Penile length preservation in penile prosthesis placement: tips & tricks

Penile Prosthesis (PP) is offered to patients with erectile dysfunction (ED) who prefer a definitive management, but subjective or objective penile length shortening after PP surgery is a concern. This review article aims to describe various preoperative, intraoperative and postoperative procedures and factors that may preserve or increase penile length during PP surgery. Preoperative strategies by the surgeon include vacuum erection devices (1 month), penile traction devices (2-4 months), and optimal surgical timing in priapism (early vs. delayed), and patient decisions include choosing a high-volume centre (>25 PP/year) and implant type (malleable vs. inflatable). The intraoperative manoeuvres included the subcoronal no-touch technique, cavernosal tissue-sparing dilatation, ventral phalloplasty, suspensory ligament release, suprapubic lipectomy, the sliding technique, the multiple-slit technique, and tunical expansion procedures. Simultaneous radical prostatectomy and PP surgery is gaining momentum to preserve the penile length in patients who have preexisting ED. Postoperative protocols included immediate postoperative inflation (60-80% inflated for 6 weeks), pump inflation protocol and the use of a vacuum device (without the ring, for 12 weeks). Using the above factors, the gain in penile length may range between 0.2 and 6.0 cm. The outcomes of these procedures are not universally reproducible at all centres.