Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases

Abstract

Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. In this article we report the results of a retrospective study of 355 cases of cosmetic elongation, enlargement and combined elongation and enlargement phalloplasty. We found a significant improvement in length at rest, stretched length and circumference at rest at 2, 6 and 12 months post-surgical procedure (all p < 0.0001). 5-item International Index of Erectile Function (IIEF-5) was also increased at 12 months post-surgery compared to baseline (p < 0.0001). This was consistent with an IIEF-5 improvement of 6.74% compared to baseline. This study is clinically relevant due to the large cohort of patients included and because it is the first study to use an inverse periosteal-fascial suture not described previously as part of the surgical methodology.

Figure 1

The inverse periosteal-fascial suture is intended to prevent the post-operative scar retraction of the dissected suspensory ligament. In order to reach and dissect the suspensory ligament, the Scarpa’s fascia (fundiform ligament) is first sectioned. Once the severing of the suspensory ligament is completed, a non-resorbable 2-0 suture is applied. It initially involves the left side Scarpa’s fascia, then the pubic bone periosteum in the deepest possible portion and then again the contralateral, right side Scarpa’s fascia. When tightening the suture knot, an introflection (inversion) of both bands towards the sloping point of the pubis is obtained. It thus fills the space formed by the section of the suspensory ligament and allows for the forward sliding of the penis. This technique prevents the post-operative retraction of the suspensory ligament, a frequent cause of surgical failure, and ensures a permanent and gratifying result.

Figure 2

Cosmetic phalloplasty significantly improves penis length at rest (A), stretched length (B), circumference at rest (C) and 5-item International Index of Erectile Function (IIEF-5) score (D) at 2, 6 and 12 months post-surgical procedure. Line represents median. Four stars indicate statistical significance (p < 0.0001).