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“Make it as long as you can, Doc.” Concomitant surgical treatments with penile implant to enhance penile size

International Journal of Impotence Research volume 33, pages 587–595 (2021)Cite this article

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Abstract

The constant refrain for patients seeking penile implant is, “can you make it bigger?” It is a different request when the patient is young and fully potent compared with the mature individual suffering from erectile dysfunction (ED) for whom conservative therapies don’t work. The purpose of this workshop is to review strategies to make the ED patient undergoing inflatable penile prosthesis (IPP) have an enhanced penile appearance by having more of his phallus visible outside his body. Our common procedures are to use a combination of vacuum device preparation, oversizing the cylinders 1–2 cm, and daily aggressive cycling of the device for at least 6 months following implantation. More complex surgical solutions are also covered.

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Fig. 1
Fig. 2
Fig. 3
Fig. 4: IPP as tissue expander allowing longer replacement cylinders.
Fig. 5: Ventral phalloplasty or scrotoplasty.
Fig. 6: Carrion’s ventral phalloplasty improves appearance of penis.
Fig. 7: Shaeer’s ventral phalloplasty.
Fig. 8: Wang’s sliding procedure through long ventral penile incision.
Fig. 9: Egydio’s multiple slit technique (MUST).
Fig. 10: Penuma penile implant for prepubic recession.
Fig. 11: Two patients IPP + Penuma Implant.
Fig. 12: “S”-shaped deformity of lengthening cylinder.

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References

  1. Ghanem HM, Glina S, Assalian P, Buvat J. Position paper: management of men complaining of small penis despite an actually normal size. J Sex Med. 2013;10:294–303.

    Article  Google Scholar 

  2. Deveci S, Martin D, Parker M, Mulhall JP. Penile length alterations following penile prosthesis surgery. Eur Urol. 2007;51:1128–31.

    Article  Google Scholar 

  3. Habous M, Muir G, Soliman T, Farag M, Williamson B, Binsaleh SElhadek W, et al. Outcomes of variation in technique and variation in accuracy of measurement in penile length measurement. Int J Impot Res. 2018;30:21–6.

    Article  Google Scholar 

  4. Wang R, Howard G, Hoang A, Yuan JH, Lin HC, Dai YT. Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induce by intracavernosal injection. Asian J Androl. 2009;11:411–5.

    Article  Google Scholar 

  5. Osterberg EC, Maganty A, Ramasamy R, Eid JF. Pharmacologically induce erect penile length and stretched penile length are both good predictors of post-inflatable prosthesis penile length. Int J Impot Res. 2014;26:128–31.

    Article  CAS  Google Scholar 

  6. Xie D, Nicholas M, Gheiler V, Perito D, Siano L, Kislinger I, et al. A prospective evaluatin of penile measures and glans penis sensory changes after penile prosthetic surgery. Transl Androl Urol. 2017;6:529–33.

    Article  Google Scholar 

  7. Rajpurkar A, Dhabyuwala CB. Comparison of satisfaction rates and erectile function in patients treated with Sildenafil, intracavernosus prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice. J Urol. 2003;170:159–63.

    Article  CAS  Google Scholar 

  8. Sellers T, Dineen M, Salem EA, Wilson SK. Vacuum preparation, optimization of cylinder length and postoperative daily inflation reduces complaints of shortened penile length following implantation of inflatable penile prosthesis. Adv Sex Med. 2013;3:14–8. https://doi.org/10.4236/asm.2013.

  9. Canguven O, Talib RA, Cambell J, et al. Is the daily use of a vacuum erection device for a month before penile prosthesis implantation beneficial? A randomized controlled trial. Andrology. 2017;5:103–6.

    Article  CAS  Google Scholar 

  10. Montague DK, Angermeier KW. Cylinder sizing; less is more. Int J Impot Res. 2003;15:S132–5.

    Article  Google Scholar 

  11. Wilson SK, Delk J, Mulcahy JJ. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3:736–42.

    Article  Google Scholar 

  12. Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis. J Sex Med. 2015;12:1298–304.

