimension of cavernous body. Micropenis is generally defined as penile length below two standard deviations of mean value. There is no treatment with solid evidence in clinic. Our previous study found the expression of Lysyl oxidase (LOX) is downregulated with aging. Therefore, we use anti-LOX to moderate the tunica albuginea remodeling and observe penile lengthen. In the meantime, we evaluate it effects on erectile function.MethodsThis study was performed on two phases of rats: puberty and adulthood, and intervened for 7 weeks. Puberty protocol included groups of control, anti-LOX (β-aminopropionitrile), −200 mmHg vacuum aspiration (VA), −200 mmHg VA + anti-LOX, −300 mmHg VA, and −300 mmHg VA + anti-LOX; adulthood protocol comprised groups of control, anti-LOX, −300 mmHg VA, and −300mmHg VA + anti-LOX. Penile length was measured by a modified VA device and verified by stretched status. Intracavernous pressure (ICP) and maximum ICP/mean arterial pressure ratio were recorded to assess erectile function. Western bolt and histopathological staining were performed to reveal LOX activity, and transmission electron microscope was performed to reveal the microstructural changes. The concentrations of pyridinoline, desmosine, hydroxyproline and elastin were also analyzed.ResultsIn puberty groups, anti-LOX significantly increased penile length by 10.79% than control rats; the lengthening effect was more prominent in −300 mmHg VA + anti-LOX group, which is 19.84% longer. In adulthood groups, even less effective, −300 mmHg VA + anti-LOX significantly lengthened penis by 17.35%, no penile retraction observed one week later, while stretched penile length was also significantly longer (14.35%). Anti-LOX inhibited LOX activity to reduce pyridinoline level, which led penile tunica albuginea remolding. Finally, anti-LOX had no impact on erectile function, whether combined with VA or not.ConclusionsPenile length is significantly increased by anti-LOX, which inhibited pyridinoline to induce tunica albuginea remolding in puberty and adulthood rats, and all rats have on erectile dysfunction.

AB030. Penile surgery for premature ejaculation and augmentation

Premature ejaculation (PE) is a male sexual dysfunction characterized by short duration of vaginal penetration and difficult to delay ejaculation with negative personal consequence. Current management of PE includes psycho-behavioral therapy and medication (oral or topical using). Unfortunately, not all patients are benefit or effective to these therapies. On the other hand, some patients are not satisfied with the dependent of medication. As a result, some patients seek for surgery to solve their PE problems. Penile augmentation is an actually need? Still, common sense doesn’t stop size-obsessed guys from trying very sketchy treatments on a vital part of their anatomy. The typical erect penis is usually 12.5 to 15 cm long with a circumference of 10 to 12.5 cm. There’s more variation in the size of flaccid penises. Some guys are genuinely smaller than that. In rare cases, genetics and hormone problems cause a condition called micropenis—an erect penis of under 7 cm. Penile augmentation is a surgical procedure included penile lengthening or via increase in girth, or both. The lengthening of the penis involves release of the suspensory ligament of the penis via an incision just above the shaft of the penis. The release allows the penis to be brought outward in a straighter path thereby increasing the external length of the penis. In order to gain length, this was accomplished by the advancement of a pubic skin flap (V-Y flap). The gain varies depending on penis size, body build, and the amount of post-operative stretching performed. In some cases, additional procedures such as the pubic fat pad reducing with pubic liposuction can be performed to enhance the results. As far as increasing girth, there is augmentation via patient’s himself tissue or via biomaterial implantation.

Penile lengthening with porcine small intestinal submucosa grafting in Peyronie's disease treatment: long-term surgical outcomes, patients' satisfaction and dissatisfaction predictors.

Peyronie's Disease (PD) is an acquired connective tissue disorder that often leads to penile curvature (PC) and sexual dysfunction. Penile lengthening procedures (PLP) with four-layered porcine small intestinal submucosa graft (Surgisis® ES; Cook) have been widely used in patients with severe PC when erectile function is preserved. However, complications such as erectile dysfunction (ED) may limit treatment satisfaction. Focusing on patients perspective, our study aims to evaluate longterm patient-reported outcomes, satisfaction, and dissatisfaction predictors after PLP. This prospective study included 32 patients affected by PD with severe PC submitted to PLP with Surgisis® ES between 2011 and 2014. All patients were submitted to a standardized protocol with regular clinical evaluation at 3, 6 and 12months, and yearly thereafter. After the third year follow-up, IIEF-5, modified EDITS and an additional non-validated questionnaire were completed. Concerning the surgical procedure, the mean tunical defect area (TDA) was 15.9±6.9cm2 . The mean follow-up time were 49.6±12.7months and there was a significant increase in stretched penile length (p=0.01). Postoperative erectile function as assessed by IIEF-5 was positively correlated with overall treatment satisfaction evaluated through EDITS (p=0.01). TDA was negatively correlated with postoperative IIEF-5 (R=-0.56, p<0.001). TDA ≥ 14.375cm2 can predict ED with 76.9% sensibility and 58.3% specificity. Moreover, TDA ≥ 21.875cm2 can predict clinically significant ED (IIEF-5 score ≤17) with 80% sensibility and 95.2% specificity. Patient-reported longterm complications were 65.6% decreased penile length, 56.5% diminished rigidity and 25% curvature recurrence. PLP using a Surgisis® ES is a valuable surgical option for the treatment of PD with severe PC. Although it results in high rates of long-term patient-reported overall satisfaction, possible outcomes such as postoperative ED must be acknowledged. TDA is a strong predictor for postoperative ED and should be considered in clinical practice to classify patients in low- or high-risk for postoperative ED.

