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Effect of Penile-Extender Device in Increasing Penile Size in Men with Shortened Penis: Preliminary Results
Abstract
It has been suggested that the application of penile-extender devices increases penile length and circumference. However, there are a few scientific studies in this field.
The aim of this study was to assess the efficacy of a penile-extender (Golden Erect(®) , Ronas Tajhiz Teb, Tehran, Iran) in increasing penile size.
This prospective study was performed on subjects complaining about "short penis" who were presented to our clinic between September 15, 2008 and December 15, 2008. After measuring the penile length in flaccid and stretched forms and penile circumference, patients were instructed to wear Golden Erect(®) , 4-6 hours per day during the first 2 weeks and then 9 hours per day until the end of the third month. The subjects were also trained how to increase the force of the device during determined intervals. The patients were visited at the end of the first and third months, and penile length and circumference were measured and compared with baseline.
The primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow-up.
Twenty-three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05).
Our findings supported the efficacy of the device in increasing penile length. Our result also suggested the possibility of glans penis girth enhancement using penile extender. Performing more studies is recommended.
... Передача сигналів механотрансдукції модулює експресію генів, пригнічуючи апоптоз, стимулюючи проліферацію клітин і модифі- РІЗНЕ куючи позаклітинний матрикс [27]. Протягом багатьох років це було оцінено як засіб подовження замість хірургічного втручання або в поєднанні з ним для покращення результатів [28][29][30]. ...
... Nikoobakht M. та співавтори [30] провели терапію 23 пацієнтам, які скаржилися на короткий статевий член. Тракційна терапія розширювачем тривала протягом 3 міс з прогресуючою інтенсифікацією з перших 2 тиж до кінця 3-го місяця. ...
... Обхват проксимального статевого члена не збільшувався, тоді як окружність головки змінювалася між першим і другим спостереженням, ймовірно, через точку фіксації пристрою. Автори не повідомили про будь-які побічні ефекти [30]. ...
In this scientific study we reviewed the literature on non-invasive and invasive methods of male genital enhancement. A non-systematic review of current scientific evidence was conducted to obtain reliable data on surgical and non-surgical penile procedures, which may form the basis of possible indications and recommendations for the future. 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, a manual search for relevant references in the found texts was conducted. The study conducted in this paper examined and recorded the main results related to changes in penis size in men who used both non-surgical and surgical methods of penis enlargement. One of the key goals of this study was to examine in detail the impact of different methods on the length and girth of the penis, as well as to analyze possible complications after these procedures. The principles of choosing treatment methods for patients who express a desire to increase the size of the penis are based on the individual characteristics of the patient, his medical indicators and personal preferences. Doctors should take into account the patient's general health status, possible risks of complications, and his realistic expectations of the procedure. Based on the results of the literature analysis, a strategy for working with patients before penis enlargement procedures was generalized. This strategy includes detailed counseling of the patient about possible methods, their benefits and risks, as well as taking into account his personal wishes. An important step is to prepare the patient for the procedure, including all the necessary examinations and tests to determine his suitability for the intervention.
... The mechano-transduction signaling modulates gene expression, inhibiting apoptosis, stimulating cell proliferation, and modifying the extracellular matrix [19]. Over the years, it has been evaluated as a means of lengthening in place of or in combination to surgery to improve its results [20][21][22]. Gontero et al., in a prospective pilot study, evaluated the possibility of achieving a long-lasting increase in penile shaft length using the penile extender. Sixteen patients with PDD completed the 6-month therapy (daily use for at least 4 h), with a gain of 0.38 (0.02-0.73) cm on the stretched penis at sixth month and an insignificant gain on girth of 0.09 (0.24-0.05) cm. ...
... No girth is gained in the proximal penis, while the glans circumference changed between the first and the second follow up, probably due to the device anchorage point. The authors did not report any side effect [22]. While there is concordance in the studies reporting the efficacy of these devices, prospective trials with larger patients' cohorts and longer follow up is needed to evaluate the persistence of the results as well as the complications. ...
... Among non-invasive treatments, we analyzed several studies on vacuum and traction therapy. They can make a gain in length, but with moderate and time-limited results, although without major complications [18,[20][21][22]102]. It would be interesting to know if this non-invasive management can meet the needs of patients with a normal-sized penis, mitigating psychiatric disorders in those who suffer from it. ...
The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages. The aim of this study was to shed light on cosmetic surgery of male genitalia through minimally invasive and more radical techniques, with the purpose of laying the foundation for possible indications and recommendations for the future. A non-systematic literature review using the PubMed and Scopus databases was conducted to retrieve papers written in English on cosmetic surgery of the penis published over the past 15 years. Papers discussing cosmetic surgery in patients with concomitant pathologies associated with sexual dysfunction were excluded. The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications.
... A total of 29 studies were included in the review (3 concerning non-invasive approaches [10][11][12], 11 regarding injection therapies [13][14][15][16][17][18][19][20][21][22][23], and 15 reporting surgical procedures [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]). Overall, 3,327 patients were evaluated, but only 5 (17.2%) articles [13,15,18,26,29] included more than 100 subjects. ...
... The mean age of patients ranged from 23 [37] to 55.5 [19] years. Follow-up varied between 3 [11,12,28] and 60 [31] months, being over 12 months only in 10 (34.4%) articles [13,14,17,19,23,24,26,31,36,38]. The main characteristics of the studies were summarized in Table 1. ...
... Three studies [10][11][12] evaluating the non-invasive procedures for PGE focused on penile-extender devices. Only 1 paper reported a minimal (+0.03 cm) but significant increase of penile girth (p = 0.034) [10]. ...
The present study aimed to describe and critically discuss the current evidence regarding the penile girth enhancement procedures for aesthetic purposes. We designed a narrative review of the literature. A comprehensive search in the MEDLINE database was performed. Original articles in English-language, published until March 2021, were selected. A total of 29 studies were included (3 reporting non-invasive approaches, 11 injection therapies, and 15 surgical procedures). The vast majority of articles (26, 89.7%) were not randomized controlled trials, with overall low quality and limited level of evidence. Only 1 (33.3%) paper regarding non-invasive approaches reported a minimal (+0.03 cm) but a significant increase of penile girth (p = 0.034). A low rate (11.2–14.4%) of mild, temporary adverse events and poor-to-moderate patient satisfaction were found. Eight (72.7%) articles concerning injection therapies showed a significant increase in penile girth (p < 0.05). A low rate of mild complications, generally at the injection site, and a high patient satisfaction rate (75–100%) were highlighted. Nine (60%) papers on surgical treatments found a significant increase in penile girth (p < 0.05), while the other 6 (40%) studies reported a generic improvement in penile circumference. Skin necrosis or ulcers, wound infections, or need for reoperation were reported in 8 (53.3%) studies. A high patient satisfaction rate (60–100%) was reported. Our review highlighted the overall positive results of injection procedures, the poor outcomes associated with non-invasive techniques, and the good efficacy and satisfaction with a non-negligible risk of complications in patients undergoing surgical treatments. However, the adverse events are probably largely under-reported and these procedures should still be considered under investigation due to the limited evidence available and the lack of guidelines.
... This review included a total of 57 studies assessing interventions for penile lengthening and/or enlargement in 1764 healthy men complaining of a small penis (18 studies) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 2587 men with concomitant penile pathologies © 2020 The Authors BJU International © 2020 BJU International 271 (39 studies) consisting mostly of PD and ED. Of the 57 studies included in the review, 25 assessed non-invasive interventions [13,[17][18][19][20][21][22][23][24][31][32][33][34][35][36][37][38][39][40][41][42][43][44]68,69] and 32 evaluated surgical procedures [14][15][16][25][26][27][28][29][30], for a total of 2192 and 2159 men, respectively. ...
... This review included a total of 57 studies assessing interventions for penile lengthening and/or enlargement in 1764 healthy men complaining of a small penis (18 studies) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 2587 men with concomitant penile pathologies © 2020 The Authors BJU International © 2020 BJU International 271 (39 studies) consisting mostly of PD and ED. Of the 57 studies included in the review, 25 assessed non-invasive interventions [13,[17][18][19][20][21][22][23][24][31][32][33][34][35][36][37][38][39][40][41][42][43][44]68,69] and 32 evaluated surgical procedures [14][15][16][25][26][27][28][29][30], for a total of 2192 and 2159 men, respectively. ...
... The length was most commonly measured on the dorsal surface from the penile base (pubo-penile junction) to the tip of the glans (meatus), whereas girth was most commonly measured in the flaccid state at one or more levels along the penis shaft. More specifically, these two measuring methods were explicitly described in 48 [13][14][15][16][17][18][19][20][21][22][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][60][61][62][63][64][65][66][67][68][69] and 39 papers [13][14][15][16][17][18][19][20][21][22][23][24][25]27,[31][32][33][34][35][36][37][38][39][40][41][42]44,48,54,[60][61][62][63][64][65][66][67][68][69], respectively. ...
