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      Penile Enhancement Procedures with Simultaneous Penile Prosthesis Placement

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          Abstract

          Here we present an overview of various techniques performed concomitantly during penile prosthesis surgery to enhance penile length and girth. We report on the technique of ventral phalloplasty and its outcomes along with augmentation corporoplasty, suprapubic lipectomy, suspensory ligament release, and girth enhancement procedures. For the serious implanter, outcomes can be improved by combining the use of techniques for each scar incision. These adjuvant procedures are a key addition in the armamentarium for the serious implant surgeon.

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          Device-associated infections: a macroproblem that starts with microadherence.

          R Darouiche (2001)
          Medical devices are responsible for a large portion of nosocomial infections, particularly in critically ill patients. Device-associated infections can cause major medical and economic sequelae. Bacterial colonization of the indwelling device can be a prelude to both infection and malfunction of the device. The pathogenesis of device-associated infection centers around the multifaceted interaction among the bacteria, the device, and the host. Bacterial factors are probably the most important in pathogenesis of infection, whereas device factors are the most amenable to modification with the objective of preventing infection. Some, but not all, of the studied bacterial receptors satisfy the proposed "adherence/infection" version of Koch's postulates. Traditional surface-modifying preventive approaches have largely focused on antimicrobial coating of devices and resulted in variable clinical success in preventing device-associated infections. The potential protective role of newer innovative approaches, such as biofilm modification and bacterial interference, ought to be further investigated.
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            A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications.

            Yoram Vardi, Yaron Har-Shai, Yaron Harshai … (2008)
            Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). The aim of this review is to describe the various reported techniques and to provide the available scientific data on the success and complication rates of penile enhancement procedures. We performed an extensive systematic review based on a search of the MEDLINE database for articles published between 1965 and 2008. The following key words were used: penis, enhancement, enlargement, phalloplasty, reconstruction, girth, lengthening, and augmentation. Only English-language articles that were related to penile surgery and dysmorphobia were sought. We excluded articles in which fewer than five cases were described and articles in which the type of surgical treatment and the outcome were not clear. Of the 176 papers found, 34 were selected and critically analyzed. We found only a small number of well-designed and comprehensive studies, and most of the published articles reported data that were obtained from small cohorts of patients. The more recently published studies presented better methodologies and descriptions of the surgical techniques than did the older publications. In general, penile enhancement surgery can cause a 1-2-cm increase in penile length and a 2.5-cm augmentation of penile girth. Unwanted outcomes and complications, namely penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction were reported frequently in these studies. Disappointing short- and long-term patient satisfaction rates following these procedures were also reported in most studies. To date, the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high. In our opinion, until new, reliable, and more objective and reproducible data are available, these procedures should be regarded as investigational and patients should be discouraged from undergoing these invasive treatments.
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              Penile length alterations following penile prosthesis surgery.

              M. A. Parker, John P Mulhall, David Martín … (2007)
              Determine the impact of penile prosthetic surgery on penile length. Stretched flaccid penile length was measured in men undergoing first-time penile implant surgery. Measurements were done before implantation and at 1 and 6 mo postoperatively. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) at 6 mo postoperatively. Patients also provided subjective assessment of penile changes at 6 mo postoperatively. Preoperative and postoperative IIEF and EDITS scores were compared as were the patients who complained of penile length loss with those who did not. Of the 56 patients, 50% were diabetic and 28.5% had previous radical prostatectomy; 78% of the implants were three-piece (Alpha-1, Mentor) and 22% were two-piece (Ambicor, American Medical Service). There were no statistically significant differences in penile length after the surgery compared to preoperative measurements. Forty of 56 patients (72%) reported a decrease in penile length, 10 of 50 (19%) reported no change, and 6 of 56 (9%) had a slight increase. Subjective penile length loss was more common in patients who had undergone radical prostatectomy before prosthesis implantation (32%). No statistical difference in EF domain scores occurred between patients who complained of penile length loss and those who did not; however, men complaining of length loss had lower IIEF satisfaction domain and EDITS scores. Penile prostheses do not have a negative impact on measured stretched flaccid penile length. Treatment satisfaction scores do not depend on subjective penile length loss.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Adv Urol
                Journal ID (iso-abbrev): Adv Urol
                Journal ID (publisher-id): AU
                Title: Advances in Urology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1687-6369
                ISSN (Electronic): 1687-6377
                Publication date (Print): 2012
                Publication date (Electronic): 28 June 2012
                Volume: 2012
                Electronic Location Identifier: 314612
                Affiliations
                1Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33602, USA
                2Division of Plastic Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL 33602, USA
                3LSU Health Sciences Center, 255 Bert Kouns Industrial Loop, Shreveport, LA, USA
                Author notes

                Academic Editor: Andrew Kramer

                Article
                DOI: 10.1155/2012/314612
                PMC ID: 3395210
                PubMed ID: 22811703
                SO-VID: 3c4ec735-a7cb-4628-b769-22d8c88e592e
                Copyright © Copyright © 2012 Tariq S. Hakky et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 February 2012
                Date accepted : 5 June 2012
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Urology
                Data availability:
                ScienceOpen disciplines: Urology

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