Advancements in penile lengthening techniques concurrent with penile prosthesis placement: a narrative review

Penile prosthetic devices stand as the foremost solution for medication-resistant erectile dysfunction. Frequently, medical conditions triggering erectile dysfunction also led to penile shortening, detrimentally impacting patients' quality of life. This narrative review aims to explore and evaluate the various techniques available for penile lengthening that can be performed concurrently with inflatable penile prosthesis (IPP) insertion. We conducted a comprehensive examination of the literature, utilizing PubMed focusing on key terms such as "penile prosthesis corporal length", "inflatable penile prosthesis and short penis", and "buried penis". The review identified several advanced methodologies for preserving and enhancing penile length during IPP insertion. These techniques include subcoronal IPP insertion, sliding technique, modified sliding technique, multiple slice technique, and circumferential incision with grafting. Supplementary procedures aimed at improving the perception of increased length involve ventral phalloplasty and suprapubic lipectomy. It is worth noting that the maximum length gain seems to be constrained by the length of the neurovascular bundles. In summary, the evidence available in the literature is limited due to the short of case series reported, lack of randomized controlled trials, and heterogeneity of the studies. The literature suggests that for carefully selected patients, surgical penile lengthening procedures performed concurrently with IPP insertion emerge as effective treatments for individuals grappling with penile shortening and severe erectile dysfunction. Well-designed, larger studies are needed to establish the safety and efficacy of these procedures.