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
... Among the 6 studies assessing nonsurgical management of men complaining of a small penis size, 2 (with a total of 67 men) investigated penile extenders 25,30 aimed at increasing both length and girth, 2 (n ¼ 64 men) investigated injectables aimed at increasing girth, 1 (n ¼ 27 men) investigated vacuum devices, and 1 (n ¼ 92 men) assessed psychoeducation, aiming to avoid any physical intervention ( Table 2). ...
... Extenders required a patient commitment of 4e9 hours/day for a total of 3e6 months. 25,30 Both studies of extenders, although using different devices, reported significant increases in FNSL and FSL, with 1 study also reporting a significant increase in erect length (EL) (P < .001). 25,30 Nonetheless, the mean length increase was <2 cm in both series, with even lower gains in EL, 30 and any girth increase was nonsignificant (P .05). ...
... 25,30 Both studies of extenders, although using different devices, reported significant increases in FNSL and FSL, with 1 study also reporting a significant increase in erect length (EL) (P < .001). 25,30 Nonetheless, the mean length increase was <2 cm in both series, with even lower gains in EL, 30 and any girth increase was nonsignificant (P .05). Although complications and reasons for treatment interruption were not reported in 1 of these studies, the other reported that 11.1% of patients discontinued extender use due to pain, numbness, bruising or lack of efficacy. ...
Introduction:
Evidence on penile enhancement interventions is lacking. Nonetheless, many non-evidence-based solutions are readily available.
Aim:
To investigate enhancement and nonenhancement interventions in men without penile abnormalities seeking to increase penis size.
Methods:
We performed a systematic review with no time restrictions adhering to the PRISMA guidelines. Studies with fewer than 10 cases or including men with organic penile pathologies or previous penile surgeries were excluded.
Main outcome measures:
When available, treatment efficacy was evaluated based on patient satisfaction, penile size increase, and complications.
Results:
We included 17 studies, assessing a total of 21 interventions in 1,192 men screened, with 773 followed up after nonsurgical (n = 248) or surgical (n = 525) treatment. The quality of the studies was poor in terms of methodology for patient selection and outcomes assessment. The vast majority of series reported normal penile size. Among nonsurgical treatments, extenders increased flaccid length (but by <2 cm), injectables increased girth but were associated with a high complication rate, and vacuum devices did not increase size. Surgical interventions included suspensory ligament incision (the most used method; n = 12), tissue grafting (autologous, n = 2; dermal fat, n = 3, ex vivo, n = 2), flaps (n = 2), and penile disassembly (n = 1). Some men reported a significant size increase; however, complications were not infrequent, and none of the techniques was externally validated. When provided, counseling was effective, with the majority of men coming to understand that their penis was normal and unwilling to undergo any further treatment.
Conclusion:
Treatment of small penis in normal men is supported by scant, low-quality evidence. Structured counseling should be always performed, with extenders eventually used by those still seeking enhancement. Injectables and surgery should remain a last option, considered unethical outside of clinical trials. Marra G, Drury A, Tran L, et al. Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sex Med Rev 2020;8:158-180.
... 10 Another therapeutic option is the use of a penile traction device to extend the penis noninvasively, working by stretching the penile tissue through careful mechanical attraction to increase the length and thickness of the penis. 31,40,42 The penile traction device is safe to use for PDD patients of various penile sizes. 40 While using a vacuum erectile device temporarily increases blood to the corpus cavernosum, the long-term use for increasing penile length or thickness is still debated. ...
... 7,31,40,43 The V-Y advancement flap with or without a silicone sheath and a radial artery-based forearm free flap is an invasive surgical procedure that can also be used as a penile elongation procedure. 40,42 Penile augmentation, which is the procedure of augmentation of the penis, is an attempt made by an individual to make his penis larger and longer to satisfy his sexual desire or his partner without changing the function of the penis. 44 To increase the thickness of the penis, it can use injectable materials, lipo injection, dermis grafts, venous grafts for corpus cavernous, temporalis fascia transfer, and the use of autologous fibroblasts lining the biodegradable frame. ...
The dissatisfaction of men due to their penile size is found in a number of studies. Concerns can be focused on the penile length or width or even both, whether erect or flaccid. Men who are worried about the penile size also want to increase the size of the penis. Concerns about men’s penile size are also increasing because they think normal penile size is what is shown in pornography. These worries can affect self-esteem, sexual function, and satisfaction, to physical and mental health. Small penis anxiety is an anxiety that arises when a man observes his flaccid penile size and feels concerned that his penile size is less than the normal size. In addition, this concern persists even though it has been refuted by clinical examination. Penile dysmorphic disorder is excessive self-concern, distress, and a preoccupation with trivial or even non-existent deficiencies in penile size and shape that can lead to impaired function. Until now, there have not been effective guidelines for managing patients with complaints of penile size. Some of the treatments that can be conducted are psychosexual counseling, cognitive behavioral therapy, the use of selective serotonin reuptake inhibitors, penile traction devices, and invasive procedures. Various modalities of therapy have been tried to overcome excessive concern about penile size. Yet, so far, no good results have been obtained. Thus, clear and effective guidelines are needed to make treatment can be carried out properly.
... The duration of application of these devices has not been concluded, but usually ranges from 4-6 h per day (29,30). In one study, after 2 months, men were asked to leave the traction device on for 9 h per day (31). Compliance and patient selection is a significant issue given the time requirements for this minimally invasive treatment. ...
... Compliance and patient selection is a significant issue given the time requirements for this minimally invasive treatment. Outcomes have been encouraging as patient satisfaction has unanimously improved after use for 3-6 months and flaccid or SPL has increased 1-3 cm in different studies (29)(30)(31). Oderda and Gontero conducted a review which aimed to explore whether nonsurgical methods of penile lengthening may have some scientific background. They concluded that penile extender devices seem to be non-inferior to surgery (32). ...
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.
... The majority of patients did not report significant adverse events despite the long duration of PTT. These findings were confirmed by another prospective study conducted in 23 men who complained of short penis [Nikoobakht et al. 2011]. Following PTT for 4-6 h per day during the first 2 weeks and then 9 h per day until the end of the third month with increasing traction forces during determined intervals, there was a statistically significant increased in penile length both for the flaccid (mean 8.8 ± 1.2 cm to 10.5 ± 1.2 cm) and for the stretched state (11.5 ± 1 cm to 13.2 ± 1.4 cm), after 3 months of use. ...
... It has been claimed that PTT can increase the penile girth ] through soft tissue cellular proliferation and growth in a multiplanar fashion from chronic traction. However, two studies found no significant changes to the penile circumference following PTT [Gontero et al. 2009;Nikoobakht et al. 2011]. It is interesting, however, that no girth decrease was reported with PTT, as one would have instinctively thought. ...
In recent years, penile traction therapy (PTT) has gained considerable interest as a novel nonsurgical treatment option for men with Peyronie’s disease (PD) and short penises. The current published literature suggests that selected cases of PD may benefit from a conservative approach with PTT, resulting in increased penile length and reduction of penile deformity. It appears to be safe and well tolerated but requires a great deal of patient compliance and determination. This article reviews the current literature pertaining to the use of PTT in men with PD, short penises and in the setting of pre- and postprosthesis corporal fibrosis.
... formity involves inducing artificial erections using intracavernosal injections of vasoactive agents, followed by the use of a goniometer to quantify the extent of curvature or deformity, as shown in (Fig. 3A) [30,33]. Although a directly measured and quantified penile morphology database has served as the foundation for various clinical studies and procedures, such as penile enlargement and shaping surgeries, it is challenging to visualize changes in sexual function because it is not possible to record and measure variations in penile morphology across a specific time period [14,[34][35][36][37][38]. Furthermore, the data can vary depending on the observer, and during direct measurement, it is important to consider factors such as temperature, arousal level, and previous ejaculations, which can all influence the measurement of penile length [30]. ...
For many males, sexual function holds significant value in determining their quality of life. Despite the importance of male erectile function, no quantitative method to measure it accurately is currently available. Standardized assessment methods such as RigiScan™, International Index of Erectile Function (IIEF-5), and the stamp test are used to evaluate sexual function, but those methods cannot repetitively and quantitatively measure erectile function. Only direct measurement can quantitatively assess the shape of an erect penis. This paper presents the essential requirements for developing an ideal measurement method for penile erection. It also introduces current approaches for diagnosing male sexual function and reviews ongoing research to quantitatively measure erectile function. The paper further summarizes and analyzes the advantages and disadvantages of each method with respect to the essential requirements. Finally, the paper discusses the future direction toward the development of Penile Erection Morphometry.
... The evidence for use of penile traction therapy is summarised in Supplementary Table 1 [62][63][64][65][66]. Overall, penile traction therapy seems to be effective in lengthening the penis in both the flaccid (+1.7-2.3 cm) and stretched (+1.3-1.7 cm) state with minimal side effects. ...
