Penis Enlargement

Fig.1 - PLGA Scaffold for penile widening

Introduction

Insufficient 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.







Fig.2 - Tissue sample harvesting from scrotal subcutaneous tissue

Cell Isolation and Scaffold Preparation

Two 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 Seeding

Cell 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.






Fig.3 - Penile degloving

Surgical Procedure

Penile degloving (Fig.3) for implantation of PLGA scaffolds, between dartos and Buck’s fascia, is performed up to penile base.













Fig.4 - Scaffolds are placed onto Buck's fascia and fixed with several sutures
Two scaffolds seeded with cells are placed onto penile shaft next to each other and fixed to the Buck’s fascia with, 3-0 Vicryl suture, to prevent their movement (Fig.4).

Fig.5 - Several spatulas are placed over scaffolds to enable easier pulling back of the skin.
Penile skin with dartos is pulled back using 4–5 spatulas placed over scaffolds in order to prevent their disruption, movement, and sticking to the tissue (Fig.5). Subcoronal incision is closed in two layers. Elastic compressive dressing is applied for 2 weeks after surgery to prevent movement and rubbing between scaffolds and surrounding tissue.
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.




Penis enlargement


Fig.6 - Outcome after 1 year.

Clinical results

In 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.
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Fig.7 - Seroma Formation

Complications

Possible 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.









Conclusions

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.

Related Arguments:

  • Real penile Augmentation
  • Sava Perovic technique
  • Tissue engineering





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