Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis?

PURPOSE: A buried penis causes voiding dysfunction and limits penetrative sexual intercourse. This pilot study evaluates the urinary outcomes in men with buried penis following insertion of malleable penile implants. MATERIALS AND METHODS: Men with buried penis and co-existing urinary problems and erectile dysfunction underwent malleable penile prosthesis implantation were reviewed in a prospective ethics approved database. Patient demographics, flow rate (Qmax), International Prostate Symptom Score (IPSS), Patient Global Impression of Improvement (PGI-I) score, International Index of Erectile Function (IIEF)-5 score, Sexual Encounter Profile (SEP) and overall satisfaction score (on a 5-point scale) were recorded. RESULTS: A total of 12 men (age 55 to 72 years) were reviewed, and the average gain in penile length post-implant, as measured from the pubis to the tip of the glans penis, was 6.8 (3 to 8) cm. There was a significant improvement in IIEF-5 score (8.2 vs. 22.5; p=0.029) post-implant, and more than half of patients were able to resume normal sexual intercourse and positive SEP-2 and SEP-4 were reported in 9 (75%) and 8 (67%) patients. There were no significant intraoperative or postoperative complication. Significant improvement in Qmax (8.4 ml/s vs. 18.6 ml/s; p=0.042) and IPSS (24.5±5.5 vs 15.5±3.5; p=0.038) were observed. More than two-thirds (83%) reported PGI-I score at 1 or 2, while 9 (75%) patients scored a 5/5 in overall satisfaction rate. CONCLUSIONS: Malleable penile implants increases penile length and improves urinary function in a highly select group of men with a buried penis and erectile dysfunction.

Sexual Dysfunction Among Men Who Have Sex with Men: a Review Article.

PURPOSE OF REVIEW: The goal of this review article is to evaluate sexual dysfunction among men who have sex with men (MSM). RECENT FINDINGS: Men who have sex with men are commonly affected by sexual dysfunction. Often sexual dysfunction in MSM will significantly impact their psychological well-being perhaps even more than their heterosexual counterparts. Despite the frequency and high impact of sexual dysfunction in MSM, access to appropriate care may be limited. It is important for urologists, especially sexual medicine clinicians, to be aware of and comfortable with differences in sexual practices of MSM. Penile pathology in this patient population will negatively affect their quality of life and well-being. Therefore, it is important to properly assess and treat these patients.

Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas / Urological and psychological approach of secondary complications to penile aesthetic modifications

Objetivos: Dada la escasez de artículos científicos que revisen las distintas técnicas disponibles para modificaciones estéticas en el pene y que son causa de problemas uro-andrológicos posteriores, se revisa la literatura existente tras la asistencia de una infección peneana tras inyección de ácido hialurónico subcutáneo con fines estéticos. Material y métodos: Se expone un caso de un varón de 38 años de edad sin antecedentes médicos o psiquiátricos de interés, que acude a la urgencia por presentar inflamación y abscesificación en la piel peneana tras la inyección de ácido hialurónico. Fue preciso tratamiento quirúrgico mediante denudamiento y exéresis de la piel afecta, siendo la posterior evolución satisfactoria. El análisis psicológico realizado mostró una personalidad narcisista, posiblemente secundaria a traumas en la infancia. Se ha revisado la literatura presente en bases de datos médicas, así como información disponible on-line. Resultados. El aumento del tamaño del pene es una importante preocupación cultural y social, por lo que existen en el mercado distintos dispositivos para satisfacer esta demanda, entre los que destacan la fitoterapia, los ejercicios de estiramiento, pesas, bombas de vacío o dispositivos extensores. Entre las técnicas quirúrgicas descritas están la liposucción púbica, la sección del ligamento suspensorio del pene o la inyección de material autólogo o sustancias sintéticas, entre otras. Existen otras modificaciones estéticas peneanas entre las que destacan una amplia variedad de piercings genitales, tatuajes e implantes subcutáneos también denominados pocketing o "implantes 3D". Todas estas técnicas o modificaciones se describen en este artículo junto con sus posibles complicaciones urológicas asociadas más frecuentes. Conclusiones: Cada vez son más frecuentes las manipulaciones estéticas en el pene, y tanto la terminología popular como sus implicaciones médico-quirúrgicas deben ser conocidas por los urólogos y andrólogos

Objectives: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. Material and methods: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. Results: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. Conclusions: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. Community

Effects of penile fracture and its surgical treatment on psychosocial and sexual function.