... This provides the release of growth hormone and cell division, which leads to an enlargement of the penis. In addition, under the influence of the extender, the activity of the metalloproteinase enzyme is enhanced, resulting in tissue remodeling, scar resorption and collagen breakdown [5]. ...
Male dissatisfaction with the penis size is the most common manifestation of penile dysmorphophobia. Despite the diversity of penis enlargement methods a single safe technique that fully satisfies patients has not yet been developed.The aim of this work is to compare the results of a combined operation on installation of a silicone implant or a collagen matrix impregnated with autologous stem cells with simultaneous ligamentotomy to increase the length and circumference of the penis.In 2017–2022 there were performed penis enlargement surgeries in 2 centers. In Public Non-Profit Organization Of The Kharkiv District Council «Kharkiv Regional Clinical Center Of Urology And Nephrology Named After V.I.Shapoval (Kharkiv, Ukraine) 38 patients from Ukraine and Poland were operated by Professor Knigavko O.V. with implantation of a porous Max Pol matrix (manufactured by Dersmithson, M.D. Choi), and in the “Mexico phalloplastic center” (Mexico city, Mexico) by Dr. Aguilar I.E. implantation of non-absorbable silicone implants in 36 patients was perfomed. The results of penis enlargement were evaluated in the early (2 months) and long-term (6 months) terms.While implanting a silicone implant the majority of the patients – 31 (86.1%) are satisfied with the result, 27 (75%) patients mention an improvement in sexual life, 31 (86.1%) also mention an increase in their own self-sufficiency. At the same time, some patients mentioned the following complications: 2 (5.6%) patients mentioned displacement of the silicone matrix, 1 (2.8%) patient mentioned prolapse of the matrix, 1 (2.8%) patient mentioned a decrease in erection (which did not improve after removal of the matrix), in 1 (2.8%) case the silicone implant had to be removed due to the fact that the patient did not liked the appearance.While using a collagen-like matrix made of polymerized polylactic acid impregnated with own stem cells in 38 patients, we haven’t seen any complications that caused the removal of the matrix. However, 5 (13.2%) patients required additional polylactic acid gel injections between 6 and 36 (97.4%) months to optimize the shape or volume of the penis. 34 (89.5%) patients mentioned an improvement in the sexual function and sexual sensations of their partner, harmonization of relationships in a couple, and 36 (97.4%) men – an increase in a sense of self-sufficiency.Thus, modern implants can improve the size and appearance of the penis, improve the quality of sexual life and the feeling of self-sufficiency in operated men. The use of silicone implants is simpler, almost does not require specific rehabilitation after surgery, however, in a small part of patients prolapse of the prosthesis and dissatisfaction with the final result are present. Most of operated patients were satisficed results of silicone implant. The use of a polymer matrix impregnated with own stem cells requires a special laboratory, more time for preoperative and postoperative rehabilitation, however, it is more physiological and can be considered as a standard for safe penis enlargement.
... The study characteristics of each article including patient description and dimensions recorded are summarized in Table 1 [3,[12][13][14]. Of the seventy-five studies included, nineteen were conducted in North America [14,[21][22][23][24][25][26][27][28][29][30][31][32][33][34], nineteen in Europe [3,12,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51], five in South America [13,[52][53][54], eight in Africa [55][56][57][58][59][60][61], twenty in Asia [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77], one in Oceania [78], and three across multiple regions [79][80][81]. Twenty-three studies evaluated volunteers while thirty-six studies reported data from men evaluated for urological reasons. ...
Purpose:
Normative male genital measurements are clinically useful and temporal changes would have important implications. The aim of the present study is to characterize the trend of worldwide penile length over time.
Materials and methods:
A systematic review and meta-analysis using papers from PubMed, Embase, and Cochrane Library from inception to April 2022 was performed. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Pooled means and standard deviations for flaccid, stretched, and erect length were obtained. Subgroup analyses were performed by looking at differences in the region of origin, population type, and the decade of publication. Metaregression analyses were to adjusted for potential confounders.
Results:
Seventy-five studies published between 1942 and 2021 were evaluated including data from 55,761 men. The pooled mean length estimates were flaccid length: 8.70 cm (95% CI, 8.16-9.23), stretched length: 12.93 cm (95% CI, 12.48-13.39), and erect length: 13.93 cm (95% CI, 13.20-14.65). All measurements showed variation by geographic region. Erect length increased significantly over time (QM=4.49, df=2, p=0.04) in several regions of the world and across all age groups, while no trends were identified in other penile size measurements. After adjusting for geographic region, subject age, and subject population; erect penile length increased 24% over the past 29 years.
Conclusions:
The average erect penis length has increased over the past three decades across the world. Given the significant implications, attention to potential causes should be investigated.
... Overall, a total of three studies over the past two decades have reported modest, but significant increases in penile length following usage of traction devices [37][38][39]. The most recent of which by Nowroozi et al. in 2015, which enrolled 54 patients who used a penile extender between 4 to 6 h per day for 6 months, resulted in significant increases for flaccid, stretched, and erect penile lengths [38]. ...
Purpose of Review
Some men experience small penis syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists. We aim to provide an updated review of aesthetic penile augmentation procedures.
Recent Findings
Augmentation procedures range from invasive to noninvasive. 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.
Summary
In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. Our review summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures.
... Once the treatment is discontinued, the penis returns to its initial size within months. [23][24][25][26] For example, a vacuum pump was recommended for 20-30 min per session, three times a week for 6 months in the study by Aghamir et al. 26 Only 11.1% of patients reported a length gain of >1 cm. The satisfaction rate was approximately 30%. ...
There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation (PA) using injectable hyaluronic acid (HA) gel. Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year. Penile size, erectile function, and psychological burden measured by the Index of Male Genital Image (IMGI), Index of International Erectile Function (IIEF), and Beliefs about Penis Size (BPAS), respectively, were assessed at the beginning and at 1, 3, 6, and 12 months postinjection. The volume of HA gel injected was 21.5 ± 3.7 ml. Compared to baseline data, flaccid penile girth and length significantly increased by 3.41 ± 0.95 cm (P < 0.01) and 2.55 ± 0.55 cm (P < 0.01) at the 1st month postinjection, respectively. At the endpoint, despite attenuations, statistically significant improvements in flaccid penis size were still obtained, namely 2.44 ± 1.14 cm in girth (P < 0.01) and 1.65 ± 0.59 cm in length (P < 0.01). Similarly, erectile penile girth statistically increased by 1.32 ± 1.02 cm (P < 0.01) at the 1st month but were only 0.80 ± 0.54 cm bigger than baseline (P < 0.01) at the endpoint. At the 1st month, the average score of IMGI and the mean score of IIEF statistically increased by 46.2 ± 10.5 (P < 0.01) and 7.6 ± 6.2 (P < 0.01), respectively; the score of BAPS significantly decreased by 18.3 ± 4.5 (P < 0.01). These alterations remained steady during follow-up. Considering the significant penile size improvement, lasting psychological benefit, and low complication rate, PA with HA might serve as an appropriate alternative for patients with SPS.
... 23 Otro procedimiento para alargar el pene es el uso no invasivo de pesarios o equipos diseñados especialmente para provocar la tracción permanente del miembro. Estas técnicas requieren que el paciente las utilice de 4 a 9 horas diarias, entre 3 y 6 meses, con lo que se obtiene un promedio de alargamiento de 2.3 a 2.7 cm. 24,25 Engrosamiento del pene El engrosamiento del pene es una técnica aún más debatida que el alargamiento, pues hasta la fecha no existe ninguna indicación absoluta para realizar este procedimiento. La única guía realizada para el alargamiento del pene señala que no existe fundamento para engrosarlo. ...
El tamaño del pene mantiene una relación estrecha con la autoestima e identidad sexual y tiene gran repercusión social, según la idiosincrasia mexicana. La cirugía estética de los genitales masculinos se encuentra en auge desde la década de 1970, por la necesidad de corregir las deficiencias y deformidades físicas que causan estrés psicológico en el hombre. Es importante considerar la valoración preoperatoria y selección de los pacientes para lograr los resultados estéticos deseados. Esta revisión expone la evaluación preoperatoria y las distintas técnicas desarrolladas en el campo de la cirugía estética de los genitales masculinos.PALABRAS CLAVE: alargamiento de pene, cirugía estética de genitales, engrosamiento del pene.
... and in stretched penile length from 11.5 cm to 13.2 cm (P < .05). 46 A second study followed 54 patients who used traction therapy for 4−6 hours/day for 6 months. At 6 month follow up, significant increases in flaccid, stretched, and erectile penis lengths, with mean gains of 1.7, 1.3, and 1.2 cm, respectively, were observed (P < .001). 5 A final study following 16 men using PTT for 4−6 hours/day for 6 months, the same timeframe as the prior study, found a significant change in flaccid and SPL, 2.3 and 1.7 cm, respectively (P < .001). ...
