Technique widens, lengthens penis in implant recipients

Key Points

Rome-A team of researchers from Italy has developed and refined a technique that widens and lengthens the penis in patients receiving prostheses for erectile dysfunction.

The procedure, which uses autologous fibroblasts seeded on a biodegradable poly(lactic-co-glycolic acid) scaffolding (PLGA, Regen Biotech, Inc., Sungnam, Korea) is conducted simultaneously with the implant. The procedure can add up to 2.8 cm to girth and up to 3 cm in length, researchers rported.

"This is a new surgical technique and a new indication for tissue engineering," Salvatore Sansalone, MD, senior lecturer in urology at the University of Rome, told Urology Times. "This also has potential as a treatment for patients with other clinical problems, such as Peyronie's disease."

The extent of the lengthening is limited by the mobility of the neurovascular bundle, Dr. Sansalone noted.

High degree of satisfaction reported

At a mean follow-up of 37 months (range, 18-54), the mean girth increase was 2.1 cm (range, 1.3 cm to 2.8 cm), and the mean gain in length was 2.7 cm (range, 2.20 cm to 3.2 cm). None of the patients evidenced infection, retraction, or skin dehiscence at follow-up. Glans sensation, orgasm, and ejaculation were preserved in all patients. All achieved sexual activity, and 20 patients (87%) reported "high" satisfaction, two reported "fair" satisfaction, and one said he was dissatisfied with the outcome.

Dr. Sansalone told Urology Times that the cell bioengineering procedure reported in the study has since been refined. Initially, cells for the PLGA scaffold (seeded with fibroblasts) were obtained by harvesting samples of the scrotal dartos fascia, dicing and centrifuging them to separate cells, culturing the cells, encouraging them to multiply for 3 weeks, seeding them onto the scaffold, and allowing them to adhere and mature before implantation.

"When we began this procedure, we would use cells from the dartos fascia and cultivate them. Today, we draw blood, centrifuge it, place the scaffold in the serum, and it is ready in 24 hours. We can draw blood from the patient one day and implant the next," Dr. Salvatore said, noting that the scaffold is biodegradable and had completely disappeared in patients by 6 months' follow-up.

"We took samples of the tissue (at 6 months) and found it to be similar to dartos fascia. It was almost normal tissue, without significant scarring," he added. "We usually do not cut the suspensory ligament because it cannot provide real penile lengthening. Only albugineal circular incision and grafting provides lengthening, but it can be done only during simultaneous prosthesis implantation due to a very real risk of erectile dysfunction."

Currently, the procedure is only offered at a clinic in Belgrade, Serbia, but Dr. Sansalone said he expects it to expand across Europe.