Concomitant Ventral Phalloplasty During Penile Implant Surgery: A Novel Procedure That Optimizes Patient Satisfaction and Their Perception of Phallic Length After Penile Implant Surgery

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Abstract
Introduction: Despite previous reports showing consistently elevated patient satisfaction with penile implantation, it is our impression that patients who have had a prosthesis placed often complain of penile shortening postoperatively. Aim: We sought to evaluate if the release of the penoscrotal web would optimize patient perception and satisfaction regarding penile length after such procedure. Main Outcome Measure: Utilizing a questionnaire, we evaluated patient satisfaction, focusing on phallic size. Methods: Ninety patients (mean age 62) underwent penile prosthesis placement during a 17-month period. Forty-three were carried out with takedown of penoscrotal web during a 17-month period (group 1). Of group 1, 39 patients had an inflatable implant placed (inflatable penile prosthesis) and 4 had a semirigid implant. The patients were directly inquired with a seven-item questionnaire 3 months after the procedure. These results were then compared to a group of 37 patients that had penile implants placed without release of the penoscrotal web (group 2). All the patients involved in the study had a high insertion of the scrotum ventrally (penoscrotal web). Results: Of the patients, 42/43 (98%) (group 1) reported good overall satisfaction of the surgical procedure; 36/43 (84%) reported some degree of increase in penile length; 5/43 (12%) reported no significant change in their perception of penile length postoperatively. The remaining two patients reported a decreased penile length. The clinical records from group 2 demonstrated 31/37 (84%) of the patients complained of penile shortening, and only one patient reported an increase in penile length. Postoperative complications in group 1 consisted of wound hematoma (2/43) and focal superficial wound dehiscence (3/43). The operative time for group 1 patients was approximately 12 minutes (mean 11.7) longer. Conclusions: Release of penoscrotal web is a simple, safe, and reproducible procedure that can enhance patient perception of penile length and further improve satisfaction.

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