Khalil Mahmoud I, Machado Bruno, Miranda Alexandre, Eltahawy Ehab
Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.
Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Transl Androl Urol. 2021 Jun;10(6):2658-2668. doi: 10.21037/tau-21-27.
Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate 'normal' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient's overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were "penile lengthening", "penile enhancement", "penile girth", "inflatable penile prosthesis" and "glans augmentation". Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.
抱怨阴茎短小的患者给泌尿外科临床工作带来了挑战。那些寻求阴茎延长手术的男性通常高估了“正常”阴茎长度，而且在很多情况下，他们会将阴茎长度与男子气概和自尊程度联系起来。阴茎假体装置是保守治疗方案失败后勃起功能障碍（ED）的金标准治疗方法。阴茎缩短是可膨胀阴茎假体（IPP）植入成功后最常见的长期主诉。这对患者的总体满意度和生活质量有重大影响。我们使用PubMed对当前阴茎长度保留或增加的手术方法以及阴茎假体（PP）植入患者的围手术期方案进行了全面的文献综述。使用的关键词有“阴茎延长”“阴茎增大”“阴茎周长”“可膨胀阴茎假体”和“龟头增大”。在PP植入的同时，针对阴茎缩短的情况可以采用几种手术技术，例如PP植入的冠状沟下方法、滑动技术、改良滑动技术（MoST）、多次滑动技术（MuST）和白膜网状扩张术（TMEP）。辅助技术也可以改善主观阴茎长度，包括阴茎腹侧成形术、耻骨上脂肪切除术、悬韧带松解以及使用可膨胀阴茎植入物。术前方案，包括使用真空勃起装置、牵引治疗，似乎也能改善术后效果，将术后疼痛降至最低，并鼓励早期使用装置。目前，专家们对于特定的延长手术或何时进行这些手术以优化结果尚未达成共识。此外，在手术前必须设定合理的预期，并对患者及其伴侣进行广泛的咨询。当应用于经过适当选择的患者时，阴茎延长手术显示出有希望的结果，并发症发生率极低。
