Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied.

OBJECTIVES: To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification. METHODS: Eleven (11) out of 28 psychosomatically normal men (25-35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement--ligamentolysis): n=5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n=3 and (c) panniculectomy--suprapubic lipectomy and penile lengthening: n=2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied. RESULTS: The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid--stretched penis) was 1.6 cm (1-2.3 cm) [p=0.0014], the mean circumference gain was 2.3 cm [p=0.003] at the base and 2.6 cm [p=0.0012] subcoronaly. Significant (20%-53%) [p<0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients. CONCLUSIONS: Although penile size alteration was not spectacular or satisfying the patients' "great" expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.

Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old.

OBJECTIVES: To estimate the sizes of the external genital organs in physically normal adult males younger than 40 years old, as well as to correlate the resulting values with age and a number of somatometric parameters, to provide data that could be clinically applicable by the practicing urologist. METHODS: Fifty-two physically normal men, 19 to 38 years old, underwent tape measurements of penile dimensions in the flaccid-stretched state (total, shaft, glanular lengths), penile shaft volume calculation, and ultrasonographic testicular volume estimation. The resultant values were correlated with age, height, weight, body mass index, waist/hip ratio, and index finger length. RESULTS: The mean testicular volume was 16.9 +/- 4.7 cm(3), with the right testis (17.5 +/- 5.8 cm(3)) measuring slightly larger than the left (15.85 +/- 4.9 cm(3); P = not significant). The mean total penile length was 12.18 +/- 1.7 cm, the mean penile shaft length was 7.76 +/- 1.3 cm, the mean glanular length was 4.4 +/- 0.4 cm, and the mean penile shaft volume was 46.5 +/- 17.2 cm(3). Among the various correlations performed, the penile lengths (total, shaft, glanular) to index finger length (P <0.05) and to penile shaft volume (P <0.001) were statistically significant. CONCLUSIONS: Data on the size of the external genital organs among physically normal young adult men were provided and a novel formula for penile shaft volume calculation was proposed. Age and somatometric parameters were not associated with the size of the genitalia, excluding the index finger length, which correlated significantly with the dimensions of the flaccid, maximally stretched, penis.