The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1±32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6±9.3 h. The mean sexual relationship score decreased during first year (P=0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P<0.05). The mean erectile function domains remained stable in all groups (P>0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P>0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.

Patient-Reported Social, Psychological, and Urologic Outcomes After Adult Buried Penis Repair.

OBJECTIVE: To assess changes in hygiene, urination, and sexual activity after surgery for adult-acquired buried penis. MATERIALS AND METHODS: The study included men who underwent buried penis repair from 2011 to 2015. Patients were asked pre- and postoperative questions on hygiene, urinary difficulties, sexual difficulties, and difficulties with activities of daily living (modified Post-Bariatric Surgery Quality of Life Questionnaire). Postoperative satisfaction was assessed at a minimum of 6 months. Pre- and postoperative data were compared with chi-squared analyses. RESULTS: Of 14 eligible patients, 12 completed postoperative questionnaires. Buried penis repair required debridement of penile skin with split-thickness skin grafting to penis (n = 11; 92%), escutcheonectomy (n = 12; 100%) and abdominoplasty (n = 10; 83%), scrotoplasty (n = 7; 59%), and securing the supra-penile dermis to the pubic dermal or periosteal tissue (n = 12, 100%). The average length of follow-up was 31 months (±20 months). Mean age was 50 (±10.5 years) and mean body mass index was 55 (±13.7 kg/m2). Wound complications (all Clavian Grade 1) occurred in 9 of 12 patients. Patients reported improvement in hygiene (100%), urination (91%), and sexual function (41%); 92% of patients reported they would choose to have the surgery again; and 83% felt that surgery had led to a positive change in their lives. The ability to perform most activities of daily living, as assessed by the Post-Bariatric Surgery Quality of Life Questionnaire, improved significantly. Over 90% of men had lost additional body weight at last clinical follow-up. CONCLUSION: Buried penis repair positively impacts social, psychological, and functional outcomes for patients. Wound complications should be expected but are easily managed.

Chordee and Penile Shortening Rather Than Voiding Function Are Associated With Patient Dissatisfaction After Urethroplasty.

OBJECTIVE: To identify factors that predict patient satisfaction after urethroplasty by prospectively examining patient-reported quality of life scores using 3 validated instruments. METHODS: A 3-part prospective survey consisting of the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) score, and a urethroplasty quality of life survey was completed by patients who underwent urethroplasty preoperatively and at 6 months postoperatively. The quality of life score included questions on genitourinary pain, urinary tract infection (UTI), postvoid dribbling, chordee, shortening, overall satisfaction, and overall health. Data were analyzed using descriptive statistics, paired t test, univariate and multivariate logistic regression analyses, and Wilcoxon signed-rank analysis. RESULTS: Patients were enrolled in the study from February 2011 to December 2014, and a total of 94 patients who underwent a total of 102 urethroplasties completed the study. Patients reported statistically significant improvements in IPSS (P < .001). Ordinal linear regression analysis revealed no association between age, IPSS, or IIEF score and patient satisfaction. Wilcoxon signed-rank analysis revealed significant improvements in pain scores (P = .02), UTI (P < .001), perceived overall health (P = .01), and satisfaction (P < .001). Univariate logistic regression identified a length >4 cm and the absence of UTI, pain, shortening, and chordee as predictors of patient satisfaction. Multivariate analysis of quality of life domain scores identified absence of shortening and absence of chordee as independent predictors of patient satisfaction following urethroplasty (P < .01). CONCLUSION: Patient voiding function and quality of life improve significantly following urethroplasty, but improvement in voiding function is not associated with patient satisfaction. Chordee status and perceived penile shortening impact patient satisfaction, and should be included in patient-reported outcome measures.

Sexual and Overall Quality of Life Improvements After Surgical Correction of "Buried Penis".

BACKGROUND: "Buried penis" is an increasing burden in our population with many possible etiologies. Although surgical correction of buried penis can be rewarding and successful for the surgeon, the psychological and functional impact of buried penis on the patient is less understood. METHODS: The study's aim was to evaluate the sexual satisfaction and overall quality of life before and after buried penis surgery in a single-surgeon's patient population using a validated questionnaire (Changes in Sexual Functioning Questionnaire short-form). RESULTS: Using Likert scales generated from the questionnaire and 1-tailed paired t test analysis, we found that there was significantly improved sexual function after correction of a buried penis. Variables individually showed that there was significant improvement with sexual pleasure, urinating, and with genital hygiene postoperatively. There were no significant differences concerning frequency of pain with orgasms. CONCLUSIONS: Surgical correction of buried penis significantly improves the functional, sexual, and psychological aspects of patient's lives.

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis.

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life.

INTRODUCTION: Management of adult acquired buried penis is a troublesome situation for both patient and surgeon. The buried penis has been associated with significant erectile and voiding dysfunction, depression, and overall poor quality of life (QOL). AIM: To identify outcomes following reconstructive surgery with release of buried penis, escutcheonectomy, and circumcision with or without skin grafting. METHODS: We retrospectively identified 11 patients treated by a single surgeon between 2007 and 2011, patient ages were 44-69; complete data review was available on all 11. OUTCOME MEASURES: Validated European Organisation for Research and Treatment of Cancer 15 QOL, Center for Epidemiologic Studies Depression Scale (CES-D), and International Index of Erectile Function (IIEF) surveys assessed patient QOL, depression, and erectile function pre- and postoperatively. RESULTS: Mean body mass index (BMI) was 48.8 (42.4-64.6). Mean operative time was 191 minutes (139-272). Mean length of stay was 2.1 days. Ten of 11 patients required phallic skin grafting. There was one perioperative complication resulting in respiratory failure and overnight stay in the intensive care unit. Wound complications were seen in 2/11 patients, and 1 needed surgical debridement for superficial wound infection. Skin graft take was seen in 100% of the patients. Ninety-one percent of patients noted significant improvement in voiding postoperatively. Ninety-one percent of patients reported significant erectile dysfunction preoperatively. Subsequently, IIEF scores improved post surgery by an average of 7.7 points. Clinical depression was noted to be present in 7/11 patients preoperatively and 2/11 postoperatively based on CES-D surveys. QOL improved significantly in 10/11 compared with preoperative baseline; however, many patients noted significant difficulties based on their weight and other comorbidities. CONCLUSIONS: Management of adult acquired buried penis is a challenging, yet correctable problem. In our series it appears that by using established surgical techniques we were able to achieve significant improvements in erectile function, QOL, and measures of depression.

Paediatric male circumcision and penile hygiene: a Japanese mothers' view.

This paper analyses the views of 20 Japanese mothers concerning paediatric male circumcision and penile hygiene. In Japan, routine male circumcision has never been implemented for newborns and children, and adult males are mostly circumcised at aesthetic clinics. However, media reports indicate a trend of Japanese mothers willing to have their sons circumcised. In discussing penile hygiene and male circumcision, the construct of a 'sexual script' becomes relevant to understanding how linguistic and gender barriers made references to male genitalia and penile hygiene largely appear as 'vulgar' and 'unfeminine' in daily life conversations. Peers were often identified as the main source of information and only mothers who have struggled with their children's penile infections have learnt about male genital hygiene, a domain of knowledge largely transmitted by men. Male circumcision becomes a double-edged sword that could help prevent penile infections but also an embarrassing conversational topic that could elicit discrimination because most Japanese children are uncircumcised.

