Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy.
Department of Andrology and Male Genitalia Reconstructive Surgery, University of Foggia, Foggia, Italy.
Eur Urol Focus. 2024 May;10(3):432-441. doi: 10.1016/j.euf.2023.08.012. Epub 2023 Sep 13.
Recommendations regarding the management of penile size abnormalities and dysmorphophobia are important in guiding evidence-based clinical practice.
To present a summary of the 2023 European Association of Urology sexual and reproductive health evidence-based recommendations for the management of penile size abnormalities and dysmorphophobia.
A broad and comprehensive scoping exercise covering all areas of the guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a strength of recommendation were assigned for each recommendation according to the evidence identified. The evidence cutoff date for the 2023 guidelines is June 1, 2022.
Well-structured studies reporting high level of evidence, with standardized PROMS were deficient on penile size abnormalities and dysmorphohobia. A shared definition for short penis/micropenis was also lacking. Categorisation of penile abnormalities according to congenital, acquired, and dysmorphophobic aetiology is deemed compulsory. A detailed medical and psychosexual history and precise measurements of penile size are essential in the diagnostic pathway. Patients with normal penile size who are seeking penile augmentation should be referred for psychological evaluation for potential dysmorphophobic disorders. Penile length and girth enhancements can be achieved via a multitude of treatments, but a personalised management plan is crucial for satisfactory results. Endocrinological therapies, when indicated, are effective in the prepubertal setting only. Vacuum therapy has a limited evidence base in treatment protocols, although acceptable outcomes have been reported for penile traction therapy. Surgical techniques to enhance penile length and girth have limited evidence and should only be proposed after extensive patient counselling.
Management of penile abnormalities and dysmorphophobia is a complex issue with considerable ethical concerns. The adoption of a structured diagnostic and therapeutic pathway is crucial, as recommended in the guidelines.
Requests for medical/surgical treatments to increase penis size have increased dramatically worldwide. Several conservative and surgical treatments are available. However, few patients receive clear information on the benefits and possible harms of these treatments. These guidelines aim to provide a structured path to guide both physicians and patients in the selection of appropriate treatment(s) to increase penis size.
有关阴茎大小异常和畸形恐惧症管理的建议对于指导基于证据的临床实践非常重要。
总结 2023 年欧洲泌尿外科学会（EAU）性与生殖健康循证建议，以管理阴茎大小异常和畸形恐惧症。
对指南涵盖的所有领域进行了广泛而全面的范围界定工作。检索的数据库包括 Medline、EMBASE 和 Cochrane 图书馆。根据确定的证据，为每个建议分配了一个证据水平和推荐强度。2023 年指南的证据截止日期为 2022 年 6 月 1 日。
关于阴茎大小异常和畸形恐惧症的研究报告缺乏结构良好、报告高水平证据、使用标准化 PROMS 的研究。缺乏对短小阴茎/小阴茎的共同定义。根据先天性、获得性和畸形恐惧症病因对阴茎异常进行分类被认为是强制性的。详细的医学和性心理史以及精确的阴茎大小测量对于诊断途径至关重要。寻求阴茎增大的正常阴茎大小的患者应转介进行潜在的畸形恐惧症障碍的心理评估。阴茎长度和周长的增强可以通过多种治疗方法实现，但制定个性化的管理计划对于获得满意的结果至关重要。内分泌治疗在青春期前的情况下有效，但仅在有适应证的情况下。真空疗法在治疗方案中的证据基础有限，尽管已经报道了阴茎牵引疗法的可接受结果。增强阴茎长度和周长的手术技术证据有限，仅在对患者进行广泛咨询后才应提出。
阴茎异常和畸形恐惧症的管理是一个复杂的问题，涉及到重大的伦理问题。建议采用结构化的诊断和治疗途径，这在指南中得到了推荐。
全世界要求进行医学/手术治疗以增大阴茎的需求急剧增加。有几种保守和手术治疗方法。然而，很少有患者获得关于这些治疗方法的益处和可能危害的明确信息。这些指南旨在提供一个结构化的路径，指导医生和患者选择适当的治疗方法来增大阴茎。
