Combining Erection Restoration and Factual Penile Enhancement Based on Revolutionary Penile Fibro-Vascular Assembly

Conventional penile venous surgery for erection restoration and surgery for penile augmentation have been controversial. Based on de novo penile fibrovascular assembly, we report innovative penile venous stripping (PVS) and factual penile girth enhancement (FPGE).

From 2013 to 2023, refractory impotence and dysmorphia prompted 31 patients to seek PVS and FPGE, and all of them were confirmed with veno-occlusive dysfunction. PVS involves stripping erection-related veins, primarily one deep dorsal vein and two cavernosal veins, after the ligation of each emissary vein closest to the outer tunica albuginea using 6-0 nylon. FPGE was performed bilaterally along the tunica albuginea. Then, two tunic defects were fashioned with a 70.0 × 30.0 mm² venous stripe and covered with either autologous venous walls (AVW) or Surgiform (SF). Penile girth was measured, and radio-opaque contrast was used to compare intracorporeal retention. Patients resorted to follow-up if there was no surgery. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score and Erection Hardness Scale (EHS) were used yearly during follow-up via the Internet.

Overall, among 31 patients, 18 underwent PVS and FPGE, and they were allocated to the surgery group; The remaining 13 were categorised as the control group. The follow-up period was 0.2-10.0 (5.5 ± 1.6) years. In the surgery group, the radiopacity of the postoperative cavernosogram was consistently enhanced. Although indifference was observed in IIEF-5 and EHS (p ≥ 0.95; 20.8 ± 2.3 vs. 20.7 ± 2.1; 3.1 ± 0.2 vs. 3.3 ± 0.2) between AVW and SF, a significant improvement was detected after surgery (both p ≤ 0.01 in IIEF-5 and EHS scores (9.7 ± 2.8 vs. 20.8 ± 2.3; 1.7 ± 0.6 vs. 3.2 ± 0.2, respectively)). In addition, the diameters of the glans and penile shaft were significantly increased (both p ≤ 0.01; 28.0 ± 2.3 and 28.2 ± 2.1 mm vs. 35.3 ± 2.2 and 36.3 ± 2.1 mm, respectively). The satisfaction rate was 81.3% (13/16) when two inconsistent data were excluded in the AVW subgroup.

Although this retrospective study encountered limitations, the combined PVS and FPGE surgery shows promise. Further validation requires a larger sample size and more extended surveillance.