No evidence of depression, anxiety, and sexual dysfunction following penile fracture.

There is a gap in the literature about psychological status of patients following penile fracture surgery. We aimed to assess the long-term psychological status of penile fracture patients who have been treated by immediate surgical repair. A total of 32 patients with penile fracture have been treated surgically at our center. These 32 patients and 30 healthy control subjects were included in the study. All participants have completed the Hospital Anxiety and Depression Scale (HADS), Glombok-Rust Inventory of Satisfaction Scale (GRISS), and the premature ejaculation diagnostic tool (PEDT). The mean age of patients was 30.4 years and the mean body mass index was 27.3 kg m(-2). Sexual intercourse was the most common cause of the fracture. Immediate surgical repair was performed in all cases using a circumferential subcoronal incision and none of the patients had urethral injury intraoperatively. All tears were unilateral with a mean size of 1.5 cm. Only two patients had superficial dorsal vein rupture. At the day of assessment, the mean time elapsed after penile trauma was 15.9±6.3 months (range: 6-23). Only three patients had complications due to penile fracture including minimal penile curvature, penile nodule, and penile pain during intercourse. The mean scores obtained from PEDT, HADS, and GRISS did not show any statistically significant difference between groups. Anxiety, depression, premature ejaculation, and sexual dyssatisfaction levels were similar in both penile fracture patients who underwent immediate surgical repair and healthy control subjects. Immediate surgical repair of corporal ruptures have not shown any harmful psychogenic sequelae on patients with penile fracture.

Penis ligaments: their use in "increasing" the size of the penis in penile augmentation procedures. Anatomical description in human cadavers and clinical results of a phalloplasty series.

AIM: To present in human cadavers the anatomical basis of penis lengthening operations and reproduce this technique in a group of patients. MATERIALS OF STUDY: Penis ligaments in ten human cadavers were identified and dissected releasing the penis from its fixation to pubic arch. The same technique was applied to a group of forty patients that demanded a penis lengthening operation. RESULTS: The dissection of penis ligaments increases the distance pubic bone-tip of the penis for 3.1 +/- 0.6 cm. In patients, the increase in length 12 months post-operatively was 3.5 +/- 1.3 cm (2.3-5.1 cm) flaccid and 1.8 +/- 1.4 cm (1.4-3.2 cm) erect. There was a statistically significant difference (p < 0.005) between preoperative and postoperative status. The overall satisfaction rate was 67.5%. DISCUSSION: Cadavers study shows that this technique offers significant mobilization of the penis with a 3 cm gain, while on living tissue it has similar results. Anatomical parameters that might influence the final outcome of the operation are the length (antero-posterior dimension) of the pubic arch (corresponds to the length of the ligament), its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis. CONCLUSIONS: Division of ligaments of the penis increases its apparent length. Significant anatomical parameters are the length of the pubic arch, its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis.

Membrana e fusão penescrotal / Webbed pênis and penoscrotal fusion

Membrana penescrotal ou fusão penescrotal na forma isolada é uma rara anomalia de etiologia obscura, na qual a pele do pênis e o escroto estão fundidos. A fusão pode ser completa, com total ausência de angulação do pênis e escroto, ou incompleta, com uma membrana de extensão variável ligando o pênis proximal ao escroto. O objetivo da correção cirúrgica é separar o pênis do escroto, o que poderá ser realizado facilmente, utilizando-se plástica com retalhos em ?Z?, plásticas com retalhos ?V-Y?, ou incisão transversal e sutura vertical. Os resultados com a correção precoce são mais gratificantes e auxiliam a prevenir vários problemas psíquicos.

