Osama Shaeer1. 1. Kasr El Aini Faculty of Medicine, Department of Andrology, Cairo University, Cairo, Egypt. dr.osama@alrijal.com
Abstract
INTRODUCTION: Augmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of hyaluronic acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation. AIM: This work is the first report on glans augmentation by grafting. MAIN OUTCOME MEASURES: Maximum circumference of the glans, self-reported impression of the augmented volume and glans sensitivity. METHODS: Ten males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either side. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures. RESULTS: Maximum circumference of the glans increased by 16.6%, declining to 14.2% by the last follow-up visit (10-12 months), a 2.3% decline. Self-reported impression of the augmented volume was high and well maintained over the follow-up period. Glans sensation, engorgement, erectile function, and ejaculatory control were preserved. CONCLUSION: This pilot study on glans augmentation by grafting reports promising results with retention of the added volume at 1-year follow-up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.
INTRODUCTION: Augmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of hyaluronic acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation. AIM: This work is the first report on glans augmentation by grafting. MAIN OUTCOME MEASURES: Maximum circumference of the glans, self-reported impression of the augmented volume and glans sensitivity. METHODS: Ten males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either side. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures. RESULTS: Maximum circumference of the glans increased by 16.6%, declining to 14.2% by the last follow-up visit (10-12 months), a 2.3% decline. Self-reported impression of the augmented volume was high and well maintained over the follow-up period. Glans sensation, engorgement, erectile function, and ejaculatory control were preserved. CONCLUSION: This pilot study on glans augmentation by grafting reports promising results with retention of the added volume at 1-year follow-up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.