Introduction
Penile traction therapy (PTT) and vacuum erection devices (VED) are nonsurgical conservative treatment options that have been used in the treatment of various urologic and sexual disorders such as Peyronie's Disease (PD) and Erectile Dysfunction (ED). Recently expanded uses for these therapies now include penile lengthening and with surgical interventions such as penile prosthesis surgery (PPS) and radical prostatectomy (RP). These devices can be used as both monotherapy or combination therapy.
Objectives
To review the indications and clinical studies for PTT and VED.
Methods
A literature search was conducted using PubMed to identify relevant studies addressing PTT, VED, and their indications. Searched terms included penile traction therapy, penile traction device, vacuum erection device, Peyronie's disease, penile prosthesis, radical prostatectomy, subjectively small penis, penile lengthening, erectile dysfunction.
Results
PTT with dynamic traction devices has shown favorable benefits for PD in many studies. The benefits of VED for PD cannot be confirmed due to limited studies with poor quality. In posterior urethroplasty, VED shows promise postoperatively, with additional trials also needed. In PPS, both PTT and VED have had positive findings in pre- and postoperative treatment. In RP patients, VED use has had positive outcomes while new literature shows beneficial effects of dynamic PTT and provides a basis for future studies. VED use does not show great benefit in patients with small penis, however PTT does have some positive findings. In ED, VED has a history of successful use and PTT has promising new data available.
Conclusion
PTT and VED have been utilized in urologic and sexual conditions with various success. Several promising areas utilizing both PTT and VED are being studied, however, more research needs to be done in these areas prior to becoming a standard treatment.
Mehr J, Santarelli S, Green TP, et al. Emerging Roles of Penile Traction Therapy and Vacuum Erectile Devices. Sex Med Rev 2021;XX:XXX–XXX.
... Studies have assessed the use of mechanical therapies in Peyronie's disease [5][6][7][8][9][10] , dysmorphophobia [11][12][13] and ED, which can be iatrogenic after surgery such as radical prostatectomy [14][15][16] or pathological (such as associated with diabetes or vascular pathology) [17][18][19] . The patient-reported outcomes from mechanical therapies depend both on the underlying cause and on the clinician and patient expectations. ...
A variety of devices are available for the management of patients with erectile dysfunction, Peyronie’s disease, penile dysmorphophobia, for support before and after penile prosthesis insertion, and after radical prostatectomy. Traction devices include, but are not limited to, Penimaster PRO (MSP Concept, Berlin, Germany), Andropenis and Andropeyronie (Andromedical, Madrid, Spain), and the Restorex (PathRight Medical, Plymouth, USA). The other type of devices are vacuum devices such the Osbon ErecAid (Timm Medical, MN, USA). Different devices are optimal for different clinical applications, and robust and contemporary clinical data show a variety of strengths and weaknesses for each device. Research currently favours the use of traction devices for improvement of penile curvature and erectile function in patients with Peyronie’s disease compared with vacuum devices; Penimaster Pro and Restorex have been shown to be associated with the best outcomes in this indication. Vacuum devices are favoured for treatment of erectile dysfunction and penile length loss after radical prostatectomy; the Osbon ErecAid is the most well-studied device for this indication. Research into other uses of vacuum and traction devices, such as for penile dysmorphophobia or before and after penile prosthesis, is very limited. Compliance, cost and availability remain substantial challenges, and further high-quality evidence is required to clarify the role of traction devices in urology and sexual medicine.
... 23 Otro procedimiento para alargar el pene es el uso no invasivo de pesarios o equipos diseñados especialmente para provocar la tracción permanente del miembro. Estas técnicas requieren que el paciente las utilice de 4 a 9 horas diarias, entre 3 y 6 meses, con lo que se obtiene un promedio de alargamiento de 2.3 a 2.7 cm. 24,25 Engrosamiento del pene El engrosamiento del pene es una técnica aún más debatida que el alargamiento, pues hasta la fecha no existe ninguna indicación absoluta para realizar este procedimiento. La única guía realizada para el alargamiento del pene señala que no existe fundamento para engrosarlo. ...
El tamaño del pene mantiene una relación estrecha con la autoestima e identidad sexual y tiene gran repercusión social, según la idiosincrasia mexicana. La cirugía estética de los genitales masculinos se encuentra en auge desde la década de 1970, por la necesidad de corregir las deficiencias y deformidades físicas que causan estrés psicológico en el hombre. Es importante considerar la valoración preoperatoria y selección de los pacientes para lograr los resultados estéticos deseados. Esta revisión expone la evaluación preoperatoria y las distintas técnicas desarrolladas en el campo de la cirugía estética de los genitales masculinos.PALABRAS CLAVE: alargamiento de pene, cirugía estética de genitales, engrosamiento del pene.
... Traction therapy offers a length gain with a maximum of approximately 2 cm. 24,25 In men with Peyronie's disease, 2 randomized controlled studies show that the use of traction therapy significantly improves stretched penile length with a maximum of 3.0 cm. 26,27 Besides this, there is a large spectrum of surgical procedures available, such as the division of the suspensory ligament to increase penile length and injection of autologous fat cells, silicone, and hyaluronic acid for girth enhancement. ...
Background
Men concerned about their penis size often consult professionals working in urology, andrology, surgery, and sexual medicine.
Aim
To inform professionals in the sexual medicine field about small penis syndrome as a clinical syndrome and to provide recommendations for treatment.
Methods
This was an overview of the existing literature combined with our extensive clinical experience.
Results
Small penis syndrome is a syndrome with psychiatric comorbidities and social consequences that impair life. Men with these concerns tend to be susceptible for treatment that is not evidence based and potentially harmful.
Clinical Implications
Treatment of men with concerns about penis size should start with a thorough biopsychosocial assessment, followed by extensive psychoeducation, counselling, and psychological interventions, even if surgery is being considered.
Strengths & Limitations
The strength of this study is the concise overview of the existing literature combined with clinical experience which leads to important recommendations. Limitation is that this is not a systematic review.
Conclusion
Complaints about penis size should be taken seriously, and a thorough biopsychosocial and multidisciplinary assessment is required.
... 39 Mechanical stressing restructured collagen and allowed its stretching in Dupuytren's disease tissue, 23,40 while the traction device was reported to lengthen the penis in some noncontrolled case studies. 6,24,25 A recent animal study also showed that the traction device and VD can exert a tissue remodeling effect to correct penile curvature. 41 Our study revealed that VD (−300 mmHg) significantly increased penile length by 8.2% compared with the controls. ...
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.
... 34e36 Although conditions other than PD are outside the scope of the present review, because length is a key concern with PD and given the relative paucity of publications of PTT and PD, 2 notable studies of non-PD populations are included as a proof of concept. 37,38 Nikoobakht et al 37 performed a prospective study of 23 patients (mean age ¼ 26.5 years) who presented with complaints of "short penis." The primary outcome was changes in flaccid and stretched penile lengths compared with baseline after PTT for 3 months (4e6 hours/day for the first 2 weeks followed by 9 hours/day for the remaining period). ...
Introduction:
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.
Aim:
To present and summarize the current literature on penile stretching for the treatment of PD.
Methods:
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.
Main outcome methods:
Penile curvature correction was effective, and stretched penile length was improved.
Results:
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.
Conclusions:
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.
... 23 Otro procedimiento para alargar el pene es el uso no invasivo de pesarios o equipos diseñados especialmente para provocar la tracción permanente del miembro. Estas técnicas requieren que el paciente las utilice de 4 a 9 horas diarias, entre 3 y 6 meses, con lo que se obtiene un promedio de alargamiento de 2.3 a 2.7 cm. 24,25 Engrosamiento del pene El engrosamiento del pene es una técnica aún más debatida que el alargamiento, pues hasta la fecha no existe ninguna indicación absoluta para realizar este procedimiento. La única guía realizada para el alargamiento del pene señala que no existe fundamento para engrosarlo. ...
... 23 Otro procedimiento para alargar el pene es el uso no invasivo de pesarios o equipos diseñados especialmente para provocar la tracción permanente del miembro. Estas técnicas requieren que el paciente las utilice de 4 a 9 horas diarias, entre 3 y 6 meses, con lo que se obtiene un promedio de alargamiento de 2.3 a 2.7 cm. 24,25 Engrosamiento del pene El engrosamiento del pene es una técnica aun más debatida que el alargamiento, pues hasta la fecha no existe ninguna indicación absoluta para realizar este procedimiento. La única guía realizada para el alargamiento del pene señala que no existe fundamento para realizar engrosamiento de éste. ...
El tamaño del pene mantiene una relación estrecha con la autoestima e identidad sexual y tiene gran repercusión social, según la idiosincrasia mexicana. La cirugía estética de los genitales masculinos se encuentra en auge desde la década de 1970, por la necesidad de corregir las deficiencias y deformidades físicas que causan estrés psicológico en el hombre. Es importante considerar la valoración preoperatoria y selección de los pacientes para lograr los resultados estéticos deseados. Esta revisión expone la evaluación preoperatoria y las distintas técnicas desarrolladas en el campo de la cirugía estética de los genitales masculinos.PALABRAS CLAVE: alargamiento de pene, cirugía estética de genitales, engrosamiento del pene.
