Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant. An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between to The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought.
Urology ; Size of the penile : — Vacuum erection devices revisited: its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. Add Item s to:. They found that post-operative flaccid penile length, stretched penile length, and penile circumference were significantly smaller than pre-procedure values 5. Incisions were made in the Size of the penile albuginea from apex of the corpora to the crura and saphenous vein patches were placed. We review the data on measurement methods of the flaccid, stretched, and erected penis with the aim of constructing a recommendation for best practice. J Urol ; : Additionally, while all implants were AMS products, not all patients had the same model of penile prosthesis or the same site of insertion penoscrotal or infrapubic. With regard to the Toronto coed bath house girthour results showed that the mean penile girth was Paniflov 29 described his technique for penile elongation in
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Urinary Incontinence Size of the penile. Retrieved April 12, Gibbons, Jr. Most people assume that a morning erection is a sign of…. Men who want surgery to increase the length of their penis should try non-invasive methods like penile traction devices or extenders first, and in some cases, even try therapy to make them feel more confident about their bodies, said Italian urologists Slutty sex games a paper published in the April issue of the British Journal of Urology International. A systematic review and penilf of nomograms for flaccid and erect penis length and circumference in up to 15 men". Horowitz, Barbara N. JHU Press. Super squid sex organ discovered Archived at the Wayback Machine. Francois Eid. Archived from the original on 11 January Retrieved 5 September Histological study of the cloacal region and associated structures in the hedgehog tenrec Echinops telfairi.
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- Penile implant surgery involves placing a prosthetic device inside the penis and scrotum.
- The term penis applies to many intromittent organs , but not to all; for example the intromittent organ of most cephalopoda is the hectocotylus , a specialised arm, and male spiders use their pedipalps.
- We will present you with facts from all the scientific studies done on penis size so that once you have finished reading this article, you will feel content that you have the most accurate answer to the question.
- Understandably so, the size of the penis after a penile implant is a major concern for most penile implant patients.
- Human penises vary in size on a number of measures, including length and circumference when flaccid and erect.
- A penile prosthesis is treatment option for men with erectile dysfunction ED.
We prospectively correlated co-morbid conditions and demographic data with implanted penile prosthesis size to enable clinicians to better predict implanted penis size following penile implantation. We present many new data points for the first time in the literature and postulate that radical prostatectomy RP is negatively correlated with penile corporal length.
Patient demographics, medical history, baseline characteristics and surgical details were compiled prospectively. Pearson correlation coefficient was generated for the correlation between demographic, etiology of ED, duration of ED, co-morbid conditions, pre-operative penile length flaccid and stretched and length of implanted penile prosthesis. Multivariate analysis was performed to define predictors of implanted prosthesis length. From June to June , 1, men underwent primary implantation of penile prosthesis at a total of 11 study sites.
The most common patient comorbidities were CV disease Primary etiology of ED: RP Mean duration of ED is 6. Implanted penile prosthesis length is negatively correlated with some ethnic groups, prostatectomy, and incontinence. Positive correlates include CV disease, preoperative stretched penile length, and flaccid penile length. In modern society, men have perseverated over penile length. This biometric parameter has been a source of consternation for adolescent boys and mature men alike.
As recently as April of , national media was set ablaze by a large study reporting and reviewing nomograms of flaccid and erect penile size measurements 4. In developing the nomograms, Veale showed a strong and consistently statistically significant correlation was between flaccid stretched or erect length and height.
Penile length holds a strong psychological grip on the psyche of man as a measure of strength, potency, masculinity, and virility. However, as men age, comorbid conditions such as hypertension, diabetes mellitus, hyperlipidemia, and treatment for pelvic cancers may negatively affect penile size. As an example, it has been shown that men lose penile length and girth after undergoing a radical prostatectomy RP 5.
Penile length loss in this situation may be the result of structural changes from fibrosis of the corpora cavernosa 6. This may be the sequelae of nerve injury, ischemia from accessory pudendal artery ligation, or unopposed sympathetic tone leading to corporal smooth muscle contraction and a hypertonic retracted penis 7 , 8.
Currently, there is a paucity of data regarding how these and other factors influence penile length. This trial is the first of its kind and, to our knowledge, the only prospective, multi-institutional data-set that explores the correlation of co-morbid conditions and demographic data with implanted penile prosthesis size. Moreover, these intra-op measurements are of the total corpora length of the penile erectile tissue using solid metal instruments and can be argued to be the best way to measure true erectile length.
This study aims to report clinical outcomes of penile prosthesis, many of which have not been previously discussed in the literature. PROPPER was designed to quantify penile prosthesis durability, complications and effectiveness, including patient reported functionality, satisfaction and quality of life outcomes.
