Dorsal phalloplasty accompanying penile prosthesis implantation minimizes penile shortening and improves patient satisfaction

Abstract

Many patients complain of shortened length following penile prosthesis implantation. Dorsal phalloplasty (DP) can accompany prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient’s body. DP is done through the same incision. A nonabsorbable suture approximates the under surface of the skin where the penis meets the pubis to the periosteum of the pubic bone. This adjunctive procedure results in more visible proximal penile shaft. We compared penile visible length (pubic skin surface to tip) in patients who had the adjunctive procedure with prosthesis insertion to patients who had only the penile prosthesis. Totally, 66 patients had DP and 60 did not. All patients were operated through a penoscrotal incision. The tacking suture of # 5 nonabsorbable braided polyester was passed through the pubic periosteum then into the subcutaneous tissue and dermis of the under surface of the pubic skin. The suture was tied after prosthesis insertion. Efficacy of DP was evaluated by measured gain in erect visible length in the DP group, maintenance of that length gain until final follow up at 3 years, as well as by the difference in subjective evaluation criteria between both groups. The DP group had a 23% increase in visible length compared to pretacking (p < 0.0001) that was durable to 36 months. Subjectively, 80% of patients in the prosthesis alone group reported a shorter penis in contrast to 6.1% in the DP group. The DP group reported 28.4% higher satisfaction with length, compared to the control group (p < 0.0001). In conclusion, DP accompanying prosthesis insertion improved visible length, minimized the impression of shortening, and enhanced satisfaction with length.