    Article  Google Scholar 

  13. Welliver C, Kottwitz M, Ahmad A, Wilson SK, Kohler TS. Manufacturers’ data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol. 2016;34:993–8.

    Article  Google Scholar 

  14. Miranda-Sousa A, Keating M, Mireira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med. 2007;4:1494–9.

    Article  Google Scholar 

  15. Shaeer O, Shaeer K, AbdelRahman IFS, Raheem A. Dorsal phalloplasty accompanying penile prosthesis implantation minimizes penile shortening and improves patient satisfaction. Int J Impt Res. 2019;31:276–81.

    Article  Google Scholar 

  16. Hakky, TS, Suber J, Henry GD, Smith D, Bradley P, Martinez D, et al. Penile enhancement procedures with simultaneous penile prosthesis placement. Adv Urol. 2012:314612. https://doi.org/10.1155/2012/314612.

  17. Wilson SK, Simhan J, Wilson’s Workshop. Is modeling an inflatable penile prosthesis obsolete for patients with Peyronie’s disease? Int J Impot Res. 2020. Epub ahead of print.

  18. Wilson SK, Mora-Estaves C, Egydio P, Ralph D, Habous M, Love C, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144–8.

    Article  Google Scholar 

  19. Clavell-Hernandez j WangR. Penile size restoration with nondegloving approach for Peyronie’s disease: initial experience. J Sex Med. 2018;15:1506–13.

    Article  Google Scholar 

  20. Gaffney CD, Pagano MJ, Weinberg AC, Small AC, Kuehas FE, Egydio PH, et al. Lengthening strategies for Peyronie’s disease. Transl Androl Urol. 2016;5:351–62.

    Article  Google Scholar 

  21. Egydio PH, Kuehhas FE. The multiple slit technique (MUST) for penile length and girth restoration. J Sex Med. 2018;15:261–9.

    Article  Google Scholar 

  22. Elist JJ, Baniqued M, Hosseini A, Wilson SK. Correction of retractile penis with subcutaneous soft silicone penile implant. IJIR. 2019. https://doi.org/10.1038/s41443-019-0174-3.

  23. Shirvanian V, Lemperle G, Pinto CA, Elist JJ. Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report. Int J Impot Res. 2014;26:100–4.

    Article  CAS  Google Scholar 

  24. Wilson SK, Cleves MA, Delk JR. Ultrex cylinders: problems with uncontrolled lengthening (the S-shaped deformity). J Urol. 1996;155:135–7.

    Article  CAS  Google Scholar 

  25. Wallen JJ, Madiraju SK, Wang R, Henry GD. Implementation of length expanding inflatable penile prosthesis is not sufficient to prevent postsurgical shortening. Asian J Androl. 2018;21:98–100.

    Article  Google Scholar 

  26. Scovell JM, Liehui GE, Barrera EV, Wilson SK, Carrion RE, Hakky TS. Longitudinal and horizontal load testing of inflatable penile implant cylinders of two manufacturers: an ex vivo demonstration of inflated rigidity. J Sex Med. 2016;13:175057.

    Article  Google Scholar 

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Authors and Affiliations

  1. Institute for Urologic Excellence, La Quinta, CA, USA

    Steven K. Wilson

  2. Rush University Medical Center, Chicago, IL, USA

    Laurence Levine

  3. University of Texas Medical School, Houston, TX, USA

    Run Wang

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  1. Steven K. Wilson
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  2. Laurence Levine
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Correspondence to Steven K. Wilson.

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Conflict of interest

SKW: Consultant AMT, Coloplast, International Medical Devices. Stockholder Neotract. Lecturer Boston Scientific. LL: Consultant Coloplast, International Medical Devices. RW: Consultant Coloplast, International Medical Devices.

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Wilson, S.K., Levine, L. & Wang, R. “Make it as long as you can, Doc.” Concomitant surgical treatments with penile implant to enhance penile size. Int J Impot Res 33, 587–595 (2021). https://doi.org/10.1038/s41443-020-0306-9

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