The study was initiated in June and patients with AMS penile prostheses continue to be enrolled at a total of 11 high-volume implant centers in the United States and Canada.
Patients diagnosed with erectile dysfunction who underwent penile implantation were invited to participate in the study if they were willing and provided consent for study enrollment and were willing to answer at least two questions related to satisfaction and device use 1 year following implantation. Men deemed not suitable for a penile implant by their physician were excluded from the study. Institutional Review Board approval was obtained at all sites Shulman IRB and the study consent process was conducted based on site requirements.
Demographic, etiology of ED, duration of ED, co-morbid conditions, and pre-operative penile length flaccid and stretched , operative technique, implant type and length, and duration of surgery were evaluated.
Physician investigators recorded baseline patient characteristics and surgical implantation details, including etiology of ED, duration of ED, co-morbid conditions, pre-operative penis length flaccid and stretched , operative technique, implant type and length, and duration of surgery.
Patient responses to treatment with penile prostheses were prospectively measured at regular intervals during a 1- to 5-year post-implantation period using optional validated patient survey questionnaires and electronic data collection. Follow-up questionnaires were obtained in person, by mail and telephone by the surgeon or authorized study personnel.
Data were collected in an online secured database. Patients were asked two standardized questions to assess device use and satisfaction, including I whether they use the device and II if used, with what frequency.
Satisfaction was gauged on a 5-point Likert scale of very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied and very dissatisfied.
The question on use is answered yes or no. A study outlining baseline patient characteristics has been previously published Statistical analysis has been previously described Pearson correlation coefficient was estimated for the correlation between demographic, etiology of ED, duration of ED, co-morbid conditions, pre-operative penile length flaccid and stretched and length of implanted penile prosthesis.
A multivariate linear regression model for the length of implanted penile prosthesis was developed with selected baseline covariates from the univariate analyses. All statistical analyses were performed using SAS 9. From June to June , 1, men underwent primary implantation of a penile prosthesis at 11 study sites.
All subjects underwent primary implantation; no replacement implant patients were included in the study. The majority of study participants were White As depicted in Figure 2 , the most common primary etiology of erectile dysfunction was RP Twenty three percent men had an etiology of ED that was different than the aforementioned categories. The most common concomitant conditions were cardiovascular disease Mean duration of erectile dysfunction was 6.
Pearson correlation coefficients between implanted penile cylinder length and other parameters are shown in Table 1. These significant risk factors were included in a linear regression model for multivariate analysis Table 2. In this analysis, patients with CV disease had the highest average device length. In addition, White and Black or African American patients, compared to other ethnicities, had larger average device lengths. The generation and maintenance of an erection is a complex process that involves both biologic and psychological factors Biologically, this phenomenon requires smooth muscle relaxation, arterial dilation and venous constriction.
There are a number of elements that may lead to an impaired erectile response; radical pelvic surgery, pelvic radiation, hypercholesterolemia, cardiovascular disease, diabetes mellitus, and hypogonadism.
These disease states result in the alteration of the elastic and distensible characteristics of the penile smooth muscle which may lead to penile length alterations, as well as, veno-occlusive dysfunction Interestingly, the percentage of penile smooth muscle is intimately related to the ability to engage adequate veno-occlusion, however the concentration of collagen fibrils is correlated to stretched longitudinal penile length Type I collagen is poorly compliant while type III is expandable and elastic.
Collagen IV is found in the basal lamina and is large composition of blood vessels 14 , Some investigators have noted that elastic fibers wane with aging furthermore contributing to penile length alterations 16 , To our knowledge, this is the first study attempting to correlate penile prosthesis length with demographics and comorbid conditions in a prospective fashion.
This large, multi-institutional registry elucidates several important concepts that have been debated in the past. We postulated and found that a history of a RP is weakly negatively correlated with implanted penile prosthesis length. We also observed that stress urinary incontinence correlated with shorter penile prosthesis length. This is likely because many of the cases of SUI were caused by radical pelvic surgery.
We also confirmed that pre-operative penile length was correlated with implanted penile prosthesis length as Deveci previously noted in 18 in 56 men undergoing first-time implantation. There was no statistical difference noted between pre- and postoperative penile lengths A surprising outcome was the positive correlation between cardiovascular disease and penile prosthesis length.
Additional research into possible explanations for this observation is warranted. Prior studies have disputed the impact of RP on penile length. They found that post-operative flaccid penile length, stretched penile length, and penile circumference were significantly smaller than pre-procedure values 5. The rationale for this phenomenon is likely due to neuropraxia secondary to nerve damage and possibly decreased arterial inflow from ligation of the accessory internal pudendal arteries leading to ischemic apoptosis.
