Article

Effect of Penile-Extender Device in Increasing Penile Size in Men with Shortened Penis: Preliminary Results

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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.
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... 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. ...
Article
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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.
... 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. ...
... 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. ...
Article
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.
... 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. ...
Article
Full-text available
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.
... 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. ...
Article
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.
... 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. ...
Article
Full-text available
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. ...
Article
Full-text available
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.
... 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. ...
Article
Full-text available
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.
... 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). ...
Article
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.
... Throughout history, the wish for penis enlargement has inspired a variety of surgical procedures as well as various original nonmedical remedies [1,[6][7][8][9][10][11][12][13]. ...
Article
Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.
... 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). ...
Article
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.
... In a small study of 15 patients complaining of a small penis, the authors suggested that penile length might be enhanced by the use of penile extenders [55]. Further research, though preliminary, also suggests that penile traction devises might play a role in the treatment of penile shortening [56,57]. Oderda and Gontero conducted a review which aimed to explore whether nonsurgical methods of penile lengthening may have some scientific background. ...
Article
Introduction.  With the worldwide increase in penile augmentation procedures and claims of devices designed to elongate the penis, it becomes crucial to study the scientific basis of such procedures or devices, as well as the management of a complaint of a small penis in men with a normal penile size. Aim.  The aim of this work is to study the scientific basis of opting to penile augmentation procedures and to develop guidelines based on the best available evidence for the management of men complaining of a small penis despite an actually normal size. Methods.  We reviewed the literature and evaluated the evidence about what the normal penile size is, what patients complaining of a small penis usually suffer from, benefits vs. complications of surgery, penile stretching or traction devices, and outcome with patient education and counseling. Repeated presentation and detailed discussions within the Standard Committee of the International Society for Sexual Medicine were performed. Main Outcome Measure.  Recommendations are based on the evaluation of evidence-based medical literature, widespread standards committee discussion, public presentation, and debate. Results.  We propose a practical approach for evaluating and counseling patients complaining of a small-sized penis. Conclusions.  Based on the current status of science, penile lengthening procedure surgery is still considered experimental and should only be limited to special circumstances within research or university institutions with supervising ethics committees. Ghanem H, Glina S, Assalian P, and Buvat J. Position paper: Management of men complaining of a small penis despite an actually normal size. J Sex Med **;**:**-**.
... 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. ...
Article
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.
Article
Penile augmentation is an ongoing debate. Emerging evidence proves a relationship between dissatisfaction with penile size and sexual dysfunction. Despite a widespread belief of the value of penile size, and the prevalent complaint of a "small penis," penile augmentation still stands short of addressing the demand. This report highlights the studies added to medical literature on penile augmentation in 2011-2012, including data on normal penile dimensions and the expected dimensions for a normal person, determination of the prevalence of the dissatisfaction with penile size, its effect on erectile function, female partner's opinion of the value of penile size, as well as further experience with augmentation techniques.
Article
Full-text available
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.
Article
Sexuality is a sensitive issue that may be difficult to explore through surveys involving direct contact. Epidemiological studies in this domain are scarce. Online surveys may provide more anonymity and less direct contact encouraging participation. The Global Online Sexuality Survey (GOSS) reports on different aspects of male and female sexuality. The Global Online Sexuality Survey-Arabic-Males (GOSS-AR-M) is the Arabic version reporting on male sexuality. To evaluate male ejaculatory function, penile size and contraceptive trends among Arabic speakers in the Middle East. The survey was randomly offered online to web surfers in the Middle East. Prevalence of premature ejaculation, ejaculatory latency, penile size and their correlation with erectile function. A total of 82.6% reported various degrees of premature ejaculation, associated with a statically significant decline in erectile function, despite a median intravaginal ejaculatory latency time (IELT) of 5 minutes, 95% confidence interval (CI) of 8.4-9.8. Adjusted to the World Standard Population by the World Health Organization, the collective prevalence was 83.7%. Local anesthetics gave better results and tolerance in delaying ejaculation. Self-measured erect penile length from symphysis pubis to glans was 15.6 cm ± 4.1, 95% CI = 15.4-15.9, yet, 30% were dissatisfied with size, mainly in the flaccid state, with dissatisfaction being inversely proportional with erectile function. Intrauterine device was the method mostly used by couples, and condoms had a high dissatisfaction rate. The prevalence of premature ejaculation appears to surpass that of erectile dysfunction, despite the possibility that it may be overreported considering the acceptable IELT of the population surveyed. Premature ejaculation and concerns over genital size may be considered as risk factors for ED. More male contraceptive measures should be introduced and popularized. Alleviating dissatisfaction with condom utility via health education should be a priority.
Article
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.
Article
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.
Chapter
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.
Chapter
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.
Chapter
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.
Article
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.
Article
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.
Article
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.
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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.
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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.
Article
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.
Chapter
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.
Article
What's known on the subject? and What does the study add? Penile lengthening methods remain a controversial issue. Surgical procedures of “lengthening phalloplasty” are characterized by poorly defined indications and an unacceptably high rate of complications, as recently outlined by a literature review, while non-surgical techniques are largely popularized by the media but often lack scientific evidence. In the literature we found only ten articles/abstracts of studies pertaining to the topic of our review. With our review, we aimed to explore whether non-surgical methods of penile lengthening may have some scientific background. We focused specifically on penile extenders, which among conservative methods are those whose efficacy is supported by some scientific evidence. It seems that penile traction devices should be proposed as the first-line treatment option for patients seeking a penile lengthening procedure. Penile size is a matter of great interest among men who are affected by ‘short penis syndrome’ or just believe themselves to have a small penis, even though the dimensions of the organ fall within the normal range. Surgical procedures of ‘lengthening phalloplasty’ lack standardized indications and carry a high risk of complications. Several non-invasive methods of penile lengthening have been described, such as vacuum devices, penile traction devices and penoscrotal rings; even ‘physical exercises’ have been popularized through the media. Most of these techniques, however, are not supported by any scientific evidence. We briefly analyse the efficacy and scientific background of such non-surgical methods of penile lengthening. It seems that penile extenders represent the only evidence-based technique of penile elongation. Results achieved do not seem to be inferior to surgery, making these traction devices an ideal first-line treatment option for patients seeking a penile lengthening procedure.
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 Gm
  • P Martini
  • Fi Scroppo
  • M Mancini
  • Castiglioni
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.
Article
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
Article
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. Gontero P, Di Marco M, Giubilei G, Bartoletti R, Pappagallo G, Tizzani A, and Mondaini N. Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study. J Sex Med 2009;6:558–566.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
Full-text available
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.
Article
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.
Article
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.
Article
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.