... 23 Otro procedimiento para alargar el pene es el uso no invasivo de pesarios o equipos diseñados especialmente para provocar la tracción permanente del miembro. Estas técnicas requieren que el paciente las utilice de 4 a 9 horas diarias, entre 3 y 6 meses, con lo que se obtiene un promedio de alargamiento de 2.3 a 2.7 cm. 24,25 Engrosamiento del pene El engrosamiento del pene es una técnica aun más debatida que el alargamiento, pues hasta la fecha no existe ninguna indicación absoluta para realizar este procedimiento. La única guía realizada para el alargamiento del pene señala que no existe fundamento para realizar engrosamiento de éste. ...
El tamaño del pene mantiene una relación estrecha con la autoestima e identidad sexual y tiene gran repercusión social, según la idiosin-crasia mexicana. La cirugía estética de los genitales masculinos se encuentra en auge desde la década de 1970, por la necesidad de corregir las deficiencias y deformidades físicas que causan estrés psicológico en el hombre. Es importante considerar la valoración preoperatoria y selección de los pacientes para lograr los resultados estéticos deseados. Esta revisión expone la evaluación preoperatoria y las distintas técnicas desarrolladas en el campo de la cirugía estética de los genitales masculinos. PALABRAS CLAVE: alargamiento de pene, cirugía estética de genitales, engrosamiento del pene. Este artículo debe citarse como Carrillo-Córdova LD, Carrillo-Esper R, Carrillo-Córdova JR, Carrillo-Córdova CA. Cirugía estética de los genitales masculinos. Rev Mex Urol. 2017 julio;77(4):318-327. Abstract Penis size is closely related to self-esteem and sexual identity and has a strong social impact in the Mexican culture. Male genital cosmetic surgery has been on the rise since the 1970s, based on the necessity to correct deficiencies and physical deformities that cause significant psychologic stress. It is important to pay special attention to the preop-erative evaluation of patients and their selection to achieve the desired results. The present review covers the preoperative preparation and different techniques developed in the field of male cosmetic surgery.
... Both flaccid and stretched penile sizes increased significantly during the first and second follow-up. Additionally, the circumference of the glans penis significantly increased after PTT (29). More recently, in another series, 54 men with a 'short penis' underwent PTT 4 to 6 h per day for 6 months. ...
Penile traction therapy (PTT) is a new therapeutic option for men with Peyronie's disease (PD). However, it has a long history of use in other fields of medicine including bone, skin, skeletal muscle, and Dupuytren's. Mechanotransduction, or gradual expansion of tissue by traction, leads to the formation of new collagen tissue by cellular proliferation. As a molecular result, continuous extension of the fibrous plaque causes significant increases in collagenase and metalloproteinases, and, ultimately, to fibrous plaque softening and extension. This hypothetical knowledge has been supported by recent well designed experimental studies. Furthermore, several clinical papers have provided promising results on the use of PTT in PD patients. It has been shown in some series that the use of PTT significantly increases flaccid and stretched penile lengths and results in significant penile curvature improvement when compared to baseline. Furthermore, the use of PTT concomitantly with either verapamil or interferon α-2b has also been shown to be an effective therapy. Additionally, the beneficial effect of PTT on penile length before or after penile surgery in men with corporal fibrosis has been described. Finally, as a minimally invasive alternative treatment option to penile augmentation surgery in men with dysmorphophobia, PTT use has shown promising results by several experts. Studies have shown that PTT provides an acceptable, minimally invasive method that can produce effective and durable lengthening of the penis in men complaining of a small/short penis. There are, however, several criticisms related to the designs of the reported studies, such as small sample size and selection bias. Well-designed studies with larger numbers of patients and longer follow-up periods are, however, needed to establish the true benefits of PTT.
... The regular application of an external penile traction device can provide some degree of penile length gain in men with short penises (6,7). ...
Introduction:
Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery.
Objective:
The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant.
Methods:
An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between 2002 to 2012. The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought.
Discussion:
Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion.
Conclusions:
Strategies to preserve and potentially increase penile size are of great importance to all implanters. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach are simple ways to optimize penile length. A direct comparison of treatment outcomes evaluating the various approaches is not currently possible, owing to divergent study techniques. The implanting surgeon can best serve his patient by adopting a combination of different strategies that are individualized and specific to the patient's needs.
... Finally, in line with previous reports our study revealed no significant changes in erect circumference or degree of curvature with the use of PTT. 5,17 Recently CCH became the first drug approved by the Food and Drug Administration for the management of PD. The 2 landmark randomized prospective controlled trials (IMPRESS I and II) demonstrated a 34% improvement in mean penile curvature. ...
The concomitant use of penile traction therapy (PTT) with interferon alpha-2b (IFN) has been previously described. We present an update on our clinical experience to assess the benefit and duration of daily traction.
A retrospective review of patients who underwent IFN therapy between 2001 and 2012 was performed. Charts were reviewed and data collected regarding various patient demographics, vascular parameters, objective length and curvature measurements and use of PTT. PTT was further stratified according to duration of daily use.
One-hundred and twelve patients underwent a median of 12 IFN injections (range 6-24). Daily use of PTT was reported by 31% of patients. There were no differences in patient demographics, initial vascular status, pre-treatment stretched penile length (SPL), erect circumference and curvature between patients who followed a PTT regimen and those who did not. Overall use of PTT did not impact change in penile circumference (PTT +3.2mm [SD 6.5] vs. no PTT +2.1mm [SD 7.4], p=0.45), change in curvature (PTT -8.1 degrees [SD 16.0] vs. no PTT -9.9 degrees [SD 11.8], p=0.49), or change in SPL (PTT +2.4mm [SD 0.9] vs. no PTT +1.3mm [SD 0.8], p=0.56). Men who used PTT ≥3 hours/day gained significantly greater SPL compared to those not using PTT (4.4mm [SD 0.5] vs. 1.3mm [SD 0.8], p=0.04).
Routine use of PTT during intralesional injections (ILI) with IFN for PD may provide a small but subjectively meaningful improvement in SPL, without affecting curvature, if used for at least 3 hours a day.
Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
A BSTRACT
Purpose
The purpose of this study was to synthesize evidence and propose a technique for estimation of stretched penile length (SPL) applicable to children.
Materials and Methods
This review has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, and Scopus databases were queried on penile length (PL) measurement techniques in humans published from 1990 onward. The devices and the techniques used for PL measurement, state of the penis, the habitus of the participants, proximal and distal landmarks for measurement, handling the foreskin and pubic pad of fat, optimal stretching of the penis, and other factors (including the environment) which should be accounted for in the technique were identified from the study cohort (90895 participants across 145 included studies).
Results
PL has been represented through flaccid (33.79%), stretched (81.3%), and erect (12.41%) PLs as well as the greatest corporeal length (1.4%). Following devices have been used to measure the PL in the study cohort: rulers [54.68%], calipers [9.7%], measuring tapes [14.5%], coloured measuring strips [2.06%], spatulas/tongue depressors [11.03%], FitKit, syringe [1.4%], cotton swab (and ruler), titan cylinders, slide gauge and ultrasonography [1.37%]. The factors relevant to SPL measurement have been incorporated into the proposed SPL INdicator Technique (SPLINT) which is essentially a holistic extension of the “ Conventional PL Measurement” technique.
Conclusions
There is a wide range of heterogeneity in the technique for estimation of PL across the study cohort; the underlying factors have been identified along with the respective variables, and the SPLINT for SPL has been described.
Introduction:
Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening.
Objectives:
This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure.
Methods:
A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment.
Results:
Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement.
Conclusion:
Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
Introduction
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.
Objective
To review the current practice for treatment of men presenting for penile augmentation surgery.
Methods
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.”
Results
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.
Conclusion
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 2021;XX:XXX–XXX.
The aim of this review is to describe reported techniques and to provide available scientific data on the success of penis length procedures for cosmetic purposes. Penis lengthening methods remain a controversial issue. Penis size is a matter of great interest among men who are affected by ‘small penis anxiety’’ or just believe themselves to have a small penis, even though the dimensions of the organ fall within the normal range. We performed a narrative review of the literature based on a comprehensive search in the MEDLINE database for original articles published until March 2021, referring to lengthening approaches exclusively for aesthetical reasons. Abstracts, opinion papers and case series ≤10 patients were not considered. We included the results of 14 papers in the review that gathered the experience obtained in a total of 1661 patients. Four of the studies referred to non-surgical procedures for penile length augmentation (PLA) and the remaining 10 analyzed the results of invasive (surgical) procedures. Both invasive and non-invasive techniques achieve similar improvements in penis length. These procedures vary in complexity and require specialized training and experience. However, the low scientific quality of the analyzed papers makes it difficult to establish recommendations to choose one technique over any other. However, it seems reasonable that, if possible, non-invasive techniques should be proposed as a first-line treatment. Before deciding the procedure, we must carry out a correct psychological evaluation of our patients, discuss with them the technique of choice, and adjust their expectations.
