Development of female cosmetic surgery followed by rising popularity of reconstructive genital surgery induced that penile lengthening and widening gained tremendous interest in male population. Considerable improvement of penile aesthetic appearance and size is now possible, although this surgery remains a challenge requiring strict attention.
Various methods were employed in recent years for penile girth extension, resulting in many postoperative complications and disappointing outcome. The most common method, lipofilling, results in deformities such as asymmetry of the penis or curvature, as well as irregular distribution of fat nodules. Autologous dermal fat grafting has also been reported. Possible complications of this procedure include graft loss, unsightly donor site scar, and temporary or permanent penile shortening and deformities. Silicone liquid injection also has been used commonly for cosmetic purposes in recent years, primarily to fill small defects. It is not recommended due to many complications including migration, swelling, penile deformities and late granulomatous reactions. Corporeal body enlargement can also be achieved by expanding the tunica albuginea with saphenous vein graft, but there are deficient reports to confirm the reliability and efficacy of this procedure.
Tissue engineering in penile surgery is a new approach to fabricate a new functional tissue from autologous cells.
We report great success in real penile enhancement surgery using biodegradable scaffolds (poly-lactic-co-glycolic acid, PLGA), which are 50 mm in length, 30 mm in inner diameter and 4 mm in thickness. Our novel technique is formed on the concept of tissue engineering based upon collection of autologous cells, their expansion in culture and their return to the patient in sufficient quantities for penile girth augmentation. The basic idea is to transplant autologous cells onto biocompatible and biodegradable scaffolds that will provide appropriate mechanical strength to induce three-dimensional tissue growth and consequent penile enlargement. The scaffolds have good mechanical strength and biodegradable behavior that supports the growth of new tissue with minimal inflammation during 6 to 16 weeks until scaffolds are completely degraded and absorbed in human body. This way average gain is about 30% in penile girth (mean value 3.15 cm). Further lengthening can be achieved by simultaneous ligamentolysis followed by correction of penopubic and penoscrotal angle. Implantation of scaffolds can be easily repeated giving more gain in penile circumference.
Physical measurements of penile length and mid-shaft penile circumference both in the flaccid and erect state are obtained and recorded pre and postoperatively. Preoperative, intraoperative and postoperative intracavernous injection of Prostaglandine E1 is used for assessment of erectile function. After subcoronal incision and penile degloving two cell seeded scaffolds are shape adjusted and transplanted between dartos and Buck’s fascia. When the skin is non compliant, scaffolds are placed under lifted neurovascular bundle. Ventral longitudinal incision with penile eversion and degloving is used in patients who request prepuce preservation. Penile skin reconstruction follows repair of dartos fascia. A compressive dressing is left in place for 7-10 days. Two weeks after surgery, patients should start using vacuum device twice a day (5-10 minutes) during the first six months to prevent temporary penile retraction.
The degradation rate for scaffolds ranges from 6 to 16 weeks after pre-treatment with 75% ethanol. Histological examination six months after intervention demonstrated newly generated tissue which appeared viable with significant cell number, collagen content and ingrowth of capillaries.
Our clinical experience with this new treatment approach for penile girth enhancement showed its remarkable safety, reproducibility, superior cosmetic results, low morbidity and low incidence of postoperative complications comparing to previously established procedures. Possibility of performing this procedure under local anaesthesia and short hospital stay (mean 2.11 days) are the points in favour for the low cost-effectiveness of this approach. Mean operative time is approximately one hour and final surgical outcome concerning penile girth gain is almost 3 cm. Erectile dysfunction or sensitivity deficiencies have not been reported so far in immediate postoperative period or later. Patients resume their sexual activity 4-6 weeks after surgical intervention.