SUMMARY :
Purpose: patients who perceive that their penile girth and length are inadequate often live with inferiority complex. Although the necessity for penile enhancement remains controversial and its methodology is complicated, we report a corrective procedure with autologous preputial flap transfer. It can be performed on an outpatient basis under local anaesthesia with minimal morbidity because of anatomical vicinity, pudendal innervation and histological identity.
Patients and Methods: In 85 men aged 21 to 71 years, who complained of a small penis (girth or erectile length less than 9 cm), We performed autologous preputial flap transfer for shaft augmentation and ligation of retrocoronal plexus for glanular enlargement. The first circumferential incision is made and deepened to Buck's fascia. The veinlets (9-29 in number) of retrocoronal plexus are all freed and ligated with 6-0 nylon for postoperative glanular enlargement insidiously. The second circumferential wound is made at the midpoint of the penile shaft as superficially as possible. Then the preputial flap is created after an incision is made along the median raphe. A longitudinal incision is carried out from the midpoint of the dorsal prepuce to 6-7 cm cephalic to the penopubic fold. Then venous stripping surgery is performed if necessary. The suspensory ligament is dissected and released until the collagen bundles of the ischiocavernosus muscle is met. The preputial flap is then transferred 90 degrees and sutured 2-3 cm above the penopubic fold. For shaft elongation the first 90-degree Z-plasty is performed at the pubic region, likewise the second 90-degree Z-plasty is performed at the penoscrotal junction together to lengthen the copulatory portion of the penis.
Results: With a mean follow-up period of 2 years 3 months (range 3 months to 4 years), penile girth increased in all by a mean of 2.1 cm (range 1.5-2.5 cm) and length increased in 66 by a mean of 1.9 cm (range 1.5-2.5 cm). Of the remaining, 18 reported no length increase and 1 noted a shortened penis attributed to wound contracture owing to chronic posthitis preoperatively. Thus, the rate of improvement was 98.8% (84/85), while the rate of satisfaction was less (77.6%; 66/85). Prolonged penile oedema was noted in 2 patients, and 1 complained that the glans was small in relation to the augmented shaft. Haematoma occurred in 1 patient; otherwise, no significant complications arose.
Conclusion: This preputial flap procedure is safe, cost-saving and effective, preserves pudendal innervation, and can be performed on an outpatient basis under local anaesthesia even the operation time is long. It offers the advantages of less morbidity, privacy guarding, reduced effects of anaesthesia and more rapid return to activity with minimal complications. Careful psychological selection is mandatory, and regular follow-up is advised.