Penis ligaments: their use in "increasing" the size of the penis in penile augmentation procedures. Anatomical description in human cadavers and clinical results of a phalloplasty series.

AIM: To present in human cadavers the anatomical basis of penis lengthening operations and reproduce this technique in a group of patients. MATERIALS OF STUDY: Penis ligaments in ten human cadavers were identified and dissected releasing the penis from its fixation to pubic arch. The same technique was applied to a group of forty patients that demanded a penis lengthening operation.
RESULTS: The dissection of penis ligaments increases the distance pubic bone-tip of the penis for 3.1 +/- 0.6 cm. In patients, the increase in length 12 months post-operatively was 3.5 +/- 1.3 cm (2.3-5.1 cm) flaccid and 1.8 +/- 1.4 cm (1.4-3.2 cm) erect. There was a statistically significant difference (p < 0.005) between preoperative and postoperative status. The overall satisfaction rate was 67.5%. DISCUSSION: Cadavers study shows that this technique offers significant mobilization of the penis with a 3 cm gain, while on living tissue it has similar results. Anatomical parameters that might influence the final outcome of the operation are the length (antero-posterior dimension) of the pubic arch (corresponds to the length of the ligament), its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis.
CONCLUSIONS: Division of ligaments of the penis increases its apparent length. Significant anatomical parameters are the length of the pubic arch, its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis.