nach oben

Erschienen in:

08.11.2017 | Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)

An Update on the Management of the Short Penis: Results from a Systematic Review

verfasst von: M. Falcone, M. Sibona, M. Preto, A. Cocci, M. Timpano, L. Rolle, C. Ceruti, M. Oderda, P. Gontero, G. Garaffa

Erschienen in: Current Sexual Health Reports | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The aim of this manuscript is to systematically review the current literature on surgical management of the short penis, focusing on surgical and functional outcomes and postoperative complications.

Recent Findings

Penile size still represents a major concern among a large proportion of men regardless of age and socio-cultural background. On the other hand, there is still no clear agreement on the definition of a short penis. Penile inadequacy can be secondary to a variety of clinical conditions, either organic or psychogenic; moreover, the causes of a short penis could be divided in congenital or acquired. A surgical intervention is often requested to address these conditions, with a variety of different techniques that reflect the vast heterogeneity of the etiologies of the disease. Surgical and patients’ satisfaction outcomes are extremely variable, as long as the different techniques are hardly comparable. As a general statement, a lack of objective data, mainly concerning postoperative lengthening results, must be emphasized.

Summary

To date, penile lengthening procedures remain highly controversial. Recent evidences show better results in case of intrinsic or “false” penile shortness, while there is a lack of standardized studies concerning patients affected by penile dysmorphic disorder.

Vardi Y, Harshai Y, Gil T, Gruenwald I, Gruenwald I. A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications. Eur Urol. 2008;54(5):1042–50. https://doi.org/10.1016/j.eururo.2008.07.080.CrossRefPubMed

Shamsodini A, Al-Ansari AA, Talib RA, Alkhafaji HM, Shokeir AA, Toth C. Complications of penile augmentation by use of nonmedical industrial silicone. J Sex Med. 2012;9(12):3279–83. https://doi.org/10.1111/j.1743-6109.2011.02563.x.CrossRefPubMed

Kayes O, Shabbir M, Ralph D, Minhas S. Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol. 2012;9(9):499–507. https://doi.org/10.1038/nrurol.2012.150.CrossRefPubMed

Xu J-G, Lv C, Wang Y-C, Zhu J, Xue C-Y. Management of concealed penis with modified penoplasty. Urology. 2015;85(3):698–702. https://doi.org/10.1016/j.urology.2014.06.044.CrossRefPubMed

Mondaini N, Ponchietti R, Gontero P, et al. Penile length is normal in most men seeking penile lengthening procedures. Int J Impot Res. 2002;14(4):283–6. https://doi.org/10.1038/sj.ijir.3900887.CrossRefPubMed

• Garaffa G, Spilotros M, Christopher NA, Ralph DJ. Total phallic reconstruction using radial artery based forearm free flap phalloplasty in patients with epispadias-exstrophy complex. J Urol. 2014;192(3):814–20. https://doi.org/10.1016/j.juro.2014.03.105. This study highlights the role of the radial artery-based forearm free flap in patients affected by the rare exstrophy–epispadias complex. CrossRefPubMed

• Falcone M, Garaffa G, Raheem A, Christopher NA, Ralph DJ. Total phallic reconstruction using the radial artery based forearm free flap after traumatic penile amputation. J Sex Med. 2016;13(7):1119–24. https://doi.org/10.1016/j.jsxm.2016.05.003. This study highlights the role of the radial artery-based forearm free flap in patients affected by traumatic penile amputation. CrossRefPubMed

•• Tausch TJ, Tachibana I, Siegel JA, Hoxworth R, Scott JM, Morey AF. Classification system for individualized treatment of adult buried penis syndrome. Plast Reconstr Surg. 2016;138(3):703–11. https://doi.org/10.1097/PRS.0000000000002519. This study provides a useful classification of the different types of “false” penile shortness. CrossRefPubMed

Han D, Jang H, Youn C, Yuk S. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. BMC Urol. 2015:4–8. doi:https://doi.org/10.1186/s12894-015-0044-3.

10.

Westerman ME, Tausch TJ, Zhao LC, et al. Ventral slit scrotal flap: a new outpatient surgical option for reconstruction of adult buried penis syndrome. Urology. 2015;85(6):1501–4. https://doi.org/10.1016/j.urology.2015.02.030.CrossRefPubMed

11.

Chen Y, Ding X, Luo C, et al. A new plastic surgical technique for adult congenital webbed penis. J Zhejiang Univ Sci B. 2012;13(9):757–60. https://doi.org/10.1631/jzus.B1200117.CrossRefPubMedPubMedCentral

12.

Xu L, Zhao M, Yang Z, et al. Modified penile augmentation by dermal-fat graft in post-hypospadias adults. Aesthet Plast Surg. 2016;40(1):120–9. https://doi.org/10.1007/s00266-015-0593-6.CrossRef

13.

Xiao K, Cheng K, Song N. A new surgical procedure for phallic reconstruction in partial penis necrosis: penile elongation in combination with glanuloplasty. Ann Plast Surg. 2014;72(6):638–42. https://doi.org/10.1097/SAP.0000000000000051.CrossRefPubMed

14.

Egydio PH, Kuehhas FE. Penile lengthening and widening without grafting according to a modified “sliding” technique. BJU Int. 2015;116(6):965–72. https://doi.org/10.1111/bju.13065.CrossRefPubMed

15.

• Rolle L, Falcone M, Ceruti C, et al. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the “sliding” technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117(5):814–20. https://doi.org/10.1111/bju.13371. This study provides data concerning the surgical outcomes of the “sliding techninque”.CrossRefPubMed

16.

