Occasionally, patients who have had penile prosthesis implanted, patients who have used penile enlargement pumps for many years or who have applied penile injection therapy for erectile dysfunction apply for penile enlargement surgery. These patients have special conditions and surgeons who are inexperienced in these surgeries may make wrong decisions. I am writing this article to warn both inexperienced friends in these surgeries and patients in this group.

In penis augmentation surgery, it is important that the penis is flexible and soft, especially in terms of elongation; because the penis must have a flexible and soft tissue in order to see the elongation in the erection. You have to think of the penis like a balloon. Like an inflated balloon while getting an erection, it swells with blood filling it and comes to an erection. If the tissue has lost its elasticity, hardened (meaning hardening), the erection will not stretch as much as desired. Unfortunately, this issue is misunderstood even by specialist doctors. For example, there is a misconception that the elongation obtained in penis enlargement surgery can only be seen when the penis is soft and not during an erection. Even medical articles defending this idea have been published and entered the literature. This is completely wrong. In reality, you can see the penis enlargement when it is soft right after the penis enlargement surgery, but you cannot see the full lengthening of the erection in the "first months", it is true up to this point. You start to see the elongation in the erection over time and it should take about 6-9 months. The reason for this is the hardening (solidification of the tissue around the penis) caused by the sutures placed at the bottom of the penis immediately during the surgery. For lengthening, we cut the suspensory ligament at the base of the penis that attaches the penis to the pelvis (not completely, it cuts about 80%). It is not enough to just cut the suspensory ligament, it is necessary to push the penile tissue forward. That's why, after the suspensory ligament is cut, we put stitches on the root of the penis, just behind it, pushing the penis out, in the form of a corset, pushing the penis out. After all, there are a lot of stitches at the root of the penis, on the inside. While healing occurs in this area, tissue healing occurs in a large area, which leads to stiffness. Therefore, in those who have penis enlargement surgery, the tissue hardens in a large area at the base of the penis in the first months. This hardening and loss of elasticity in the tissue prevents the penis from "swelling" enough during an erection. Therefore, in the first months, you can not see the lengthening of the erection completely. In order for you to fully see the elongation in the erection, the tissue healing at the base of the penis should end and the tissues should regain their former flexibility and softness. You can see the lengthening in the erection only after that. In other words, the hardening at the base of the penis in penis enlargement surgery is temporary; Eventually, the tissue in that area softens and allows the penis to fully lengthen during erection. This is what I'm talking about in normal cases. Also, as I mentioned above, there are patients with penile prosthesis, who have used vacuum pump devices, or who have had injections for many years to achieve an erection. The situation of these patients is special and an inexperienced surgeon may give patients false hope and accept them for penis enlargement surgery. The problem in these patients is that the penile tissue is permanently hardened. In this case - if the tissue of the penis is permanently hardened - surgical lengthening cannot be performed. These patients only benefit from thickening. Let me make this clear...

Patients with penile prosthesis: Only penile thickening surgery can be performed on these patients. Extension is not possible. There are 2 reasons for this. The first reason is that the tissue of the penis itself is not soft, but hard due to the penile prosthesis placed in it. For lengthening, it is not enough just to cut the suspensory ligament (in these cases, even if you find and cut the suspensory ligament, it is not enough), it is necessary to move the penis away from the bone tissue and slide it out. For this, the penis tissue must be soft enough. However, the penile tissue is very hard due to the penile prosthesis inside and cannot be slid out. It cannot be manipulated, it cannot be shaped. Therefore, lengthening of a penis with a penile prosthesis will fail. The other reason why lengthening could not be performed in these cases is that in some cases, the anatomy of the area at the base of the penis is impaired. Sometimes the penile prosthesis is placed from the bottom of the penis, from the area where full extension will be made. Meanwhile, the anatomy of the suspensory ligament deteriorates. In these cases, it is very difficult or even impossible to find and cut the suspensory ligament, to put a suture behind the penile tissue that will push the penis out. For these reasons, lengthening cannot be performed in patients with penile prosthesis, even if it is attempted, it will fail.

Patients who have used vacuum pumps for many years: In these patients, the penile tissue hardens. I use hardening not in the sense of erection, but in the sense of solidification in the tissue. In recent years, articles on these tools have begun to be published. Although it is said that the devices that provide elongation in the penis with traction (if the suspensory ligament is cut by surgery) will provide some benefit, there is no success with vacuum pumps. Vacuum pump devices only provide a temporary erection, but if used for many years, they cause a structural deformation of the erectile tissue of the penis. Since the penis becomes hard and loses its softness, it is very difficult to separate the penis from the bone and slide it out.

Patients who constantly inject the penis for erection: Injecting drugs into the penis before intercourse is one of the treatment methods in patients who have erection problems. These treatments are arranged by urologists. If the patient has been using penile injections for many years due to erectile dysfunction, this may cause hardening in the penis. You cannot separate a hardened penis from the pelvis and slide it out. Therefore, lengthening surgery fails.

To summarize: if there is a condition that causes permanent hardening of the penis (penile prosthesis, providing erection with a needle for many years, using a vacuum pump for a long time), the penis is an obstacle to lengthening. You can't manipulate a stiffened penis tissue, even if you cut the suspensory ligament, you can't slide it out by suturing the back. The extension fails.

Do not confuse this situation with the fact that in a normal case, the elongation in the early period after penile enlargement surgery is not very obvious in the erection. When the hardening at the base of the penis softens over time (6-9 months), you can also see the elongation in the erection. In a normal case, this hardening at the base of the penis is temporary, and eventually you will see the elongation in the erection.

Translation: Google translate

Dr. Oytun İdil (Plastic and recontructive surgeon)
www.idilpenissurgery.com
oytunmd@gmail.com
+90 533 5690649
+90 505 2965569

Op. Dr. Oytun İdil

(Plastic aesthetic and reconstructive surgeon)

• Whatsapp: +90 533 569 0649
• E-mail: oytunmd@gmail.com
• Op. Dr. Oytun İdil: +90 533 569 0649
           +90 505 296 5569
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