Penile Length Research Articles

Outcomes of surgical correction of Peyronie's disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

ObjectivePeyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD. MethodsA retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention. ResultsThere was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree (p<0.05) and satisfactory penile appearance (p<0.05) were seen in both groups without any superiority between the two groups (p=0.423 and p=0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups (p=0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance (p=0.255 and p=0.101, respectively). ConclusionPartial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Molecular mechanisms of penile traction for penile rehabilitation in a bilateral cavernous nerve crush injury rat model.

Prostate cancer is the most common solid-organ malignancy in adult men. Early detection and treatment of prostate cancer with radical prostatectomy (RP) has improved cancer-specific survival but is associated with penile shortening and erectile dysfunction. Penile traction therapy (PTT) has been demonstrated to increase stretched penile length (SPL) prior to penile prosthesis placement and may improve erectile function (EF) in patients with Peyronie's disease. We aimed to evaluate the efficacy of PTT in preserving penile length and EF after bilateral cavernous nerve crush injury (BCNI) in a rat model. Twenty-four male Sprague-Dawley rats aged 11-13 weeks were randomly assigned to three groups (n=8, each): sham operation with no PTT (Sham), BCNI without PTT (Crush), and BCNI with PTT (Traction). PTT was started on postoperative day 3. A traction force of 1 Newton was applied to the penis for 30 minutes each day for 28 days. After 28 days of traction, the cavernous nerve was stimulated while recording the intracavernosal pressure (ICP) and the mean arterial pressure (MAP) simultaneously. Cavernosal tissue was excised, and western blot analysis for endothelial nitric oxide synthase (eNOS) was performed. Significance was determined by using ANOVA with Tukey-Kruger post-hoc testing. At 4 weeks after nerve injury, the Traction group had significantly greater SPL compared to the Sham and Crush groups (30 vs. 28 and 27 mm, respectively). The Sham group had significantly greater EF (ΔICP/MAP) compared to the Crush group at 2.5, 5, and 7.5 V. The EF of the Traction group was between that of the Sham and Crush groups and was not significantly different from the Sham group at any voltages. Further downstream analysis revealed that the Traction group had significantly greater eNOS expression in cavernosal tissue compared to the Crush group, which was confirmed on western blot analysis and immunohistochemistry (IHC) staining. Findings from this animal study suggest that PTT has the potential to mitigate penile retraction after RP. While more studies are needed to determine the effect of PTT on preservation of EF, the increased eNOS expression observed in the Traction group offers a potential protective mechanism of action.

Evaluation of sexual function after robot-assisted radical prostatectomy: A farewell to IIEF questionnaire.

Longevity with localized prostate cancer (PCa) has been achieved, and the contribution of robot-assisted radical prostatectomy (RARP) to cancer control is evident. The next step to investigate in the treatment of localized PCa is improvement of the quality of life (QOL) after RARP. Erectile dysfunction has been considered a major surgical complication, and patient satisfaction after RARP has not improved despite the development of nerve preservation and penile rehabilitation. To comprehensively understand sexual dysfunction after RARP, we must investigate other complications with regard to sexual health, including low sexual desire, disturbed orgasmic function (i.e., anejaculation, orgasm intensity, painful orgasm, and climacturia), shortening of penile length, penile curvature (Peyronie's disease) and unique psychological alterations after the diagnosis of PCa, which are neglected side effects after prostatectomy. In this context, routine evaluation of erectile function by the International Index of Erectile Function only is not sufficient to understand patients' difficulties. A questionnaire is just one way of enabling patients to evaluate their pre- and postoperative concerns; listening to patients face-to-face is warranted to detect symptoms. Understanding the relationship between symptoms and preserved nerve localization can ultimately provide an individualized nerve-sparing procedure and improve patient satisfaction after RARP. In combination with psychological counseling, including the partner and medical treatment, such as testosterone replacement, it is time to reconsider ways to improve sexual dysfunction after RARP.