Egydio PH, Kuehhas FE, Sansalone S. Penile length and girth restoration in severe Peyronie’s disease using circular and longitudinal grafting. BJU Int. 2013;111(4 Pt B):E213–9. https://doi.org/10.1111/j.1464-410X.2012.11582.x.CrossRefPubMed

17.

Djordjevic ML, Kojovic V. Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie’s disease with erectile dysfunction. Asian J Androl. 2013;15(3):391–4. https://doi.org/10.1038/aja.2012.149.CrossRefPubMedPubMedCentral

18.

Mantovani F, Patelli E, Antolini C. Peyronie’s disease: endocavernous plaque excision without substitutive graft: critical 5-year experience. Riv Urol. 2013;80(Suppl. 22):28–30. https://doi.org/10.5301/RU.2013.10599.CrossRef

19.

Nowroozi MR, Amini E, Ayati M, Jamshidian H, Radkhah K, Amini S. Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function. J Sex Med. 2015;12(5):1242–7. https://doi.org/10.1111/jsm.12870.CrossRefPubMed

20.

Xu L, Zhao M, Chen W, et al. Augmentation phalloplasty with autologous dermal fat graft in the treatment of “small penis”. Ann Plast Surg. 2016;77(Suppl 1):S60–5. https://doi.org/10.1097/SAP.0000000000000782.CrossRefPubMed

21.

Mertziotis N, Kozyrakis D, Bogris E. Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique. Asian J Androl. 2013;15(6):819–23. https://doi.org/10.1038/aja.2013.58.CrossRefPubMedPubMedCentral

22.

Spinoit A-F, Van Praet C, Groen L-A, Van Laecke E, Praet M, Hoebeke P. Congenital penile pathology is associated with abnormal development of the dartos muscle: a prospective study of primary penile surgery at a tertiary referral center. J Urol. 2015;193(5):1620–4. https://doi.org/10.1016/j.juro.2014.10.090.CrossRefPubMed

23.

Kogan SJ, Williams DI. The micropenis syndrome: clinical observations and expectations for growth. J Urol 1977;118(2):311–313. http://www.ncbi.nlm.nih.gov/pubmed/894812. Accessed June 28, 2017.

24.

Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU guidelines on erectile dysfunction, premature ejaculation, penile curvature and priapism. Eur Assoc Urol Guidel. 2016.

25.

Falcone M, Gillo A, Capece M, Raheem A, Ralph D, Garaffa G. The management of the acute ischemic priapism: a state of the art review. Actas Urol Esp. 2017; https://doi.org/10.1016/j.acuro.2017.02.004.

26.

Kueronya V, Miernik A, Stupar S, et al. International multicentre psychometric evaluation of patient-reported outcome data for the treatment of Peyronie’s disease. BJU Int. 2015;115(5):822–8. https://doi.org/10.1111/bju.12968.CrossRefPubMed

27.

•• Rolle L, Ceruti C, Timpano M, et al. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the “sliding technique”. J Sex Med. 2012;9(9):2389–95. https://doi.org/10.1111/j.1743-6109.2012.02675.x. This is the first description of the “sliding technique,” an innovative surgical approach for end-stage Peyronie’s disease patients. CrossRefPubMed

28.

Li C-Y, Kayes O, Kell PD, Christopher N, Minhas S, Ralph DJ. Penile suspensory ligament division for penile augmentation: indications and results. Eur Urol. 2006;49(4):729–33. https://doi.org/10.1016/j.eururo.2006.01.020.CrossRefPubMed

29.

Ye X, Wang C, Yu Y, Zheng S. Pedicled deep inferior epigastric perforator flap for total phallic reconstruction. Ann Plast Surg. 2012;69(1):64–6. https://doi.org/10.1097/SAP.0b013e3182223d29.CrossRefPubMed

30.

Chung E, Ralph D, Kagioglu A, et al. Evidence-based management guidelines on Peyronie’s disease. J Sex Med. 2016;13(6):905–23. https://doi.org/10.1016/j.jsxm.2016.04.062.CrossRefPubMed

Titel: An Update on the Management of the Short Penis: Results from a Systematic Review
verfasst von: M. Falcone
M. Sibona
M. Preto
A. Cocci
M. Timpano
L. Rolle
C. Ceruti
M. Oderda
P. Gontero
G. Garaffa
Publikationsdatum: 08.11.2017
Verlag: Springer US
Erschienen in: Current Sexual Health Reports / Ausgabe 4/2017
Print ISSN: 1548-3584
Elektronische ISSN: 1548-3592
DOI: https://doi.org/10.1007/s11930-017-0127-0

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

Stufenschema weist Prostatakarzinom zuverlässig nach

22.04.2024 Prostatakarzinom Nachrichten

Erst PSA-Test, dann Kallikrein-Score, schließlich MRT und Biopsie – ein vierstufiges Screening-Schema kann die Zahl der unnötigen Prostatabiopsien erheblich reduzieren: Die Hälfte der Männer, die in einer finnischen Studie eine Biopsie benötigten, hatte einen hochgradigen Tumor.

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

20.04.2024 EAU 2024 Kongressbericht

Beim chronischen Harnwegsinfekt bei Frauen wird bisher meist eine Antibiotikaprophylaxe eingesetzt. Angesichts der zunehmenden Antibiotikaresistenz erweist sich das Antiseptikum Methenamin-Hippurat als vielversprechende Alternative, so die Auswertung einer randomisierten kontrollierten Studie.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2017

Prosthetic Considerations in Neophallic Reconstruction

Surgical Reconstruction After Penile Cancer Surgery

Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

The Testosterone Trials: What the Results Mean for Healthcare Providers and for Science