Conversely, Briganti evaluated 33 patients prior to, and 6 months after, RP Penile length and circumference measurements in the flaccid and the erect state were obtained.
The investigators reported no significant differences in penile length and circumference between the preoperative and postoperative evaluation either in the flaccid or in the erect state Similarly, Berookhim conducted a prospective study of penile length changes after RP in 33 men There was evidence of stretched penile length loss at 2 months, but not at 6 months after RP.
Interestingly, patients who regularly used PDE5i had no measured penile length loss. Chitale measured the erect penile length in men with stable PD on day one and again 6 months later His team found that Raheem et al. In 11 on these men, penile length increased by a mean of 0.
Our study relied on internal penile length for appropriate sizing for the penile prosthesis and not on stretched flaccid penile length. Internal corporal length measurement, we believe is the most accurate way of penile measurement. As one would suspect, there are inherent issues using stretched penile length as a definitive measure 20 , The accuracy in of this measurement is diminished when different practitioners have performed preoperative and postoperative measurements.
This may potentially account for some changes in length. The proximal starting point of the measurement should be the pubic bone. This will factor in the changes on pre-pubic fat pad changed over the study.
Using the coronal sulcus as the proximal measurement end-point provides the most consistent results In the past, penile length has been thought of as a static element. A few investigators have published studies confirming that penile size can be enhanced by inserting a penile prosthesis with oversized corporal cylinders or using a VED in the post-operative setting Wilson and Salem evaluated 37 patients who had a narrow base penile prosthesis placed into scarred corporal bodies Patients were asked to inflate their implant for up to 3 hours daily.
After several months of intracorporal stretching, the patients had their penile prosthesis replaced. Upon reoperation, it was possible to insert corporal penile cylinders that were an average of 2. Similarly, Khera and Moskovic reported a 4. This study has a few limitations.
During its waking hours, it remains hidden beneath a skin receptacle, until it becomes erect and it projects outside in a rostral direction. University of Chicago Press. Thewissen 26 February BBC News Magazine. Burns, Eugene All members of Carnivora except hyenas have a baculum.
Size of the penile. Penile Implant / Prosthesis
Help us improve our products. Sign up to take part. Penile size is a considerable concern for men of all ages. Herein, we review the data on penile size and conditions that will result in penile shortening.
Penile augmentation procedures are discussed, including indications, procedures and complications of penile lengthening procedures, penile girth enhancement procedures and penile skin reconstruction.
Access provided by. Throughout history, the penis has defined masculinity. Discussion of the penis has been deemed taboo, socially unacceptable; and at other times, it is the topic of lighthearted conversation and jokes. Length, girth and function, however, have been an issue for men throughout history.
You shall be circumcised in the flesh of your foreskins, and it shall be a sign of the covenant between me and you. The phallus was topped with a golden start and was carried through the streets during a festival in Alexandria, all the while people sung to it and recited poems.
Kelley and Eraklis 2 performed the first recorded penile augmentation in for the treatment of microphallus in the pediatric population. Subsequently, the adult population began to show interest in the procedure for cosmetic and psychological reasons, similar to that seen with reconstructive breast surgery and augmentation. Penile augmentation procedures are not an American Urological Association sanctioned procedure, and typically both plastic surgeons and urologists perform penile enlargement procedures.
The purpose of this paper is to summarize the available literature on penile size, discuss conditions that contribute to penile shortening, and to highlight the indications, procedures and complications of penile enlargement surgery.
Paintings and writings by the ancient Greeks, as early as BC suggest that they believed that a smaller penis was superior. Penile size has been suggested to correlate to certain physical characteristics. There has been some data suggesting no correlation between shoe size and penile length by Shah and Christopher in a small study.
They studied men from 54 to 87 years of age. All penises were measured on full stretch and the foot size of each patient was recorded.
After linear regression analysis, there was no statistical correlation between stretched penile length and shoe size. Specifics of measurement of penile size is important in comparing data in different papers.
Although there is no standard technique for measuring penile size, there appears to be a consensus among researchers that penile length should be measured on the dorsum of the penis beginning from the pubopenile junction to the tip of the glans Figure 1. In addition, measurements of penile girth should be obtained from the middle of the penile shaft, in all three states.
For the purpose of clarity of nomenclature, a flaccid penis is one that is unstimulated or not aroused, and would be seen when the man is in the normal anatomical position. Flaccid stretched is when the flaccid penis is pulled to its maximal distance. Lastly an erect penis is one that is maximally stimulated, either through visual, tactile or pharmaceutical manipulation.