The comparison of success status and complications in peyronie disease patients: penile plication versus plaque incision and grating techniques

Aims: This study aimed to evaluate and compare the outcomes of tunical lengthening and shortening techniques for the surgical management of Peyronie's disease (PD) in terms of penile length, patient satisfaction, and complications.&#x0D; Methods: A retrospective analysis was conducted on PD patients who underwent surgical procedures between January 2017 and May 2023 at a single institute. Patient demographics, comorbidities, penile curvature, penile length, and surgical techniques were evaluated. The surgical procedures included plaque incision and grafting, and tunical plication. Post-operative data, including penile length, residual curvature, patient satisfaction, adverse events, and erectile function, were collected at 1-12 months of surgery. &#x0D; Results: A total of 36 patients (mean follow-up period: 432.25±121.14 days) underwent surgical procedures for PD. Penile length in the tunical lengthening group (13.04±1.62 cm) was significantly longer than in the tunical shortening group (10.85±1.24 cm, p=0.001). Tunical shortening procedures were associated with a higher rate of penile shortening (57.1% vs. 6.7%, p=0.001) and suture-related discomfort (38.1% vs. 6.7%, p=0.031) compared to tunical lengthening procedures. Patient satisfaction was higher in the tunical lengthening group (80% vs. 66.7%, p=0.378). There was no significant difference in painful erection during penetrations or incapability of intercourse between the groups. The average length of hospital stay was longer for tunical shortening surgery compared to tunical lengthening surgery (1.27±0.27 vs. 1.79±0.39, p=0.023).&#x0D; Conclusion: Tunical lengthening procedures demonstrated superior outcomes in terms of penile length and suture-related discomfort compared to tunical shortening procedures for the surgical management of PD. Patient satisfaction was also higher in the tunical lengthening group. Clinicians should consider various factors when selecting the appropriate surgical technique for PD, including penile length, the degree of penile curvature, and surgeon experience. Prospective randomized studies are needed to further validate these findings and assess long-term outcomes.

Clinical Study of Modified Devine's Surgical Technique in the Treatment of Concealed Penis.

This study aimed to observe the clinical effect of modified Devine's surgical technique in the treatment of concealed penis. From July 2015 to September 2020, fifty-six children with concealed penis were treated with modified Devine's technique. Recorded the penile length and the satisfaction score preoperatively and postoperatively to confirm the effect of the surgery. Followed up the penis for bleeding, infection and edema one week and four weeks after the operation. Twelve weeks after the operation, we measured the length of the penis and observed whether there was a retraction. The length of the penis has been effectively lengthened(P < 0.001). There was significant improvement in parents' satisfaction grades (P < 0.001). All the patients had different degrees of penile edema after the operation. Most of the penile edema subsided about four weeks after the operation. No other complications occurred. No obvious penile retraction was found twelve weeks postoperative. The modified Devine's technique was safe and effective. As a treatment for concealed penis, it is worthy of wide clinical application.

Penile Length Assessment of Children Treated for Primary Buried Penis: Can Satisfying Penile Growth Always Be Achieved?

Primary buried (BP) penis is describes as a small penis caused by a penile ligaments anomaly; it is unclear if a primary BP could reach a normal length. We selected 49 patients treated at our institution between 2015 and 2020 in order to post-operatively evaluate the SPL after one year. SPL was evaluated according to the PH Tanner staging system for pre-pubertal patients according to age-normalized values. A micropenis was detected if the SPL was below 2.5 SD. A normal SPL was found in thirty-two patients, eighteen were in PH Stage 1, four were in PH Stage 2, six were in PH Stage 3, and four were in PH Stage 5. Seventeen patients showed a reduced SPL; in seven of these (four in PH Stage 4 and three in PH Stage 5), their SPL was <2.5 ST. The difference in micropenis prevalence between the pre-pubertal and post-pubertal patients was significant (p = 0.038). A primary BP grows normally during the pre-pubertal period, where patients frequently showed a normal SPL, but it seems to be unable to reach a normal length in the higher PH stages, where the SPL is used to detect a micropenis. We suggest that a primary BP should be considered not as a simple defect of the penile ligaments and surrounding tissues, but as an incomplete manifestation of a micropenis due to a growth slowdown of the organ in late puberty.

A new species of Askola Peters, 1969 (Ephemeroptera: Leptophlebiidae) from Southeastern Brazil.

Askola fortuita sp. nov. is described based on male imagos from Southeastern Brazil, near Caparaó National Park. The new species is somewhat similar to A. froehlichi Peters, 1969 in regards to development of the male compound eyes and relative length of penis, but can be readily distinguished from this and other species of the genus by the following characteristics: dorsal portion of compound eyes widely meeting on meson of head; forewings hyaline; femora white, with a submedial mark and an apical band, both orangish brown; abdominal coloration mostly translucent white; genitalia with styliger plate washed with brown and red laterally, forceps segment I reddish-brown on basal ¼ , remainder translucent white, penes yellowish brown; penes not extending beyond posterior margin of styliger plate.

