The penile phalloplasty brings up many questions presently
without precise response. 1) When can we evoke the diagnosis of adult micropenis
? It may be given if the flaccid penile length is < 7,5 cms or the flaccid
stretched length is < 13,5 cms for men between 20 and 40 years old.
By using this criterion, the real micropenis may be distinguished from
the dysmorphophobia. 2) Are really efficient the proposed surgical technics
? Anatomical study has shown that the section of the suspensory ligament
increases moderately and variably the penis length. The evolution of the
penile injection of autologue fat is unknown at the long term. 3) Is the
change of the penile size really without consequence ? If none change of
the erectile function have been reported, the prudence is still necessary
: a) the suspensory ligament plays a role for the axial stability of the
erect penis, b) as the penis of every men has specific biomechanical properties,
it is possible that the size changes may damage the erection at the long
term. 4) Are improved the sexual performances ? Presently, the patient
must be informed that there is none proove that the penile lengthening
improves the sexual results. In conclusion, the major criticism of this
surgery is its absence of validation concerning : a) its real interest,
b) its inocuity, c) its surgical technics. As in the majority of the cases,
a psychological problem is treated by surgery, a psychological follow-up
is necessary. In the absence of proove of a real interest for the patient,
this surgery will be discussed.
