Predicting Penile Length After Penile Prosthesis Implantation

Main Category: Urology / Nephrology
Also Included In: Men's health;  Cosmetic Medicine / Plastic Surgery
Article Date: 07 Apr 2006 - 0:00 PDT

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UroToday.com - Dissatisfaction with penile prosthesis implantation is multifactorial. Patients commonly report penile shortening as a major issue; it may be perceived or real. Candidates for penile prosthesis commonly have chronic and advanced ED and therefore are predisposed or already have penile shortening. To reduce dissatisfaction with the procedure and medical/legal liability, proper preoperative counseling is invaluable.

Drs. Montague and Angermeier recently studied the utility of preoperative stretched penile length (SPL) as a predictor of post-implant functional length. Forty-nine patients received either an AMS 700 CX or CXM, or AMS 700 Ultrex depending on the presence or absence of fibrosis (tunica or corporal smooth muscle), respectively. Preoperative stretch, post-operative inflated and deflated lengths were compared.

In the fibrosis patients who received the AMS 700 CX/M, preoperative SPL was predictive in 38% and within 1-cm in 88%. In the non-fibrotic group who received the girth and length expanders (AMS Ultrex), preoperative SPL was predictive in 27% and within 1-cm in 70%. Moreover, with the expanders inflated, the Ultrex group reported penile lengthening of at least 1-cm and up to 3-cm in 15% of patients.

The authors concluded that preoperative SPL was useful for counseling patients on expected penile lengths post-implant. Those patients without fibrosis who undergo the AMS Ultrex implant should expect to gain anywhere from 1 to 3-cm of additional length. Girth was not measured.

By Raymond Pak, MD

Reference:
J Sex Med 2006; 3(Suppl 1) Abstract 102.
Montague DK, Angermeier KW.

Editorial Comments:

Those of us who treat male sexual dysfunction on a regular basis know that complaints about penile length are ubiquitous: patients with ED and no prior surgery complain the penis is shrinking; patients following successful implant complain the penis shorter; patients having successful surgical correction of Peyronie's curvature with grafting complain the penis is shorter; patients having prostatectomy complain the penis is shorter. There have been numerous studies over the years that have attempted to verify these complaints and isolate their specific pathologies.

Dr. Montague has documented a very practical resource for the implanting surgeon. This work suggests that stretched preoperative penile length is a good indicator of penile cylinder size. Furthermore, this simple 'visual aide' may serve as a useful adjunct to informed consent. Patient satisfaction and expectation are strongly linked in penile prosthetic surgery.

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