Author: Prof.Osama Shaeer
Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Egypt
Key words: penile prosthesis, penile implant, penile enhancement, suprapubic lipectomy, penile length, satisfaction
Introduction: A shorter penis is one of the most frequently encountered complaints and reasons for dissatisfaction following penile prosthesis implantation (PPI) (1). Fat deposition in the suprapubic region is one of the causes of penile concealment, and can be addressed by suprapubic lipectomy (SPL). This is customarily performed in a separate session before or after PPI (2). We herein propose same-session PPI and SPL, through the same abdominal crease incision: PPI-SPL
Case presentation: PPI-SPL was performed in 22 patients with refractory erectile dysfunction and penile concealment on account of a redundant suprapubuc fat pad.
Protocol: An elliptical incision is placed through the abdominal crease and around the part of pubic skin to be excised. Suprapubic fat is resected. Scarpa’s fascia is opened to gain access to the superficial perineal pouch harboring the base of the penis. Penile prosthesis is implanted, whether semi-rigid or inflatable. Scarpa’s fascia, subcutaneous fat and the abdominal crease skin incision are closed.
Outcome: No implant infections were encountered. Visible length of the penis with the implant erected was almost the same in the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3 respectively, p=0.38). A 53.3% increase in patient satisfaction with length was detected, comparing pre-operative (2.55±0.67) to post-operative (4.77±0.43) ratings, p<0.0001.
Discussion: PPI-SPL through the abdominal crease incision appears to be a feasible and safe procedure with high patient satisfaction. It should be stressed that this procedure does not add to the true length of the penis, but rather reveals the concealed part. Nevertheless, the effect is immediately appreciable. The scar is hidden in the abdominal crease, away from the genital area, and is therefore less-stigmatizing.
Acknowledgements: Thanks to Professor Steven Wilson for the valuable opinion in the process of editing the video.
Disclosures: nothing to disclose.