Augmentation Phalloplasty for Acquired Shortening: A Systematic Review of Techniques, Outcomes and Patient Satisfaction.
Amjed Abu-ghname1, Joseph Banuelos, MD1, Krishna S. Vyas, MD, PhD, MHS1, Lucas Kreutz Rodrigues, MD1, Shane D. Morrison, MD, MS2, Steven L. Moran, MD1, Jorys Martinez-Jorge, MD1, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2University of Washington, Seattle, WA, USA.
Acquired penile shortening is an infrequent cause of small penile size in adult men. These patients represent a particular challenge due to preexisting penile anatomic deformities. With numerous techniques being performed, the purpose of our study is to summarize the available literature on length enhancement procedures used for acquired penile shortening, focusing on outcomes, complications, and patient reported satisfaction.
A systematic review was performed using the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). The electronic literature search included Medline/Pubmed, Scopus and Cochrane Databases to identify papers on aesthetic augmentation phalloplasty from 1990 to 2018. Keywords relevant to penile length enhancement were used. Studies involving 1) augmentation procedures for girth and/or length, 2) in cis-males, 3) with acquired penile shortening deformities, 4) and reporting penile dimensions and surgical outcomes, were included in our review. Studied including patients with normal penile size, congenital micropenis or buried penis were excluded.
Sixteen articles met our inclusion criteria and were reviewed from the 837 identified. A total of 1055 patients were included with mean age ranging from 16 to 69 years. Follow-up time was reported in all articles and ranged from 6 to 40 months. The penile state at which dimensions were measured was heterogeneous among the studies; varying between flaccid, erect, and/or stretched penile length.
Nine different procedures were reported; these were categorized based on the use of inflatable penile prosthesis (IPP) as part of the technique. Of all, 9 articles (632 patients) underwent a procedure using IPP. Mean gain length reported in this group ranged from 0.6 to 4.4cm, with a pooled length gain of 2.04 cm. Seven studies (423 patients) underwent penile lengthening without the use of IPP. Mean gain length reported in this group ranged from 1.3 to 4.4 cm, with a pooled length gain of 2.01 cm.
Complications rate in all the techniques ranged from 0% to 25%, with pooled complication rate of 10.5%. Both groups had comparable pooled complication rates; those with penile prosthesis had a rate of 10.4% while those without had a rate of 10.5%, (p=0.96). Finally, patient satisfaction was reported by 12 articles and the majority (9 studies) used a validated scale. Patients were generally satisfied, with reported satisfaction rates ranging from 77% to 100%.
This systematic review is the first to analyze augmentation phalloplasty outcomes in patients with acquired penile shortening. Despite the considerable differences in the use of penile prosthesis, the techniques demonstrated comparable complication rates and surgical outcomes. Although high satisfaction rates were reported, patients should still be counseled on the associated risk of complications. Augmentation phalloplasty techniques are evolving and are continuously being modified; best-practice guidelines are crucial to achieve safe and satisfactory outcomes in this population.
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