Bilateral Technique of Penis Flap with Scrotum Skin in Penile Paraffinoma Cases: A Case Report

Background: Paraffin injection into the penis is one way that people see it as increasing penis size. But many do not know that paraffin injection actually causes side effects in the form of penile paraffinoma. This study aimed to describe the management of paraffinoma using bilateral techniques.&#x0D; Case presentation: A 40-year-old married man came to the emergency room at Samuel J. Moeda Naval Hospital, Kupang, with complaints of pain and swelling of the penis for 6 hours. The pain felt to get worse when the penis was erected. The genital organs found swelling of the entire penile skin accompanied by tenderness and induration. The bilateral scrotal flap technique was because the scrotal skin had many blood vessels, good flexibility, little adipose tissue, thin skin, and could feel erogenous sensations almost the same as the physiological characteristics of the penile skin.&#x0D; Conclusion: Bilateral scrotal flap technique on the penile shaft is a surgical technique that is quite effective in eradicating paraffin from penile tissue.

Penis Girth Augmentation Using SEPA Flap and Dermofat Grafts.

Men of various ages feel that an increase in penile size would give them and their sexual partners an increased confidence. There are a variety of methods for increasing penile girth, such as injection therapies and surgery. All of these methods have a high complication rate which must be emphasized to the patients. In this article, the techniques used for increasing penile girth using dermofat grafts and SEPA (superior external pudendal artery) flaps are highlighted along with their complications and their management thereof. Ten patients were operated for penile girth augmentation between June 2016 and March 2022. Of these, six patients had augmentation using dermofat grafts and four patients had SEPA flaps. Patients were chosen as per the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI) score which was between 2 and 6 in the pre-operative period. The age range of the patients were between 25 and 57 years. The mid-penile girth in the flaccid state ranged from 8.8 to 12.3 cm. Post-operatively, after 6 months, the final girth increase varied from 1.9 to 2.6 cm. The complication rate was 50% and included skin loss, urinary obstruction, fat necrosis, and so on. The post-operative APPSSI score ranged from 2 to 12. Complications were more in uncircumcised patients and in those who desired excessive augmentation. Penis girth augmentation using SEPA flaps and dermofat grafts is indicated in patients who fulfill the criteria and give appreciable girth increase, but patients need to be aware of the potential complications of these surgeries.

Estimation of Reference Values for External Genitalia Parameters in North Indian Preterm and Term Male Newborns.

To generate gestation-wise normative data of external genitalia measurements in North Indian term and preterm male newborns. This was a hospital-based cross-sectional observational study. Male neonates born between 28-42 wk of gestation (at 24-72h of life) were consecutively recruited in the study. Newborns with major congenital malformations, chromosomal anomalies, multifetal gestation and birth injuries were excluded. Data on various genital measurements were collected [Stretched penile length (SPL), penile width (PW), upper anogenital distance (AGDu), lower anogenital distance (AGDl) and anogenital ratio (AGR)]. Out of 532 newborns, 208 (39.1%) were preterm. Mean (± SD) SPL and PW were 27.9 ± 3.6mm and 10.6 ± 1.3mm respectively. The mean values for AGDl, AGDu and AGR were 20.13 ± 4.04mm, 39.2 ± 5.59mm, and 0.51 ± 0.07, respectively. SPL less than 21mm in a term male newborn and 17.5mm in preterm should be considered micropenis (<2.5 SD) in our population. Gestation-wise percentile charts for SPL, PW, AGDl, AGDu and AGR were generated. The reference values and percentile charts generated can serve as local normative data for accurate interpretation of genital measurements in North Indian newborns, assessment of ambiguous genitalia and avoiding diagnostic errors.

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

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

Grafts vs. flaps: a comparative study of Bracka repair and staged transverse preputial island flap urethroplasty for proximal hypospadias with severe ventral curvature.

