IntroductionInsufficient penile size is a source of anxiety for men who often seek augmentation using one of a variety of techniques.
Autologous tissue engineering with biodegradable poly-lactic-co-glycolic acid (PLGA) scaffolds (Fig.1) is a new and safe therapeutic approach for penile girth enhancement.
Advantages of this technique used by Prof. Perovic are simplicity, low morbidity, reduced operative time, good results.
Cell Isolation and Scaffold PreparationTwo pieces of scrotal dartos fascia (Fig.2) are harvested in local anesthesia and transferred to the laboratory, as well as 100 mL of blood for isolation of serum, for fibroblast culture that takes 3-4 weeks.
Cell SeedingCell suspension is seeded into scaffolds by dropping on surface. Scaffolds are then rolled for 2 hours to allow cell attachment. Finally, scaffolds are filled with medium and put into an incubator overnight; 24 hours later, they are ready for use.
Surgical ProcedurePenile degloving (Fig.3) for implantation of PLGA scaffolds, between dartos and Buck’s fascia, is performed up to penile base.
Oral antibiotics are administrated for 5 days postoperatively.
The procedure doesn't need the use of urethral catheter.
Patients are discharged the day after surgery and sexual activity is not allowed for 6 weeks after surgery.
Clinical resultsIn a scientific study on patients , penile body circumference in a flaccid state after surgery ranged between 10.5 and 13.5 cm (mean 11.7 cm), and with a gain of 1.5–3.8 cm (mean 2.1 _0.28 cm). In full erection the circumference ranged from 11 to 14.5 cm (mean 12.9 cm) with a gain of 1.2 to 4 cm. (mean 1.9 _ 0.28 cm). Outcome after 1 year (Fig.6). Erectile function and penile sensitivity are not changed after surgery. After 7–24 months from surgery, all patients were satisfied with flaccid and erect penile girth and the quality of their sex life, and expressed good (25%) and very good (75%) satisfaction of penile appearance. Clinically they presented no macroscopic scar and capsule formation or relevant postsurgical complications.
>> Read more
ComplicationsPossible post-operative complication are: subcutaneous seroma (Fig.7), prepuce lymphedema, epidermal inclusion cyst, partial skin necrosis, and wound infection.
All these complications could be treated conservatively except of excessive lymphedema that needs surgical excision.
Autologous dartos cells engineered in biodegradable scaffolds is a new and promising treatment option, reccomanded by the Team of Foundation 'Sava Perovic', for achieving real penile girth enhancement. Clinical advantage derives from stable remodeling from neovasculogenesis, fibroblast-like hyperplasia and collagen accumulation typical of the highly vascularized normal connective tissue of human adult dartos.
- Real penile Augmentation
- Sava Perovic technique
- Tissue engineering