-
BJU International Jun 2015To systematically review and create nomograms of flaccid and erect penile size measurements. (Review)
Review
OBJECTIVE
To systematically review and create nomograms of flaccid and erect penile size measurements.
METHODS
Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample.
EXCLUSION CRITERIA
samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size.
RESULTS
Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6.
LIMITATIONS
relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length.
CONCLUSIONS
Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anthropometry; Humans; Male; Middle Aged; Nomograms; Organ Size; Penile Erection; Penis; Reference Values; Young Adult
PubMed: 25487360
DOI: 10.1111/bju.13010 -
BJU International Mar 2021To systematically review the literature in order to investigate the efficacy and safety of surgical and non-invasive penile enhancement procedures for aesthetic and...
OBJECTIVE
To systematically review the literature in order to investigate the efficacy and safety of surgical and non-invasive penile enhancement procedures for aesthetic and therapeutic purposes.
METHODS
A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty-nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie's disease and erectile dysfunction. Twenty-five studies evaluated non-invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non-invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing.
CONCLUSION
The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications.
Topics: Erectile Dysfunction; Humans; Hyaluronic Acid; Male; Microspheres; Organ Size; Patient Satisfaction; Penile Erection; Penile Induration; Penis; Polyesters; Polymethyl Methacrylate; Prostheses and Implants; Traction; Urogenital Surgical Procedures
PubMed: 32575166
DOI: 10.1111/bju.15145 -
American Journal of Men's Health 2022We conducted a meta-analysis to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED). From... (Meta-Analysis)
Meta-Analysis
Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials of Clinical Outcomes of Low-Intensity Extracorporeal Shock Wave Therapy in Treating Erectile Dysfunction.
We conducted a meta-analysis to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED). From July 2011 to June 2021, we finally selected 16 randomized controlled trials (RCTs) including 1,064 participants to evaluate the efficacy of LI-ESWT in the treatment of ED from PubMed, EMBASE, and Cochrane databases. The data are analyzed by Review Manager Version 5.4. Fifteen articles mentioned International Index of Erectile Function (IIEF), in the follow-up of 1 month (mean difference [MD] = 3.18, 95% confidence interval [CI] = [1.38, 4.98], = .0005), 3 months (MD = 3.01, 95% CI = [2.04, 3.98], < .00001), and 6 months (MD = 3.20, 95% CI = [2.49, 3.92], < .00001). After treatment, the improvement of IIEF in the LI-ESWT group was better than that in the control group. Besides, eight of the 16 trials provided data on the proportion of patients with baseline Erectile Hardness Score (EHS) ≤ 2 improved to EHS ≥ 3. The LI-ESWT group was also significantly better than the placebo group (odds ratio [OR] = 5.07, 95% CI = [1.78, 14.44], = .002). The positive response rate of Questions 2 and 3 of the Sexual Encounter Profile (SEP) was not statistically significant (SEP2: OR = 1.27, 95% CI = [0.70, 2.30], = .43; SEP3: OR = 4.24, 95% CI = [0.67, 26.83], = .13). The results of this meta-analysis suggest that treatment plans with an energy density of 0.09 mJ/mm and pulses number of 1,500 to 2,000 are more beneficial to IIEF in ED patients. In addition, IIEF improvement was more pronounced in patients with moderate ED after extracorporeal shockwave therapy.
Topics: Erectile Dysfunction; Extracorporeal Shockwave Therapy; Humans; Male; Penile Erection; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35319291
DOI: 10.1177/15579883221087532 -
The Journal of Sexual Medicine Feb 2019The efficacy and safety of arginine supplements in erectile dysfunction (ED) remain debatable. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The efficacy and safety of arginine supplements in erectile dysfunction (ED) remain debatable.
AIM
To assess the potential role of arginine supplements on ED as alternatives to phosphodiesterase inhibitors.
METHODS
Studies published up to April 2018 that evaluated the efficacy of arginine supplements were identified from multiple databases (Google Scholar, PubMed, Medline, Embase, Kiss, DBpia, and Cochrane databases). Studies comparing arginine supplements with placebo or no treatment; focusing only on patients with mild to moderate severity of ED; and presenting outcomes such as improvement rate, International Index of Erectile Function (IIEF) score, and adverse effects were included. Subgroup analysis for arginine alone and arginine in combination with other substances was further conducted to increase interpretability.
MAIN OUTCOME MEASURE
The strength of the association between arginine supplements and ED was assessed using relative odds ratios and weighted mean differences with 95% CI.