Self-inflicted non-healing genital ulcer: a rare form of factitious disorder.

Dermatitis artefacta is a factitious dermatological disorder with many forms of presentation that may occur on any part of the body. A diagnosis of dermatitis artefacta is often reached after rigorous and repeated investigations. Here we present the case of a 49-year-old single man complaining of a 4- month history of ulceration on the dorsal surface of the glans penis. In view of the unusual appearance of the lesion and the negative findings from clinical investigations, a diagnosis of dermatitis artefacta was made and the patient was referred for psychiatric evaluation. He was started on 20 mg/day of citalopram and titrated up to 40 mg/day by the 4th week, leading to complete remission in the following weeks. Thus, although rare, artefactual dermatitis should be considered in the differential diagnosis of unusual penile lesions.

A comparative study on two kinds of surgical procedures of penile corpora cavernosa augmentation.

OBJECTIVE: Penile augmentation surgery is still a controversial issue because of the uncertain indication, the possibility of severe complications and a variety of surgical techniques. The purpose of this study is to provide two surgical procedures of penile corpora cavernosa augmentation and to investigate its effect by implanting autogenous saphenous vein grafts or expanded polytetrafluoroethylene (ePTFE) vessel patches. METHODS: Between January 2001 and December 2005, 20 patients underwent surgeries in which bilateral longitudinal incisions were placed on the tunica albuginea and the penile corpora cavernosa were extended by means of implantation of saphenous grafts or PTFE artificial vessel patches. The patients included in this study presented either with congenital idiopathic micropenis or normal penile length and perimeter (dysmorphophobia). Before the operation, the penile length and perimeter in the flaccid and erectile states were as follows: flaccid length 2.5-7.5 cm and flaccid perimeter 3.0-7.5 cm; erectile length 4.9-10.5 cm and erectile perimeter 4.5-10.0 cm. RESULTS: Immediately after surgery, the penile corpus circumferential measurements (on table), showed remarkable increases which were 1.0-2.3 cm and 1.5-3.0 cm in the flaccid and erectile states, respectively; then, at 12 months to 5 years' follow-up, these girth gains had reduced by 0.5-1 cm in some cases. All cases in the two groups obtained satisfactory surgical results with satisfactory erection and no serious complications, such as infection and fistula. In 20 cases, 17 married cases resumed regular and satisfactory sexual activities 1 month after the operation without any functional limitation. CONCLUSION: The two kinds of surgical procedures for augmenting penile corpora cavernosa were proved to be effective and reliable, with few complications. Both saphenous grafts and ePTFE artificial vessel patches are excellent materials for reconstructing the tunica albuginea. These augmenting phalloplasties can not only be used for patients with micropenis, but also applied to satisfy the cosmetic and functional requests of patients with normal penile length and perimeter. However, the long-term outcomes of these surgical procedures need a further, detailed follow-up study.

Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma).

BACKGROUND: The practice of insertion of foreign bodies in the penis is well documented, but the clinical characteristics of penile foreign-body granuloma (FBG) and social motivation of the patients has not been studied in large groups. OBJECTIVE: The aim of this study was to evaluate the clinical and epidemiological profile of patients with penile insertion of foreign bodies and assess the significance of social motivation. METHODS: Twenty-five heterosexual male patients, who visited our clinic from 1990 to 2005, were retrospectively studied. All of them had implanted two different types of foreign bodies in their penis and had tattoos in the same area. Twenty-five male patients with genital tattoos served as clinical controls. RESULTS: The age of peak incidence of patients with penile FBG was 28 years. The youngest patient was 19 years. Twenty-three (23 of 25, 92%) of the patients were from gipsy origin, and two men were of Bulgarian origin. All the patients had risky social behaviour (prisoners and beggars). The motivation of 20 (20 of 25, 80%) of the patients was to enlarge the penile size. Fifteen (15 of 25, 60%) wanted to increase the feelings of the sexual partners. The majority of the patients (23 of 25, 92%) had injection of fatty substances, and 2 (2 of 25, 8%) had undergone implantation of a plastic pellet. In 14 cases (14 of 25, 56%), the insertion of mineral oil was complicated by formation of fistulas and wide ulcers with histological features of FBG. CONCLUSION: The reported cases represent an example of the detrimental effects of the insertion of foreign bodies in the penis. Immediate measurements should be performed to prevent severe outcomes.