Bracka repair and staged transverse preputial island flap urethroplasty are both significant methods in treating proximal hypospadias. They utilize the flap and graft techniques, respectively, to achieve a satisfactory success rate. This study aimed to compare the outcomes of these 2 methods in the treatment of proximal hypospadias with severe ventral curvature. We retrospectively analyzed 117 cases of proximal hypospadias with severe ventral curvature who had undergone either Bracka repair (n = 62) or staged transverse preputial island flap urethroplasty (n = 55). All operations were performed by a single surgeon, and the choice of method was determined by the surgeon's preference based on his experience. Cosmetic outcome was evaluated with Pediatric Penile Perception Score (PPPS). Patients' characteristics including age, penis length, glans diameter, length of the urethral defect and ventral curvature degree, cosmetic outcomes, and complication rates were all compared. There was no significant difference in age, penis length, glans diameter, length of the urethral defect, or ventral curvature degree. In the Bracka group, there were 5 patients with fistula, 1 patient with stricture, and 1 case of dehiscence. In the staged transverse preputial island flap urethroplasty group, there were 4 patients with fistula, 1 with stricture, and 2 with diverticulum. The scores of shaft skin and general appearance were consistently higher in the Bracka group than in the staged transverse preputial island flap urethroplasty group. The differences in complication rate and cosmetic outcome were not statistically different (P > 0.05). Bracka repair and staged transverse preputial island flap urethroplasty are both satisfactory staged surgical options for proximal hypospadias with severe ventral curvature and have similar complication rates. Bracka repair may create a better appearance, but more studies are needed to confirm this finding. Pediatric surgeons should consider additional factors, such as the patient's specific condition, parents' inclination, and personal experience, rather than safety, to make the best choice between the 2 methods.

Genotype-phenotype correlations, surgical selections, and postoperative complications of 5a-reductase 2 deficiency in 69 children with hypospadias.

5α-reductase 2 deficiency prevents testosterone from being converted to dihydrotestosterone, which causes abnormal urogenital sinus development. The aim of this study was to analyze the relationship between genotype-phenotype, surgical selections, and postoperative complications of 5α-reductase 2-deficient patients with hypospadias. We retrospectively evaluated the medical records of patients who were diagnosed with 5α-reductase 2 deficiency after genetic testing in the Department of Endocrinology and underwent initial hypospadias surgery in the Department of Urology in Beijing Children's Hospital, Capital Medical University (Beijing, China), from April 2007 to December 2021. A total of 69 patients were included in this study; the mean age at surgery was 34.1 months, and the average follow-up time was 54.1 months. Sixty children were treated with preoperative hormone stimulation (PHS) to promote penile growth. The average penis length and glans width were increased by 1.46 cm and 0.62 cm, respectively. The most frequent mutations were p.R227Q (39.1%, 54/138), p.Q6* (15.2%, 21/138), p.G203S (12.3%, 17/138), and p.R246Q (11.6%, 16/138). In 64 patients who were followed up, 43 had a one-stage operation and 21 had a staged operation, and there were significant differences in external masculinization score (EMS) (P = 0.008) and the average number of operation required to cure (P < 0.001) between one-stage and staged operations. PHS had a positive effect (P < 0.001) on penile development. The p.R227Q mutation was associated with higher EMS and less severe hypospadias. One-stage surgery can be selected if conditions permit. The growth and development of children are acceptable in the long term, but penis growth remains unsatisfactory. Long-term complications of hypospadias should be considered during puberty.

(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 &amp; 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 &amp;lt; 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 &amp;lt; 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 &amp;lt; 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 &amp;lt;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

(148) Comparison of Collagenase Clostridium Histolyticum to Surgery for the Management of Peyronie’s Disease: A Randomized Trial