RESULTS
In total, 10 randomized controlled trials met the inclusion criteria, reporting the outcomes of 540 patients with ED. The analysis demonstrated that arginine supplements with dosage ranging from 1,500 to 5,000 mg significantly improved ED compared with placebo or no treatment (odds ratios, 3.37 [1.29, 8.77], P = .01, I2 = 44). Arginine supplements also caused significant improvements in the IIEF subdomain scores of overall satisfaction, intercourse satisfaction, orgasmic function, and erectile function, whereas the IIEF sexual desire score remain unchanged. The adverse effect rate in the arginine-treated group was 8.3%, and that in the placebo group was 2.3%, none of which were severe.
CLINICAL IMPLICATIONS
Arginine supplements can be recommended to patients with mild to moderate ED.
STRENGTH & LIMITATIONS
The strength of this study is that it is the first meta-analysis to assess the potential role of arginine supplements in ED compared with placebo or no treatment. A limitation is that the treatment dosage and duration varied among studies, which may have contributed to study heterogeneity.
CONCLUSION
The results of our systematic review and meta-analysis provide evidence on the effectiveness of arginine supplements for mild to moderate ED. Rhim HC, Kim MS, Park Y-J, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med 2019;16:223-234.
Topics: Arginine; Dietary Supplements; Erectile Dysfunction; Humans; Male; Penile Erection; Phosphodiesterase Inhibitors; Randomized Controlled Trials as Topic
PubMed: 30770070
DOI: 10.1016/j.jsxm.2018.12.002 -
Translational Andrology and Urology Apr 2024Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile... (Review)
Review
BACKGROUND
Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile lengthening procedures (PLPs) can be performed concurrently with penile prosthesis (PP) insertion in patients with severe ED, penile shortening, and/or Peyronie's disease to help combat negative emotional and psychological concerns from penile length loss with penile prosthetic device placement.
METHODS
An extensive, systematic literature review of the various pre-, intra-, and post-operative techniques that can be applied to preserve, restore or enhance penile length at the time of penile prosthetic implantation.
RESULTS
Numerous pre-operative and post-operative inflation protocols exists with vacuum erection devices and penile traction therapy. Intraoperative surgical techniques include cavernosal sparing and channeling without dilatation, subcoronal incision with circumferential penile degloving and grafting, the sliding technique, the modified sliding technique, the multiple-slit technique, the tunical expansion procedure (TEP), modified TEP, and the auxetic expansion procedure. These approaches can be meaningful to restore and/or preserve length for patients undergoing PP insertion.
CONCLUSIONS
PLPs can be performed by surgeons who have extensive penile reconstruction experience and have been trained to do these procedures, as there is significant risk to the patient and limitations to what can be expected. Each patient must be counseled in detail about the risks and benefits of these procedures and have their expectations managed as the average postoperative penile length recovery is around 3 cm and can range from 0-4.0 cm. Future research is needed to identify the appropriate candidate for each approach, and how much length gain the patient can expect.
PubMed: 38721300
DOI: 10.21037/tau-23-354 -
Fertility and Sterility Jan 2020This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful...
This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful erections, and idiopathic stuttering priapism, a variant of recurrent ischemic priapism in which no cause is discernible. The disorders are closely related although they are distinct clinically and pathologically. The main subject areas of discussion are recognition, clinical evaluation and management although current concepts surrounding their causes and mechanisms are also addressed. It is acknowledged that despite the perceived rarities of these disorders they are impactful in terms of their disease profiles and consequences. Future advances in their management will require continued development of evidence-based treatments.
Topics: Humans; Male; Penile Erection; Priapism; REM Sleep Parasomnias; Rare Diseases
PubMed: 32033724
DOI: 10.1016/j.fertnstert.2019.11.013 -
Hematology/oncology and Stem Cell... Dec 2022Priapism is defined as a persistent penile erection lasting more than 4 h. We searched the literature for reviews, case reports, and series for patients with... (Review)
Review
Priapism is defined as a persistent penile erection lasting more than 4 h. We searched the literature for reviews, case reports, and series for patients with lymphoproliferative disorders who developed priapism. The search involved all the lymphoproliferative disorders included in the revised 2016 World Health Organization classification of lymphoid neoplasms including chronic lymphocytic leukemia, multiple myeloma, Waldenström macroglobulinemia, and lymphomas. A total of 16 articles were found. The search included cases up to 4 January 2021. Priapism was seen most commonly as the first manifestation of lymphoproliferative disorders, rarely seen after treatment or after diagnosis.
Topics: Male; Humans; Priapism; Lymphoproliferative Disorders; Waldenstrom Macroglobulinemia; Leukemia, Lymphocytic, Chronic, B-Cell; Multiple Myeloma
PubMed: 34157311
DOI: 10.1016/j.hemonc.2021.05.003 -
The Journal of Sexual Medicine Mar 2021Penile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements.