128 Surgical Management of Severe Post-operative Skin Necrosis after Penile Lengthening Corporoplasty

128 Surgical Management of Severe Post-operative Skin Necrosis after Penile Lengthening Corporoplasty

130 Surgical Technique for Complex Cases of Peyronie’s Disease: Penile Prosthesis Implantation, Modified Neurovascular Bundle Release and Single or Multiple Corporeal Incisions and Grafting with Collagen Fleece

Surgery is the mainstay of treatment for Peyronie’s disease (PD), but multiple surgical approaches may be considered. We present specific surgical techniques for each individual case. We aim to demonstrate its safety and effectivity for penile curvature correction and restoring erectile dysfunction with limited complications. Data were collected from a prospective cohort of 23 consecutive patients treated in our institution with complex PD and ED, between February 2015 and May 2017. The surgical procedure consists of an implantation of penile prosthesis (malleable or inflatable) associated with single or multiple incisions of the plaque/tunica albuginea and grafting with a self-adhesive collagen fleece, and previously modified neurovascular bundle release. All patients provided informed consent and the protocol was approved by Institution Review Board (IRB). In the video attached, we described each technique, step by step. With a median follow-up of 15.3 months, the mean postsurgical penile lengthening was 2.7(1-5) cm, with an improvement of PDQ PD bother score of 4.3(2-5) points. No glans ischemia or infectious complications were recorded, but hematoma was observed in 26% patients, and the overall satisfaction was 92%.

494 Penile lengthening with porcine small intestinal submucosa grafting in Peyronie’s disease treatment: long-term surgical outcomes, patients satisfaction and dissatisfaction predictors.

Peyronie’s Disease (PD) is an acquired connective tissue disorder that often leads to penile curvature (PC) and sexual dysfunction. Penile lengthening procedures (PLP) with four-layered porcine small intestinal submucosa graft (Surgisis®ES; Cook, USA) have been widely used in patients with severe PC when erectile function is preserved. However, complications such as erectile dysfunction (ED) may limit treatment satisfaction. Focusing on patients perspective, our study aims to evaluate longterm patient-reported outcomes, satisfaction, and dissatisfaction predictors after PLP. This prospective study included 32 patients affected by PD with severe PC submitted to PLP with Surgisis®ES between 2011 and 2014. All patients were submitted to a standardized protocol with regular clinical evaluation at 3, 6 and 12 months, and yearly thereafter. After the third year follow-up, IIEF-5, modified EDITS and an additional non-validated questionnaire were completed. Concerning the surgical procedure, the mean tunical defect area (TDA) was 15.9±6.9cm2. The mean follow-up time were 49.6±12.7 months and there was a significant increase in stretched penile length (p=0.01). Postoperative erectile function as assessed by IIEF-5 was positively correlated with overall treatment satisfaction evaluated through EDITS (p=0.01). TDA was negatively correlated with postoperative IIEF-5 (R=-0.56, p<0.001). TDA ≥ 14.375cm2 can predict ED with 76.9% sensibility and 58.3% specificity. Moreover, TDA ≥ 21.875 cm2 can predict clinically significant ED (IIEF-5 score ≤17) with 80% sensibility and 95.2% specificity. Patient-reported longterm complications were 65.6% decreased penile length, 56.5% diminished rigidity and 25% curvature recurrence.

V84 - Surgical management of severe post-operative skin necrosis after penile lengthening corporoplasty

V84 - Surgical management of severe post-operative skin necrosis after penile lengthening corporoplasty

217 Maximization of Penile Length and Girth with Inflatable Penile Prosthesis Insertion: A Cadaver Study

Penile length and girth after insertion of an inflatable penile prosthesis (IPP) are a concern for patients and surgeons alike. Stretched penile length (SPL) has been described as a good surrogate measure of erect penile length after prosthesis placement. In addition, several surgical techniques have been described to increase penile length during prosthetic surgery; however, these techniques have never been directly compared in terms of overall length increase. Utilizing cadaveric male pelves, we aimed to 1) determine the relationship between SPL and post implant length and 2) compare two techniques for penile lengthening. Ten previously frozen male cadaveric pelvises were obtained for a surgical training lab. Anatomic measurements were conducted from the pubis to the tip of the glans and at the midshaft of the penis to determine length and girth respectively. Inflatable penile prostheses were then inserted using a standard penscrotal incision under direct supervision by fellowship trained prosthetic urologists. The finger trap and the sliding technique penile lengthening procedures were performed as previously described in 5 cases each.

An Update on the Management of the Short Penis: Results from a Systematic Review

The aim of this manuscript is to systematically review the current literature on surgical management of the short penis, focusing on surgical and functional outcomes and postoperative complications. Penile size still represents a major concern among a large proportion of men regardless of age and socio-cultural background. On the other hand, there is still no clear agreement on the definition of a short penis. Penile inadequacy can be secondary to a variety of clinical conditions, either organic or psychogenic; moreover, the causes of a short penis could be divided in congenital or acquired. A surgical intervention is often requested to address these conditions, with a variety of different techniques that reflect the vast heterogeneity of the etiologies of the disease. Surgical and patients’ satisfaction outcomes are extremely variable, as long as the different techniques are hardly comparable. As a general statement, a lack of objective data, mainly concerning postoperative lengthening results, must be emphasized. To date, penile lengthening procedures remain highly controversial. Recent evidences show better results in case of intrinsic or “false” penile shortness, while there is a lack of standardized studies concerning patients affected by penile dysmorphic disorder.