Abstract Introduction Since the FDA approval of Collagenase Clostridium Histolyticum (CCH) for the treatment of Peyronie’s Disease (PD), there has been significant debate as to its role and comparable efficacy in relation to surgical therapies. Specifically, investigators have compared relative utilization, costs, and outcomes with varying conclusions. Objective To compare various objective and subjective outcome measures between men undergoing CCH or surgery for PD. Methods A randomized, controlled trial (NCT04786106) is ongoing. Participants are randomized 1:1 to receive either CCH + traction (RestoreX) + sildenafil or penile surgery (plication and/or incision and grafting) + traction + sildenafil for PD. Objective, standardized (International Index of Erectile Function [IIEF] and Peyronie’s Disease Questionnaire [PDQ]), and non-standardized assessments are obtained at baseline, and post-treatment at 3, 6, 12, 24, 36, 48, and 60 months. Key outcomes include differences in standardized questionnaires, penile curvature, penile length, subsequent interventions, and non-standardized questionnaire responses. Curvature is measured in two planes and summed to provide a composite curvature. Penile length is measured from pubic symphysis to corona. All therapies were stopped prior to the 3-month time point (i.e. traction and sildenafil). Results A total of 40 men have been randomized, with 3-month data available on 27 men (CCH=14, surgery=13) and 12-month data on 15 men (CCH=5, surgery=10). Mean age at enrollment was 54.9 years, PD duration 36.6 months (mo), composite curvature 72.3 degrees (deg), and penile length 12.7 cm. All baseline variables were statistically similar between cohorts. Regarding the primary outcome, post-treatment, CCH men reported higher overall satisfaction (3-months: 100% vs 88% surgery, p=0.16; 12-months 80% vs 70%, p=0.52). For secondary outcomes at 3 months, the median differences between CCH and surgery respectively were: IIEF-EFD (+3.5 vs +7, p=0.64), PDQ-physical (-10 vs -7, p=0.47, note: lower is better for PDQ scales), PDQ-pain (-2 vs -0.5, p=0.21), PDQ-bother (-4.5 vs -8.5, p=0.60), length change (+1.0 vs -0.5 cm, p&amp;lt;0.01), curvature absolute change (-26 vs -65 degrees, p=0.01), and curvature percentage improvement (46% vs 84%, p&amp;lt;0.01). More CCH men felt that treatment improved sexual function (86% vs 79%, p=0.45), erectile function (64% vs 56%, p=0.04), penile length (36% vs 6%, p&amp;lt;0.0001), and had less impact on sensation (14% less sensation vs 56%, p&amp;lt;0.01), while surgery men were more likely to report satisfaction with curvature (75% vs 64%, p=0.52). 100% of men in both groups would recommend treatment to a friend at 3 months, whereas 100% of CCH vs 70% of surgery men would recommend their therapy at 12 months. When asked which treatment they would pick if they could start again, at 3 months 100% of CCH men reported CCH and/or traction, while 79% of surgery men indicated surgery. Conclusions Preliminary data suggests that, when compared to surgery, CCH results in higher overall satisfaction (not statistically significant), decreased curve improvement, improved penile length, and fewer impacts on erectile function and sensation. Disclosure Yes, this is sponsored by industry/sponsor: Endo Pharmaceutical Clarification Industry funding only - investigator initiated and executed study

(138) Smaller Tunical Defect With Pre-graft Plication Technique During Peyronie's Disease Surgery May Reduce Postoperative Erectile Function Loss

Abstract Introduction Peyronie’s disease (PD) is a progressive and benign acquired connective tissue disease characterized by disordered wound healing and local fibrosis of the tunica albuginea (TA). PD has two phases: acute and chronic. Surgery is the gold standard option for the correction of penile deformity in the PD chronic phase. Methods used in surgical treatment include plication, graft repair, and penile prosthesis implantation. Plaque incision (PIG) or excision (PEG) and graft placement are performed during graft repair. However, this technique can cause postoperative erectile dysfunction (ED) related to the size of the TA defect. Objective In our clinic, we use a novel "pre-graft plication technique" to reduce disruption of the integrity of the TA in patients with unidirectional curvature &amp;gt; 60 degrees. In this technique, we place 2 or 3 Essed–Schroder sutures on the convex side of the curvature before incision or excision and grafting on the plaque side. Thus, we pull the curvature angle down before PIG/PEG. We aim to improve post-op erectile function by using smaller grafts and TA incisions (figure 1). Our goal for this study was to compare the results of this technique with the standard PIG/PEG technique. Methods All patients who were operated on for PD in our clinic between 2010 and 2021 were screened. Patients aged between 40 and 70 years who underwent grafted PD repair were included in the study. Patients who underwent previous penile surgery or hormonal therapy, had significant preoperative ED (IIEF-5 &amp;lt; 17), or who received diagnoses of malignancy or depression were excluded from the study. We found 45 patients on whom we applied the pre-graft plication technique (group 1) and 32 patients on whom we applied the standard grafting technique who were appropriate for our inclusion and exclusion criteria. Demographic characteristics of the patients, comorbidities, preoperative IIEF-5 scores, stretched penile lengths, plaque sizes detected during surgery, graft sizes and types, postoperative IIEF-5 scores at the 3rd and 12th months, and 3-month postoperative penis lengths were recorded. Penile massage and daily 5 mg tadalafil were recommended as post-op rehabilitation. The results were compared with Student’s T-test. Results There were no significant differences between the groups in terms of preoperative IIEF-5 scores, penile lengths, age, or comorbidities. While there was no significant difference between the groups in the plaque sizes detected during the operation, the graft size used was significantly smaller in Group 1 than in Group 2. At follow-up, the IIEF-5 scores of the Group 1 were, on average, 1.97 and 2.36 points higher than Group 2 at 3 and 12 months of follow-up, respectively. This difference was statistically significant. There was no significant difference between the groups in terms of penile length (table-1). Conclusions Reducing post-op erectile function loss is possible with pre-graft plication technique. The extra plication suture does not cause a significant reduction in penile length. Disclosure No

