Methods of Penis Enlargement

Introduction

The penis comprises three big cylinders: two corpora cavernosa dorsally containing erectile tissue and one corpus spongiosum containing the urethra. The primary components of the penis are coated in the skin and covered by areolar tissue. Every layer of the penis is important to the penis' function and dynamics during sexual activity and voiding.

• The skin protects the penile tissues from damage while penetration and acts as a barrier against bacterial infection. If an infection or damage occurs, the skin can inhibit intracavernosal functioning, creating a confined abscess or hematoma.

• The skin is securely linked to the glans but weakly attached to the shaft, enabling freedom of movement during intercourse. The superficial (dartos) and deep (Bucks') fascias are located deep beneath the skin and provide extra structural support.

• The dartos fascia connects with smooth muscle fibers at the base of the penis to form a well-defined penoscrotal angle between the scrotal wall and the skin. The deep fascia is connected to the tunica albuginea.

• Penile ligaments are made of connective tissue that links the base of the penis to the pubic rami. The ligaments develop from the external oblique aponeurosis and are attached to the pubic symphysis.

• The suspensory ligament develops from the linea alba and attaches midline to the penile root to give dorsal support and stability of an erection. This ligament also shields the neurovascular bundle of the penis from repeated sexual damage by covering it.

• The ligament of Luschka, or the fungiform ligament, comprises dartos fibers and extends from the abdominal Scarpa's fascia to the penile shaft. The fungiform ligament connects to the pubis and is fanned laterally and ventrally to encircle the whole penile root, functioning as a support sling.

What Exactly Are Penis-Enlargement Methods?

Penis enlargement pills are supplements that promise or imply that consuming them will make the penis longer. They are marketed online and in supplement outlets under various brand names, claiming "male enhancement" or straight-up penis growth. They often contain vitamins, minerals, herbs, and supplements. Wessells established recommendations for penile elongation in 1996, and little has changed since then. Only males with a flaccid length of less than four centimeters or a stretched penile length (SPL) of less than 7.5 cm were considered when selecting for penile lengthening at the time.

Men with normal penis sizes may get penile dysmorphophobia disorder (PDD) or small penis anxiety (SPA) procedures. According to an ethical evaluation of penile elongation treatments, most men with normal penis sizes will decline after hearing and comprehending the risks and consequences involved with each surgery. All males receiving penile elongation surgery with stretched penile lengths within normal ranges should be evaluated psychiatrically.

What Is the Non-surgical Management for Penial Enlargement?

A. Testosterone:

• The objective of therapy in situations with real micropenis should be to restore a functioning penis size to enhance body image and self-esteem, allow proper standing micturition, and permit pleasurable sexual intercourse.

• The initial step in managing children with real micropenis remains the least intrusive, involving exogenous testosterone.

B. Traction Devices:

• Penile traction devices (PTD) have been studied as an independent technique to aid penile elongation and an adjunct to surgery. These devices wrap the penis and exert gentle strain to stretch and lengthen the tissue.

• Many brands of these devices, like "FastSize" and "Andro-Penis," have been developed and evaluated. The duration of use of these devices has yet to be determined. However, it often varies from four to six hours each day.

• Considering the time constraints of this minimally invasive therapy, compliance and patient selection are critical issues. Patient satisfaction has improved after three to six months of usage, and flaccid or stretched penile length has grown one to three centimeters in different trials.

What Is the Surgical Management for Penial Enlargement?

A. Penile Augmentation:

• Injectable materials such as liquid silicone, polyacrylamide, hyaluronic acid, and mineral oil have all been employed for penile augmentation. There is a high risk of foreign body response, edema, penile deformity, granulomas, and the necessity for removal.

• Since it is sourced from the patient's tissues, autologous fat grafting has been documented to improve the length of the penis and girth with no foreign body reaction. This is a significantly less invasive treatment compared to flap reconstruction or V-Y advances.

• In order to acquire a fat graft, surplus fat is liposuctioned, deposited in ten milliliters syringes, and centrifuged for three minutes at 300 gram. The superior oil and watery lower layers are removed, and the pure fat graft is obtained from the intermediate adipose layer.

• In order to boost fat transplant survival, the fat is placed into smaller needles and injected into many layers. The autologous fat graft will lose 20 to 80 percent of its thickness over the first year of engraftment, resulting in numerous surgeries.

B. Suspensory Ligament Release:

• The suspensory ligament connects the penis to the pubic symphysis and, in addition to offering support, serves as the penis's movable point during erection. This connection stops the penis from extending outward and generates an arching angle to the penile base.

• The suspensory ligament comprises the proper and arcuate subpubic ligaments, which connect the tunica albuginea to the midline of the pubic symphysis. The surgical release of this ligament transforms the penis acute angle to the pubic symphysis to an oblique angle, allowing the penis to rest in a more dependent posture, giving the appearance of lengthening.

• The most generally acknowledged surgical approach for penile elongation is a division of the suspensory ligament, with or without filler material, fat pad removal, or V-Y plasty. The suspensory ligament can be reached using a V-Y incision or a sub-coronary circumcision method.

• Full corpora detachment from the pubic ramus has been recorded to enhance the length. However, it is accompanied by severe danger to the neurovascular bundles of the penis, producing denervation and devascularization of the penis.

C. V-Y Advancement:

• A dorsal V-shaped incision was performed, along with a partial separation of the crura from the pubic ramus, which was then re-applied in the midline. The dorsal incision was secured with a V-Y advancement flap.

• The V-Y incision and consequent V-Y advancement are frequently combined with a suspensory ligament release. The incision is usually an upside-down V secured in an upside-down Y, lengthening the dorsal skin by pulling lateral tissue to the midline.

• The flap is distally located, and inadequate wound healing, flap dehiscence, and loss of the distal flap can happen if the blood supply of the flap is disturbed while dissection; bulging of the penoscrotal transition is also possible, and it can be treated with bilateral Z-plasties.

• Since V-Y advancement is frequently coupled with other treatments, it is impossible to establish the average length gained.

D. Suprapubic Lipectomy:

• Suprapubic lipectomy improved perceived penis length in individuals with a buried penis. Weight loss does not usually alleviate the problem of a broad overhanging fold, or mons pannus, in some persons.

• These folds can create issues with cleanliness, urine flow, and sexual function. A suprapubic lipectomy or restricted panniculectomy can remove the skin and fat that conceals the penis.

• A trapezoid incision is performed to cut off the skin. The lower section of the incision is designated two centimeters above the penis to enable approximation of the penis base to the pubic symphysis periosteum, and the upper part must not impede with the waistline sulcus. This procedure lengthens the exposed penile.

• It might be paired with the excision of diseased shaft skin, which may be inflammatory owing to the underlying condition and recurrent infections.

• In order to eliminate a donor site, the shaft skin can be covered using a graft from the lateral thigh or the excised mons pubis skin. If more length is required, the suspensory ligament can be released concurrently with the suprapubic lipectomy.

Conclusion:

Males with short penis should be clinically evaluated for evidence of real micropenis and checked for PDD. Patients should be treated conservatively at first, with testosterone treatment, PTD, and, if necessary, a mental evaluation. There are no recommendations for optimal surgical therapy for males seeking a penile extension. As discussed above, many surgical procedures have been developed, each with its limitations. Further research is needed to develop the best surgical approach with the fewest complications and maximum patient satisfaction.