Introduction
Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies.
Objective
To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction.
Methods
A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: “Botox”, “Botulinum toxin”, “Botulinum toxin A”, “Onabotulinum A”, “Abobutlinum A”, “BoNT”, “BoNT-A”, “Male sexual health”, “Male sexual pathology”, “Peyronie's disease”, “Premature ejaculation”, “Scrotal Pain”, “Penile Retraction”, “Scrotox”, “Erectile Dysfunction”, and “Botox in Urology”.
Results
There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration–approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers is “off-label,” and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent.
Conclusion
Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before a widespread clinical adoption can take place.
Reddy AG, Dick BP, Natale C, et al. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?. J Sex Med 2020;XX:XXX–XXX.
Peyronie’s disease (PD)-related penile deformity is managed with multiple treatment modalities including oral medications, intralesional injections, and surgery. Penile traction therapy (PTT) is one such modality with purported benefits, albeit with notable differences in the characteristics of available traction devices and published study protocols. We provide a comprehensive review of the available data supporting PTT for PD treatment. We performed a rigorous database search to identify all studies pertaining to PTT for the treatment of PD through November 2019. Seventeen trials explored use of PTT as monotherapy or in combination with surgical or nonsurgical treatment, using over five different commercially available devices. All devices were well tolerated, although compliance and daily duration of use were highly variable. PTT resulted in variable improvements in stretched penile length and penile curvature, depending on study protocol, patient population, and device. PTT appears to be a safe and well-tolerated treatment for PD as monotherapy or in combination with other nonsurgical and surgical treatments, and for men in both the acute and chronic phases. Further studies are needed to compare available devices, evaluate device characteristics associated with treatment success, differentiate outcomes in acute vs. chronic PD populations, and determine the optimal duration of use.
Erectile Dysfunction (ED) can affect males of all age groups and is often associated with an enormous decrease in quality of life. Furthermore, it is recognized as an early indicator of cardiovascular disease. Standard non-invasive therapy of ED encompasses mechanical options and pharmacological treatment with inhibitors of phosphodiesterase-5 (PDE5-i). More invasive options include local application of vasodilating agents and, in refractory cases, operative implantation of a penile prosthesis. Peyronie’s disease (PD) is caused by an inflammatory process of the penile tunica albuginea, resulting in the formation of fibrotic plaques, which may lead to penile deformity. While medical therapy can help to attain symptom relief and early plaque stabilization, different surgical approaches to correct penile curvature exist. A variety of novel treatment alternatives are available for both diseases. The following chapter sums up current treatment algorithms for ED and PD.
Purpose of Review
To summarize data on lengthening treatments from PubMed-indexed scientific publications.
Recent Findings
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.
Summary
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.
Objectives
To present our experience with multimodal therapy for Peyronie's disease.
Methods
Retrospective data were collected since 2008–2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ‒ l-arginine 2 g once and pentoxifylline 400 mg 3 times a day for 6 months ‒ and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated.
Results
One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59 ± 8.4, 59.1 ± 5.9 and 54.2 ± 4.8 years, while the mean duration of the disease was 6.3 ± 3.4, 4.8 ± 2.9 and 3.9 ± 3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2 ± 9 and 23.7 ± 8.9° in group 1 (p < 0.36); 25.4 ± 16.8 and 24.1 ± 13.6° in group 2 (p < 0.34), and 34.3 ± 17.9 and 26.1 ± 17.2° in group 3 (p < 0.001).
Conclusions
OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.
Die Größe des Penis ist für viele Männer ein Symbol der Männlichkeit und der sexuellen Leistungsfähigkeit. Gleichzeitig sind viele Männer überzeugt davon, dass ihr Selbstwertgefühl und die Anerkennung in der Partnerschaft maßgeblich durch die Penisgröße bestimmt sind und in der Regel „größer“ als besser empfunden wird. Aus diesem Grunde ist die Nachfrage nach ästhetischen, den Penis vergrößernde Operationen rasant angestiegen. Inhalt dieses Kapitels ist es, zunächst eine Landmarke zu setzen mit Hinblick auf Penismaße und Hintergründe für den Wunsch nach einer Vergrößerung. Im Anschluss wird die äußerst komplexe Anatomie und nervale Verschaltung des männlichen Genitales dargestellt mit Überleitung zu operativen Techniken sowohl für die Vergrößerung des Umfangs als auch die Verlängerung des Penis.
Objectives:
To present our experience with multimodal therapy for Peyronie's disease.
Methods:
Retrospective data were collected since 2008 to 2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ?L-arginine 2g once and pentoxifylline 400mg 3 times a day for 6 months?, and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated.
Results:
One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59±8.4, 59.1±5.9 and 54.2±4.8 years, while the mean duration of the disease was 6.3±3.4, 4.8±2.9 and 3.9±3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2±9 and 23.7±8.9° in group 1 (P<.36); 25.4±16.8 and 24.1±13.6° in group 2 (P<.34), and 34.3±17.9 and 26.1±17.2° in group 3 (P<.001).
Conclusions:
OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.
Introduction:
Peyronie's disease (PD) has historically been managed by at least 1 treatment, including oral supplements or medications, intralesional injections, or surgery. Adjunctive mechanical therapies also have been described, including penile traction therapy (PTT) and vacuum erection devices (VEDs), although relatively limited data are available on their use with PD.
Aim:
To review and summarize the published literature on the role and efficacy of PTT and VED in men with PD.
Methods:
A PubMed search was performed of all publications on PTT and VED in men with PD from inception through September 2017.
Main outcome measures:
Changes in penile curvature, length, girth, erectile function, and adverse events with PTT or VED.
Results:
PTT and VED exhibit mechanisms to improve aspects of PD, although clinical outcomes data are limited. Based on current data, PTT likely has a potential role as a primary lengthening therapy (modest improvements), in curvature correction (acute phase; unclear role in chronic phase), before penile prosthesis insertion, and after surgical correction of PD. The role of PTT as a combination therapy during collagenase Clostridium histolyticum injections is unclear. Fewer and lower level-of-evidence studies are available on VEDs and suggest potential roles in curvature correction, before penile prosthesis placement, or after PD surgery. Guideline statements from the American Urological Association and International Consultation on Sexual Medicine also support the potential role of PTT and VED in managing PD.
Conclusions:
PTT and VED represent viable therapeutic options for managing PD, with more data currently available on PTT. Because all PTT studies used a similar style of traction device, it is unclear whether results reflect outcomes of these particular devices or traction more broadly. Further studies are required to better delineate the benefits of PTT and VED, particularly in relation to other established treatments. Avant RA, Ziegelman M, Nehra A, et al. Penile Traction Therapy and Vacuum Erection Devices in Peyronie's Disease. Sex Med Rev 2018;X:XXX-XXX.
Recently, men with even normal-sized penis are increasingly interested in penile augmentation or lengthening surgery. Although these surgical procedures give additional penile length compared to original size and some satisfaction with new lengthening penis, surgical treatment can result in serious complications including troublesome anatomical deformities and erectile functional changes. Since men who are considering lengthening of the penis are concerned about postsurgical complications, it is a challenge to perform a surgical procedure. Therefore, much less invasive medical treatment such as penile traction therapy should be applied firstly than surgical modalities. Outcome of penile traction therapy using penile traction device is similar with gaining length from usual surgical procedure, but adverse events are reported nearly none except mild traction pain. Candidates for penile lengthening devices could not be listed definitely, but it might be candidates in case of shortened penis after retropubic surgery or Peyronie’s disease, before penile prosthesis reinsertion and adjuvant therapy after penile lengthening surgery. Since the research data about penile traction therapy in safety and efficacy are still insufficient at the present time, there is a need for scientific research to perform prospective randomized clinical trials on large cohorts. All of the men who applied penile traction device did not gain satisfactory penile length, but this may be helpful to the patients who want penile lengthening therapy without serious complication.
Introduction
Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life.
Aim
To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion.
Methods
An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed.
Main Outcome Measures
A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion.
Results
Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles.
Conclusion
Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients.
Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403–412.
Die Bedeutung des Penis für das Selbstwertgefühl ist für viele Männer sehr groß. Daher besteht nicht selten der Wunsch nach rekonstruktiven oder plastischen Eingriffen zur Verbesserung des Erscheinungsbildes, seltener zur Verbesserung der Funktion. Plastisch-rekonstruktive Operationsverfahren am Penis
haben ihre Indikation bei Zustand nach Verletzungen und nicht zufriedenstellenden Restzuständen nach Operationen oder anderen Maßnahmen sowie bei kongenitalen Missbildungen. Plastisch-kosmetische Indikationen bestehen selten, werden aber von Männern mit dem „Syndrom des kleinen Penis“ immer wieder nachgefragt. Insbesondere bei kosmetischen Verfahren mit dem Ziel der Penisverlängerung oder -verdickung ist jedoch größte Zurückhaltung angezeigt.