(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 &amp;lt; 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 &amp;lt;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.

(495) Does Penis Size Matter? Or, Does it Just Matter How it is Measured?

Abstract Introduction There is no popular standardized method for men to measure penis length with countless combinations of measuring implement, side of the penis, degree of penile stretch or erection, and most proximal point. Predictably, methods can yield drastically different results however both physicians and literature rarely elaborate on method of measurement. With how often penis length comes up in discussion in and outside of healthcare, no studies have been performed on the true variety of measurement methods and inappropriate direct comparison of studies with entirely different metrics. Besides quality of their new "erection", penis length is one of the most common concerns of patient's undergoing penile prosthesis surgery for erectile dysfunction. Objective To determine the various methods with which a penis can and is measured in order to better manage patients’ expectations after prosthetics surgery. Methods Literature review was performed to analyze variation in penile measurement techniques between scientific publications. Tiktok is a popular social media platform where users can create, share, and discover short videos and share comments related to those videos. Several videos on tiktok discussing methods to measure a penis have recently skyrocketed to popularity with as many as 10 to 15 million views and 10-20k comments. Content analysis of users who commented their techniques was performed to inform a short survey posted to tiktok asking users to vote on the most common discrepancies identified in our analysis. Results Publications in literature range broadly in method of measuring the penis with the most significant variation due to starting measurement at the pubic bone vs mons pubis. Similarly, early analysis of tiktok comments of the top 5 most viewed videos discussing measuring techniques redemonstrates the same common discrepancies observed in literature review. This study is ongoing but we expect the results of our tiktok survey to prove that there is no common shared method that most tiktok users use to determine penile measurement. While some scientific articles do report more than one measurement of the penis, there is also no research into the accuracy and repeatability of each measurement method to patient’s experience and expectations regarding penis length. Conclusions A standardized method for penis measurement will unify the scientific community and patients with concerns relating to penile length whether specific to expectations after prosthesis surgery or otherwise! Disclosure No

(435) Multi-institutional Safety and Efficacy Outcomes with the Penuma Penile Implant