Penile length from pubopenile skin to meatus and fat pad depth from pubic bone to pubopenile skin. Reprinted with permission from Journal of Urology. To date, there have been few studies published on penile size. The first reported study was conducted by Loeb in , where he examined 50 subjects, age ranging from 17 to 35 years. He measured the penis only in the flaccid state and found the average size to be 9.
In , Schonfeld and Bebe looked at the normal variability of penile size, both length and girth of the penis from birth to maturity.
With respect to penile length, measurements were recorded only in the stretched state, however they looked at penile girth in both the erect and flaccid conditions. They found that the average stretched length was approximately In addition they found the average girth of the flaccid penis location of measurement not mentioned to be 8. In , Kinsey published his hallmark paper on penile length, which until was the largest published series.
Kinsey examined men between the ages of 20 and 59 and measured subjects in both the flaccid and the stretched flaccid states. He found that the average flaccid length was 9. Nearly 50 years later in , Bondil et al. Penile length was recorded in three conditions; flaccid, maximal flaccid stretched and flaccid after stretch. Lengths were found to be In , da Ros and colleagues published the first series examining the length of the erect penis.
The study was conducted in a group of Caucasian men who were interested in penile lengthening. Measurements of girth were taken both proximally and distally. The authors found that the average erect length in their subjects was In , Bogaert and Hershberger 11 investigated the relationship between sexual orientation and penile size.
The authors had two cohorts, of homosexual men and heterosexual men with a mean age of 30 in both groups. Self-reported penile length was performed in five measurements; estimated erect size, flaccid penile length, erect penile length, flaccid girth and erect girth.
The authors reported that there was a significant difference in both penile length and girth in this self-reported mailed questionnaire population. The average flaccid homosexual penis was The average erect penis was Furthermore, flaccid penile girth measurements were 9. Lastly, erect girths measured Wessells et al. They examined penile lengths in 80 men with a mean age of 54 years. Patients were excluded if they had any penile abnormalities that is, disease, history of urethroplasty or congenital deformities.
Measurements were taken in the flaccid, stretched and erect conditions. The average flaccid length was 8. Girth was recorded midshaft in the flaccid condition and erect conditions at 9. The largest study on penile length was published in by Ponchietti et al. The goal of their study was solely to determine the variability in penile size.
Subjects ranged from age 17 to 19 years and measurements were recorded in the flaccid and flaccid stretched states. Flaccid circumference was recorded in the middle of the shaft. Mean flaccid length was 9. Schneider et al. Their experimental population consisted of men aged 18—19 years. Measurements were carried out in the flaccid length, and subjects were given calipers to measure penile width, not circumference.
The average self reported flaccid penis measured 8. In , Awwad et al. Table 1 summarizes all the aforementioned studies 12 Table 1. After reviewing these data, some conclusions can be drawn regarding penile length and girth. Average erect penile length ranges from What is the significance of these findings? By applying these findings, one might be able to assess the patients who are 2 s. These data give reconstructive surgeons a starting point as to when penile augmentation might be deemed medically necessary or appropriate.
Penile shortening is a phenomenon that is associated with certain medical and surgical conditions. These conditions include prostate cancer patients treated with radical prostatectomy, Peyronie's disease and congenital anomalies. There is also some evidence that erectile dysfunction may be an independent risk factor for shortening. There have been several studies that have evaluated penile length after radical retropubic prostatectomy RRP.
In , Munding et al. All men had erections that were sufficient for penetration preoperatively. Penile measurements were recorded in triplicate on all patients in the holding area prior to surgery. These were performed in the stretched flaccid condition only, from the tip of the glans to the pubopenile skin. The same measurements were taken again 3 months postoperatively. No erect measurements were recorded, nor was penile girth recorded. A second study published in by Savoie et al. Penile lengths and girth of 63 men undergoing RRP were measured pre- and postoperatively.
Measurements were recorded from the pubopenile skin to the meatus, in the flaccid and stretched flaccid conditions. Penile circumference was also measured midshaft.
Measurements were taken preoperatively in the holding area and then 3 months postoperatively. Theories include early penile shortening related to urethral shortening due to RRP, or secondary corporal fibrosis from chronic hypoxia and fibrosis.
There is increasing evidence, however, that penile shortening is not limited to surgical treatments of prostate cancer. This was demonstrated by Haliloglu et al. All subjects received hormone deprivation therapy in the form of a luteinizing hormone releasing hormone LH-RH agonist, either leuprolide or goserelin every 3 months for a total of nine injections.