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Most patients experience a slight decrease in penile size following the penile implant surgery. The reduction is small and is on the order of ¼ of an inch. The main reason as to why this happens is that following the penile implant, the glans or head of the penis, does not become fully erect. This semi – erect glans penis accounts for the slight reduction in penile size during the erection.
Patients who are considering undergoing the penile implant need to have realistic expectation about their surgery and they need to understand that the penile implant is not a penis enlarging procedure. Patients also need to select an experienced penile implant surgeon who will insert the largest possible device that the penis can accommodate.
With proper surgeon selection and reasonable expectations, the perceived reduction in penile size should be negligible and insignificant following penile implant insertion.
So what do the actual penile surgery studies show? Two excellent studies show a loss in erect penile length of about ¼ of an inch or 0.7 cms following the penile implant (1) (2) . These studies measured erect penile length just prior to the surgery. The erection was achieved by injecting Prostaglandin E 1 into the side of the penis. This measured length was then compared with the length of the erect penis after placement of the penile implant. Again, the loss was about ¼ of an inch.
It is especially important for patients to understand that the underlying disease process causing ED can lead to a decrease in penile length. The most important causes of ED that can result in a shorter penis include Peyronie’s disease or “bent penis”, priapism – or prolonged erection, radical prostatectomy for prostate cancer, and removal of an infected penile implant. All of these conditions can shorten the penis. Again, patients with these conditions must have reasonable expectations concerning penile size after the implant.
There are a number of surgical procedures that can be done at the time of penile implant to lengthen the penis. These procedures are usually reserved for those patients with a short penis due to Peyronie’s disease or to some other cause. Bear in mind that procedures performed at the time of penile implant increase operative time and operative complexity. As a result, they may increase the risk of infection of the penile implant.
Various procedures have been tried to increase penile length following penile implant. One approach is to insert a penile implant that increases in length during inflation. One such device is the AMS 700 LGX. Unfortunately, this devise has resulted in S–shaped penile deformity and this device has a high rate of mechanical malfunction.
Other approaches to lengthen the penis include cutting the penile suspensory ligaments and performing pelvic liposuction. More complicated procedures involving extensive penile dissection have also been devised, but these procedures are usually reserved for patient with profound shortening due to Peyronie’s disease.
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1. Wang, R, Howard, G, Hoang, A, Yuan, JH, Lin, HC, Dai, YT, Prospective and Long Term Evaluation of Erect Penile Length Obtained with Inflatable Penile Prosthesis to That Induced by Intracavernosal Injection, Asian Journal of Andrology, 2009, 11, 411 – 415
2. Osterberg, EC, Maganty, A, Ramasamy, R, Eid, JF, Pharmacologically Induced Erect Penile Length and Stretched Penile Length Are Both Good Predictors of Post Inflatable Prosthesis Penile Length, International Journal of Impotence Research, 2014, 26, 4, 128 – 131,
3. 40. Borges F, Hakim L, Kline C. Surgical Technique to Maintain Penile Length After insertion of an Inflatable Penile Prosthesis Via Infrapubic Approach, Journal of Sexual Medicine, 2006, 3, 550-553