Abstract Introduction Penuma is a novel soft silicone penile sleeve implant that is FDA cleared for cosmetic augmentation of the penis, including enhancing the girth and length of the flaccid penis, and the correction of cosmetic deformities of the penis, such as retractile penis and mid-shaft indentations. 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 of the Penuma proximal to the coronal sulcus necessitating 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. Objective Our objective is to provide recent multi-institutional data on safety and efficacy outcomes in patients undergoing Penuma penile implant surgery across multiple high volume implant surgeons at tertiary care centers. Methods We performed a retrospective analysis of men undergoing Penuma implants between November 2020 and March 2022 with three surgeons, each working at a separate large academic hospital. Adverse events including infection and unsatisfactory cosmetic outcomes requiring revision as determined by physician follow up and patient questionnaires were recorded. Outcomes include measurements of incidents of peri and post-operative adverse events and penile length and girth pre- and post-operatively (Figure 1). Results 169 male patients underwent Penuma implant surgery. Mean age was 42.3 +/− 9.8 years. Mean BMI was 28.7 +/− 4.1. Our patient population was very healthy (3% tobacco smokers, 2% diabetes, 1% cardiovascular disease). Pre-operative mean flaccid length was 7.6 +/− 1.9 cm. Post-operative mean length was 11.2 +/− 1.9 cm. Patients added an average of 3.8 +/− 1.9 cm to their penile length, a 50% increase (p &amp;lt; 0.001). Pre-operative mean flaccid girth was 9.1 +/− 1.4 cm. Post-operative mean girth was 12.5 +/− 1.2 cm. Patients added an average of 3.4 +/− 1.1 cm to their penile girth, a 37% increase (p &amp;lt; 0.001). Complications rates were: infection 0.6%, seroma 1.2%, and erosion 3.6% (Figure 2). Complication rates were found to be lower than those reported in a previously published, IRB-approved retrospective review of Penuma patient outcomes. Ten patients (5.9%) reported unsatisfactory cosmetic results - all had persistent flaring of the Penuma at the coronal sulcus; all but one opted for revision surgery (Figure 3). Based on patient questionnaires, all revisions had satisfactory cosmetic outcomes. One revision was completed under local anesthesia at the time of scrotoplasty. Conclusions The Penuma implant can be used to safely enhance flaccid penile length and girth in patients with retractile penis or other cosmetic deformities and forms of cosmetic augmentation. Should complications occur, they are mainly cosmetic. Their correction is completed easily and with low risk. Disclosure No

(161) Xiaflex Nonresponders Show Alteration in Penile Measurements: Post-Market Analysis of Predictors for Treatment Success

Abstract Introduction The IMPRESS trial revealed that intralesional collagenase clostridium histolyticum, Xiaflex, is safe and efficacious for treating the physical and subjective effects of Peyronie’s Disease (PD). However, little is known about the other manifestations of PD, namely penile shortening and efficacy for patients of diverse racial backgrounds or with severe penile curvatures. Objective To evaluate predictors associated with response to treatment and alterations in penile morphological measurements. Methods Consecutive patients treated with Xiaflex for dorsal, lateral, and ventral penile curvatures ≥ 25°, in the absence of hourglass deformity, were included in this study. Before treatment and eight weeks after the last injection cycle, during penile duplex Doppler ultrasound evaluation, penile curvature was measured with a goniometer after induced artificial erection via injection of prostaglandin E1 (PGE1). IIEF score, PGE1 dose, circumference, and erectile as well as stretched penile length were also assessed at these times. Based on the results of the IMPRESS trial, patients were considered Xiaflex responders if the decrease in their penile curvature were ≥ 15° (n =134) and Xiaflex nonresponders if the decrease in their penile curvature were &amp;lt; 15° (n =89). Initial measurements were in increments of 5°. Intention to treat analysis was performed. Results Two hundred and twenty-three patients with penile curvature ≥ 25° who received XIAFLEX were included in this study. One hundred and thirty-four patients (60.1%) responded to Xiaflex, while 89 (39.9%) patients did not respond. African American men were 3 times more likely to respond to treatment than their non-African American counterparts (Odds Ratio (OR) =3.35 (95% CI, 1.15-10.70), p =0.031). On the other hand, men with an initial penile curvature of greater than 60° were less likely to respond to Xiaflex (OR = 0.34; 95% CI, 0.16-0.69; p=0.003). However, patients with lateral and ventral curvatures responded at comparable rates to those with dorsal curvatures. Subsequently, changes in penile morphologic measurements post Xiaflex were analyzed. Average stretched penile length, erectile length, and erectile circumference prior to treatment for responders were 13.93 cm, 13.39 cm, and 11.81 cm, respectively; for nonresponders, it was 14.27 cm, 13.72 cm, 11.64 cm, respectively. Nonresponders were shown to experience a significant decrease in penile erect length (-0.55 cm) and circumference (-0.58 cm) (p=0.002 and p=0.002, respectively), whereas responders showed no significant alterations in penile morphologic measurements. Conclusions Our analysis revealed that men with penile curvatures ≥ 60° are less likely to respond to Xiaflex injections and thus may be considered for surgical intervention upon initial presentation. Furthermore, men who do not respond may even be at a higher risk for shortening of penile erect length and circumference. The actual clinical significance of a decrease in average erect length of 0.55 cm and circumference of 0.58 cm is difficult to determine and should be considered per patient preferences. Further investigations into predictors for response to Xiaflex and the pathophysiology behind penile shortening in Xiaflex nonresponders are warranted. Disclosure No