AB49. Penile augmentation

INTRODUCTION: Lengthening phalloplasty is an operation that results in increased length of the penile shaft. This procedure has been gaining popularity because of the increasing demand in the past few years. There are different surgical techniques to achieve the desired results. In this study we are describing a unique modified surgical technique with comparison to other known procedures in relevant English literature. METHODS: This retrospective study includes 32 male patients who presented to our clinic for penile lengthening procedure over the last 6 years. All patients were evaluated by a single urologist to decide their eligibility for such a procedure using relevant inclusion/exclusion criteria. Patients who are included underwent a standard per-operative evaluation. Their assessment included full andrology and psychological evaluation. The procedure for all patients was performed by the same urologist and plastic surgeon simultaneously. Post-operative evaluation included measurement of the gain in penile length in cm. A successful surgical outcome is defined as: achieving a lengthening of equal or more to 2 cm. RESULTS: A total of 32 patients have been included. The age ranged from 29 to 38 years with a mean or median of 33 years. The average pre-operative penile length was: xx cm the average penile lengthening achieved post-operatively was: 3.7 cm with a range of 2.8 to 4.7 cm. There were no major complications such as hemorrhage, hematoma or infection in any of the patients. No failure of the procedure has been observed in any of the patients. One patient suffered partial wound dehiscence following return to sexual activity two week safer surgery but healed with local wound care. Patients’ satisfaction with the outcome when questioned during their 6 months follow up visit reached 31/32 with one case of dissatisfaction owing to the residual scar. DISCUSSION: The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves a combination of urological and plastic surgical steps to achieve the maximum length with the safest optimum outcome. Liposuction of the pupic fat is done using the conventional liposuction cannula to increase the reveal additional length at the root of the penile shaft. A transverse incision is made cephalad to the root of the penis. The incision is deepened till pupic bone by releasing the sub cutaneous fascia and the scarpas fascia which is continuing from the abdomen and investing the shaft of the penis. The suspensory ligament is identified and blunt dissection is continued on each side to the ligament towards undersurface of the pupic bone. The suspensory ligament is released from its bony attachment gradually but leaving the most poster-inferior quarter intact. The hemostasis is secured using bipolar cautery and vycril ligatures. The transverse incision is closed vertically which usually results in a superior and inferior dog ears. The dog ears are marked and excised. A z-plasty is marked to lengthen the scar in the vertical direction and set the new base of the penis in a more proximal point. The z-plasty flaps are incised and transposed and sutured in the new position. A small suction drain is left in few of the cases. The skin is closed in layers using resorbable sutures. CONCLUSIONS: In conclusion, it has been evident that using our multimodality technique phalloplasty is expected to provide better out come in terms of physical and visualized achieved length. It is a safe procedure with higher level of gain and superior patient satisfaction than the classically described procedure utilizing the release of the suspensory ligament alone. With the technique we have achieved 100% surgical success rate in regard to desired length gain and overall patient satisfaction rate of 97% which has not been reported using the standard procedure.