Management of multiple failed repairs of the phallus using tissue expanders: long-term postpubertal results.

PURPOSE: We present the long-term results of our experience with application of tissue expanders for phallic reconstruction in patients with a history of multiple surgical repairs. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 16 patients who underwent penile tissue expansion for treatment of failed phallic reconstruction. The patients were 5 to 22 years old (mean age 9.9) at the time of the procedure. The original diagnoses were congenital adrenal hyperplasia (1 patient), partial penile amputation (1), epispadias (3) and proximal hypospadias (11). We used different shapes and numbers of tissue expanders according to the estimated skin augmentation requirement for final reconstructive surgery. The injection port was placed at the suprapubic area lateral to the penile base, with a small incision between the anticipated expander pouch and the reservoir. Penile tissue expanders were inflated by injections after 1 to 2 weeks postoperatively. Definitive reconstructive surgery was then planned and the tissue expander was removed at penile reconstruction at 2 to 11 months (mean 4.6) after implantation. RESULTS: Only 1 tissue expander was removed due to erosion. However, sufficient expanded skin was available for urethral reconstructions and penile skin coverage in all patients (100%). There were 2 cases of overlying penile skin redness, which resolved with temporary balloon deflation. Two patients had urethrocutaneous fistulas, which were successfully repaired later. Two additional patients required meatal dilation/urethromeatoplasty for meatal stenosis. These complications were corrected within 1 year postoperatively. After a long-term followup of 3 to 10 years (mean 6.5) as patients progressed through puberty, only 3 had mild chordee. At the end of followup acceptable cosmetic and functional results were achieved in 13 patients (81%). CONCLUSIONS: Tissue expansion is associated with few complications and good cosmetic results for phallic reconstruction in patients with minimal residual skin available for additional reconstructive efforts after repeated surgeries.

Is frenuloplasty worthwhile? A 12-year experience.

INTRODUCTION: Frenuloplasty is commonly performed. Its outcome has never been reported. PATIENTS AND METHODS: We have performed 213 frenuloplasties since 1992. Patients were sent a questionnaire regarding indication, treatment advised on presentation, anaesthetic, outcome (linear analogue satisfaction score), and further intervention required. RESULTS: Overall, 48 of 209 (23%) patients replied (median age of series, 27 years; range 16-78 years: and of respondents, 27 years; range, 17-78 years). Indications included tearing/bleeding of the foreskin (n = 32), balanitis (n = 3), pain on intercourse (n = 26), phimosis (n = 4), ejaculatory (n = 1) and hygiene (n = 1) problems. Twenty-five patients received general anaesthesia. Median satisfaction score was 8 (range, 1-10). Thirty-four patients would recommend frenuloplasty to another with similar symptoms. Three of nine patients initially advised to undergo circumcision later underwent circumcision (frenuloplasty satisfaction score, 1-3), 1 awaits circumcision (score, 5), 1 has a tight foreskin (score, 3), and 4 are satisfied (scores 6,9,10,10). In total, 23 of 209 patients (11%; median age, 27 years) underwent circumcision following frenuloplasty. Median time to circumcision was 11 months (range, 5-52 months). CONCLUSIONS: This is the only reported series of frenuloplasty. The response rate reflects a young mobile population. Most men are satisfied with the outcome, including some initially advised to undergo circumcision. The overall rate of circumcision following frenuloplasty is likely to be 15-20%.