BACKGROUND
Penile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements.
AIM
To review the methodology used to report data in studies evaluating penile length and provide a detailed recommendation in conducting future high-quality research.
METHODS
The MEDLINE database was searched for randomized clinical trials and open-label prospective or retrospective studies.
OUTCOMES
The panel reviewed the modality of data reporting on these specific areas: patients' age and assessment, patient position, type of measurement instrument used, penile length technique description, examination conditions, and actual examiner.
RESULTS
Overall, 70 studies investigating penile length were selected; among these, 72.85% included at least 50 patients: 16 prospective studies, 5 randomized clinical trials, and 49 retrospective cross-sectional studies. Amongst all studies, 90% reported to measure penile length by health care practitioners in clinical settings. Penile length was assessed in all 70 studies, whereas penile girth was measured in 57.14% of patients. A semi-rigid ruler was the most commonly used measurement aid to assess penile length/girth in 62.86% of studies. Penile measurements were reportedly obtained: (i) stretched state, 60%; (ii) flaccid state only, 52.68%; and (iii) during erection, 27.43%. All studies investigating the penile length in an erect state were simultaneously assessing penile length in the flaccid state. About 90% of studies investigated penile length in adults, whereas 10% were conducted in adolescents.
CLINICAL IMPLICATIONS
The use of shared methodology to assess penile length in both adults and adolescents allows more accurate and standardized measurements.
STRENGTH & LIMITATIONS
A systematic review of the published literature allowed proper data interpretation in order to provide accurate recommendations. Main limitations of the study relied on a relatively limited number of databases for the identification of potentially eligible studies.
CONCLUSION
The methodology used in studies measuring penile length should be precise and standardized in order to provide accurate data to both clinicians and researchers. Cakir OO, Pozzi E, Castiglione F, et al. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2021;18:433-439.
Topics: Adolescent; Adult; Cross-Sectional Studies; Humans; Male; Penile Erection; Penis; Prospective Studies; Retrospective Studies
PubMed: 33648901
DOI: 10.1016/j.jsxm.2020.11.012 -
Translational Andrology and Urology Apr 2024Priapism is a rare condition characterized by persistent erection of the penis that lasts more than 4 hours in the absence of sexual stimulation and is associated with... (Review)
Review
BACKGROUND
Priapism is a rare condition characterized by persistent erection of the penis that lasts more than 4 hours in the absence of sexual stimulation and is associated with significant morbidity and complications, including erectile dysfunction and penile fibrosis. Surgical management of priapism can be extremely challenging. We herein provide a comprehensive review that aims to evaluate the role of penile prosthesis (PP) implantation in the management of priapism.
METHODS
A systematic literature search was performed using the following databases: PubMed, Embase, and Scopus to identify studies that evaluated the effectiveness of PP implantation in treating priapism and the long-term complications, outcomes, and patients' satisfaction rate.
RESULTS
Out of 717 English-language studies published between 2002 and 2022, 17 were chosen for this review. Majority of patients had a malleable PP (MPP) implant, either early or delayed after the priapism episode. Early placement (EP) of PP is widely defined between studies ranging from less than 72 hours, within 1 week, and within 3 weeks. Most common causes of priapism were sickle cell anemia (SCA), medication-induced, and idiopathic. Studies show a higher satisfaction rate ranging between 80% and 100%, with sexual intercourse achievement ranging between 64.2% and 100%. Based on the GRADE system, included studies rated as very low quality of evidence. Commonly reported complications that arise after PP procedures, include device infection, erosion, curvature, and mechanical malfunction, such as auto-inflation.
CONCLUSIONS
PP can be an effective treatment option for priapism, particularly in cases of ischemic priapism lasting more than 36 hours or recurrent priapism that is medically refractory. However, due to the very low quality of evidence, larger, well-designed studies are warranted where long-term outcomes, patients' satisfaction, and complications following priapism-related PP implantation are measured as endpoints.
PubMed: 38721288
DOI: 10.21037/tau-23-224 -
Sexual Medicine Reviews Jul 2017Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available... (Review)
Review
INTRODUCTION
Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life.
AIM
To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion.
METHODS
An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed.
MAIN OUTCOME MEASURES
A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion.
RESULTS
Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles.
CONCLUSION
Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403-412.
Topics: Humans; Male; Organ Size; Penile Erection; Penile Prosthesis; Penis
PubMed: 28238678
DOI: 10.1016/j.sxmr.2016.11.005