Introduction:
The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices.
Aim:
To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization.
Methods:
A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements.
Main outcome measures:
The development of clinically relevant guidelines.
Results:
Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials.
Conclusions:
Since the prior ICSM meeting, multiple developments have occurred in external mechanical devices and penile revascularization for the treatment of erectile and sexual dysfunction. Sexual medicine clinicians are encouraged to review and incorporate recommendations as applicable to their scope of practice.
Peyronie’s disease (PD) is the result of the formation of fibrous plaques in the tunica albuginea of the penis. Typical presentations of PD are represented by pain during erection, erectile dysfunction and penile deformities; the latter manifestations are often major factors in conditioning surgical management of the disease.
Die Bedeutung des Penis für das Selbstwertgefühl ist für viele Männer sehr groß. Daher besteht nicht selten der Wunsch nach rekonstruktiven oder plastischen Eingriffen zur Verbesserung des Erscheinungsbildes, seltener zur Verbesserung der Funktion. Plastisch-rekonstruktive Operationsverfahren am Penis haben ihre Indikation bei Zustand nach Verletzungen und nicht zufriedenstellenden Restzuständen nach Operationen oder anderen Maßnahmen sowie bei kongenitalen Missbildungen. Plastisch-kosmetische Indikationen bestehen selten, werden aber von Männern mit dem „Syndrom des kleinen Penis“ immer wieder nachgefragt. Insbesondere bei kosmetischen Verfahren mit dem Ziel der Penisverlängerung oder -verdickung ist jedoch größte Zurückhaltung angezeigt.
Most men seeking penile enhancement techniques have a normal penile size. They are either misinformed or suffer from penile dysmorphophobia and should be discouraged from undergoing invasive procedures. Less invasive techniques including penile extenders are not associated with major complications and may be beneficial from a psychological perspective.
We conducted this study to assess the efficacy and safety of AndroPenis® (Andromedical, Madrid, Spain) penile extender.
Between December 2010 and December 2013, 163 men presented to our institution complaining of small penile length and/or girth. All patients received structured psychosexual counseling. Fifty-four patients were willing to use the AndroPenis penile extender after counseling. Patients with major psychiatric disorders were excluded from enrollment. The patients were instructed to wear the device between 4 and 6 hours per day for 6 months. Penile dimensions including flaccid stretched and erected lengths were measured at baseline and after 1, 3, 6, and 9 months. Erectile function was assessed at baseline and 9 months after treatment using the simplified International Index of Erectile Function (IIEF-5). An institutional nonstandardized questionnaire was used to evaluate patient satisfaction at the end of study.
Penile length and girth enhancement as well as satisfaction rate and improvement in erectile function were assessed during follow-up.
At 6-month follow-up, a mean gain of 1.7 ± 0.8, 1.3 ± 0.4, and 1.2 ± 0.4 cm was noted for the flaccid, stretched, and erected penile lengths, respectively (all P values < 0.001). During the off treatment period, there were no significant changes in penile lengths. No effect on penile girth was observed. Patient satisfaction survey revealed modest satisfaction. From 13 patients with mild baseline erectile dysfunction, nine patients reported normal erectile function after 9 months.
Penile extender as a minimally invasive technique is safe and provides modest benefits and patient satisfaction. Nowroozi MR, Amini E, Ayati M, Jamshidian H, Radkhah K, and Amini S. Applying extender devices in patients with penile dysmorphophobia: Assessment of tolerability, efficacy, and impact on erectile function. J Sex Med **;**:**-**.
© 2015 International Society for Sexual Medicine.
Appearance of the male genitalia is linked with self-esteem and sexual identity. Aesthetic surgery of the male genitalia serves to correct perceived deficiencies as well as physical deformities, which may cause psychological distress. Attention to patient motivation for surgery and to surgical technique is key to achieving optimal results. In this review, the authors describe aesthetic surgical techniques for treatment of penile and scrotal deficiencies. They also discuss techniques for revision in patients with previous surgery.
Concerns over penile size and a desire for a longer penis are common in the male population. The number of male patients seeking an andrological consultation for the problem of 'short penis' is increasing. We looked at the numbers of patients presenting to a University andrology clinic over a 2-y period and correlated their perceived penis size with the accepted norms. Sixty-seven patients were evaluated with a median age of 27 (range 16-55) complaining of 'short penis' and requesting surgical correction. Clinical history, including the IIEF-5 questionnaire and an accurate physical examination were obtained. Data concerning measures of penile length and circumference were recorded in both the flaccid and fully stretched states and compared to the normal reference range as previously described in the nomogram we recently published (Eur Urol 2001; 39: 183-186.). All patients were also asked to estimate the length of a normal sized penis.Fourty-four (65.7%) complained of a short penis only while flaccid, 22 patients (32.8%%) while both flaccid and erect, and only one patient (1.5%) was worried only by the erect length of the penis. Fifteen (22.4%) also complained about their penile circumference. Fifty-seven (85%) patients thought a 'normal' penile length should range from 10 to 17 cm (median value of 12 cm). Ten patients (15%) were not able to estimate 'normal' penile size. No patient was found to have a penile length under the 2.5 percentile according to our nomogram. Forty-two (62.7%) subjects recalled the problem starting in childhood, when they felt that their penis was smaller than their friends'. In 25 patients (37.3%) the problem started in the teenage years after seeing erotic images. Our data show that most men who seek penile lengthening surgery overestimate 'normal' penile length. In our series, none of the patients could be classified as having a severely short penis according to our nomogram and none had any anatomical penile abnormality. Most found the use of a nomgram to show them how they compared with other men helpful. We suggest that documentation of such a demonstration should be made for any man seeking an opinion on penile lengthening surgery.
Introduction and Objective: Loss of penile length is a common complaint of patients undergoing surgical correction of penile curvature for Peyronie's (PD) disease. Penile extenders have been developed to increase penile length by regular application on the penis based on their tissue expansion properties. We assessed the value, in terms of increasing penile length, of the application of a penile extender (Andropenis ®) in men who have undergone tunica albuginea plication or grafting for PD. We also studied the impact of this treatment on the health related quality of life (HRQoL) Methods: 40 men, aged between 54 - 64 (mean 58 y.o.), undergoing PD surgery constituted the study population; 12 patients were submitted to a grafting procedure while the rest (n=28) undergone a plication technique. 20 consecutive patients were treated with a penile extender device (Andropenis ® ) while the previous 20 served as a control group. The extender was applied when the circumcision had healed (2 to 3 weeks after surgery) with a traction force of 900 to 1200 gr 8 to 12 hours daily during at least 4 months. Parameters studied were penile length before, after surgery and after the continued use of the device. HEQoL using the SF-36 questionnaire was also assessed to compare both groups of patients. Results: Penile shortening after surgery ranged from 0.5 cm to 4 cm. Shortening was slightly less relevant in patients undergoing a grafting procedure but this difference was not statistically significant. Treatment with the device produced a length increase ranging from 1 to 3 cm, this increase was proportional to the number of hours per month the patient was using the extender. There were significant differences in several of the SF-36 parameters in the patients under the device when compared to those not using the extender (p
Introduction
Pilot experiences have suggested that tension forces exerted by a penile extender may reduce penile curvature as a result of Peyronie’s disease.
Aim
To test this hypothesis in a Phase II study using a commonly marketed brand of penile extender.
Methods
Peyronie’s disease patients with a curvature not exceeding 50° with mild or no erectile dysfunction (ED) were eligible. Fifteen patients were required to test the efficacy of the device assuming an effect size of >0.8, consistent with an “important” reduction in penile curvature. Changes in penile length over baseline and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) constituted secondary end points.
Main Outcome Measures
Patients were counselled on the use of the penile extender for at least 5 hours per day for 6 months. Photographic pictures of the erect penis and measurements were carried out at baseline, at 1, 3, 6, and 12 months (end of study). The IIEF-EF domain scores were administered at baseline and at the end of study. Treatment satisfaction was assessed at end of study using a nonvalidated institutional 5-item questionnaire.
Results
Penile curvature decreased from an average of 31° to 27° at 6 months without reaching the effect size (P = 0.056). Mean stretched and flaccid penile length increased by 1.3 and 0.83 cm, respectively at 6 months. Results were maintained at 12 months. Overall treatment results were subjectively scored as acceptable in spite of curvature improvements, which varied from “no change” to “mild improvement.”
Conclusions
In our study, the use of a penile extender device provided only minimal improvements in penile curvature but a reasonable level of patient satisfaction, probably attributable to increased penile length. The selection of patients with a stabilized disease, a penile curvature not exceeding 50°, and no severe ED may have led to outcomes underestimating the potential efficacy of the treatment.
Purpose:
We provide guidelines of penile length and circumference to assist in counseling patients considering penile augmentation.
Materials and methods:
We prospectively measured flaccid and erect penile dimensions in 80 physically normal men before and after pharmacological erection.
