• A review of penile elongation surgery

      "Penile elongation surgery is less commonly performed in the public sector, but involves a collaborative approach between urology and plastic surgery. Congenital and acquired micropenis are the classic surgical indications for penile elongation surgery. The goal of intervention in these patients is to restore a functional penis size in order to allow normal standing micturition, enable satisfying sexual intercourse and improve patient quality of life. Many men seeking elongation actually have normal length penises, but perceive themselves to be small, a psychologic condition termed ‘penile dysmorphophobia’. This paper will review the anatomy and embryology of congenital micropenis and discuss both conservative and surgical management options for men seeking penile elongation therapy.
      Men complaining of short penis need to be clinically assessed for evidence of true micropenis and screened for PDD. Patients should first be treated conservatively with testosterone therapy, PTD, and a psychiatric assessment if applicable. There are no current guidelines on the best surgical management for men requesting penile elongation. Multiple surgical techniques have been developed each with their own limitations and have been reviewed above. Further work in this field is required to devise the optimal surgical procedure with the smallest complication profile and the highest patient satisfaction.

      Penile augmentation
      Different types of injectable materials have been used for penile augmentation including liquid silicone, polyacrylamide, hyaluronic acid and mineral-oil (35-37). However, there is a significant risk of foreign body reaction, swelling, penile distortion, granulomas and need for removal

      Suspensory ligament release
      As discussed, the suspensory ligament anchors the penis to the pubic symphysis and while providing support, acts as the mobile point for the penis during erection. This attachment prevents the penis from moving further outward and creates an arched angle to the penile base

      V-Y advancement
      Penile elongation using a dorsal V-Y incision in the congenital or acquired short penis was first described over 40 years ago. A dorsal V-shaped incision was made, combined with partial detachment of the crura from the pubic ramis, which were then re-approximated in the midline and the dorsal incision was closed as a V-Y advancement flap. The V-Y incision and subsequent V-Y advancement is commonly used in conjunction with a suspensory ligament release.

      Sliding elongation
      Sliding elongation has been described to lengthen the penis after significant penile shortening secondary to correction of Peyronie’s disease and severe therapy resistant erectile dysfunction (54,55). Some surgical treatments of Peyronie’s disease involve a plication on the contralateral side to correct penile curvature, which can lead to penile shortening of 3 cm or more. Rolle et al. first described this technique in three patients and gained on average 3.2 cm of penile length

      Penile disassembly
      Perovic and Djordjevic describe a technique similar to sliding elongation, which they have used to treat short penises and congenital penile anomalies. Their procedure involves separating the penis into the glans cap with neurovascular bundle dorsally, the corpora cavernosa, and the urethra ventrally."


      This article was originally published in forum thread: A review of penile elongation surgery
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