Results:
Mean flaccid length was 8.8 cm., stretched length 12.4 cm. and erect length 12.9 cm. Neither patient age nor size of the flaccid penis accurately predicted erectile length. Stretched length most closely correlated with erect length.
Conclusions:
Only men with a flaccid length of less than 4 cm., or a stretched or erect length of less than 7.5 cm. should be considered candidates for penile lengthening.
Pilot experiences have suggested that tension forces exerted by a penile extender may reduce penile curvature as a result of Peyronie's disease.
To test this hypothesis in a Phase II study using a commonly marketed brand of penile extender.
Peyronie's disease patients with a curvature not exceeding 50 degrees with mild or no erectile dysfunction (ED) were eligible. Fifteen patients were required to test the efficacy of the device assuming an effect size of >0.8, consistent with an "important" reduction in penile curvature. Changes in penile length over baseline and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) constituted secondary end points.
Patients were counselled on the use of the penile extender for at least 5 hours per day for 6 months. Photographic pictures of the erect penis and measurements were carried out at baseline, at 1, 3, 6, and 12 months (end of study). The IIEF-EF domain scores were administered at baseline and at the end of study. Treatment satisfaction was assessed at end of study using a nonvalidated institutional 5-item questionnaire.
Penile curvature decreased from an average of 31 degrees to 27 degrees at 6 months without reaching the effect size (P = 0.056). Mean stretched and flaccid penile length increased by 1.3 and 0.83 cm, respectively at 6 months. Results were maintained at 12 months. Overall treatment results were subjectively scored as acceptable in spite of curvature improvements, which varied from "no change" to "mild improvement."
In our study, the use of a penile extender device provided only minimal improvements in penile curvature but a reasonable level of patient satisfaction, probably attributable to increased penile length. The selection of patients with a stabilized disease, a penile curvature not exceeding 50 degrees, and no severe ED may have led to outcomes underestimating the potential efficacy of the treatment.
To assess a commonly marketed brand of penile extender, the Andro-Penis(R) (Andromedical, Madrid, Spain), widely used devices which aim to increase penile size, in a phase II single-arm study powered to detect significant changes in penile size, as despite their widespread use, there is little scientific evidence to support their potential clinical utility in the treatment of patients with inadequate penile dimensions.
Fifteen patients were required to test the efficacy of the device, assuming an effect size of >0.8. Eligible patients were counselled how to use the penile extender for at least 4 h/day for 6 months. Penile dimensions were measured at baseline and after 1, 3, 6 and 12 months (end of study). The erectile function (EF) domain of the International Index of EF was administered at baseline and at the end of the study. Treatment satisfaction was assessed using an institutional unvalidated five-item questionnaire.
After 6 months the mean gain in length was significant, meeting the goals of the effect size, at 2.3 and 1.7 cm for the flaccid and stretched penis, respectively. No significant changes in penile girth were detected. The EF domain scores improved significantly at the end of study. Treatment satisfaction scores were consistent with acceptable to good improvement in all items, except for penile girth, where the score was either 'no change' or 'mild improvement'.
Penile extenders should be regarded as a minimally invasive and effective treatment option to elongate the penile shaft in patients seeking treatment for a short penis.
Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed.
During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection.
The chief complaint was poor cosmetic appearance (irregular residual fat nodules in 7 men, skin deformity and scarring in 4 and scrotalization in 4). Reoperation was necessary in 6 patients, wound complications occurred in 6 and sexual dysfunction was reported by 4. Only 1 patient reported a subjective increase in penile length.
Although a verifiable complication rate may never be available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.
To describe a technique for penile lengthening and the results achieved.
The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to insert autologous cartilage previously harvested from the rib, the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis. The increased length of the penis depends directly on the elasticity of the urethra and especially of the neurovascular bundle. From June 1995 to March 1999 the technique was applied in 19 patients aged 18-52 years, who were followed for a mean (range) of 3.3 (1-4.5) years.
The increase in penile length was moderate, at 2-4 cm; there were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction. Fifteen patients reported painless sexual intercourse, the remaining four patients providing no data. During the follow-up the cartilage insert remained at about the same size as that at initial implantation.
The penile disassembly technique combined with the interposition of rib cartilage in the space between the glans cap and tips of the corpora cavernosa provides a genuine increase in penile length, with satisfactory results.
The knowledge of normal variations in the size of male external genitalia is of considerable interest to several disciplines. We carried out an extensive study in young Italian males to provide estimates of normal variations of penile dimensions.
The penile length in flaccid and stretched states and the penile circumference were measured in a random group of 3,300 young men aged 17-19 years and free from endocrine disorders and from congenital or acquired abnormalities of the penis. In a random sample of 325 subjects of the same set of people, penile length and circumference were also correlated with weight and height. Statistical analysis was performed with the Sperman test, because our data were not normally distributed as tested by the Kolmogorov-Smirnov test (p < 0.01).
The median values of penile dimensions recorded in the present study are flaccid length 9.0 cm, flaccid circumference, at the middle of the shaft, 10.0 cm, and stretched length 12.5 cm. We also observed that the penile dimensions are highly correlated with height and weight.
Since penile length and circumference correlate with anthropometric parameters such as weight and height, we suggest to consider themselves as two bodily measures which display a wide extent of normal variability along the general population.
The prognostic influence of neuroendocrine (NE) differentiation in prostate cancer patients is not yet properly established. In a series of primary hormone-naive prostate cancers from a patient population that underwent radical prostatectomy, we wanted to determine the relationship between NE phenotype expression and Gleason sum, disease stage, and serum PSA concentration.
Chromogranin A (CgA) expression was scored and compared in 105 consecutive primary prostate cancers with their homologous preoperative tumor prostate biopsies.
High grade or high stage prostate cancers expressed a significantly higher CgA score than low grade or localized diseases (p < 0.005). Both the CgA score of the surgical specimens and the PSA level in the serum increased linearly (p = 0.001). In the samples of many corresponding tumor biopsies no significant CgA staining was found.
NE differentiation in primary untreated prostate cancer is closely associated with the major prognostic parameters of survival. This association cannot be shown by evaluating the CgA staining in tumor biopsies.
Peyronie's disease (PD) is a fibrotic disorder of the penis whose etiopathophysiology remains unclear. At this time, there is no known reliable nonsurgical treatment. This study reviews our experience with external penile traction therapy to correct the deformity associated with this disorder.
To evaluate prolonged external penile traction as a nonsurgical treatment for PD.
Ten men with PD completed this noncontrolled pilot study of traction therapy using the FastSize Penile Extender. Nearly all (90%) had failed prior medical therapy. Traction was applied as the only treatment for 2-8 hours/day for 6 months. All subjects underwent pre- and post-treatment physical examination including measurement of stretched flaccid penile length (SPL) and biothesiometry.
Curvature and girth were measured during erection before and after treatment with dynamic duplex ultrasound. Assessment of erectile and sexual function was further assessed with the International Index of Erectile Function and Quality of Life Specific to Male Erection Difficulties (QOL-MED) questionnaires. At 3 and 6 months post-treatment, SPL was measured and subjective assessment of deformity by the patient was recorded.
Subjectively all men noted reduced curvature estimated at 10-40 degrees, increased penile length (1-2.5 cm) and enhanced girth in areas of indentation or narrowing. Objective measures demonstrated reduced curvature in all men from 10-45 degrees; average reduction for the group was 33% (51-34 degrees). SPL increased 0.5-2.0 cm and erect girth increased 0.5-1.0 cm with correction of hinge effect in four out of four men. International Index of Erectile Function-erectile function domain increased from 18.3-23.6 for the group. Changes in quality of life by QOL-MED were not found to be statistically significant in this small series. There were no adverse events including skin changes, ulcerations, hypoesthesia or diminished rigidity.
Prolonged daily external penile traction therapy is a new approach for the nonsurgical treatment of PD. Further study appears warranted given the response noted in this pilot study.
Penile size is a considerable concern for men of all ages. Herein, we review the data on penile size and conditions that will result in penile shortening. Penile augmentation procedures are discussed, including indications, procedures and complications of penile lengthening procedures, penile girth enhancement procedures and penile skin reconstruction.
Device in Men with Shortened Penis V-05.05: Sexual rehabilitation after penile plastic surgery
- Penile-Extender
- K Krajka
- W Lauer
- D Perkowski
- M Markuszewski
Penile-Extender Device in Men with Shortened Penis 12 Krajka K, Lauer W, Perkowski D, Markuszewski M, Matusze-wski M. V-05.05: Sexual rehabilitation after penile plastic surgery. Urology 2006;68:215.
Efficacy of the daily penis-stretching technique to elongate the “small penis
- Colpi
8 Colpi GM, Martini P, Scroppo FI, Mancini M, Castiglioni F. Efficacy of the daily penis-stretching technique to elongate the " small penis. " Int J Imp Res 2001;13(suppl 4):47.
V-05.05: Sexual rehabilitation after penile plastic surgery
- Krajka