Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament - PubMed
Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament
Márcio Ramos et al. Aesthetic Plast Surg. 2024 Apr.
Abstract
Introduction: Division of the suspensory ligament of the penis has emerged as a popular surgical approach for penile lengthening, but accurate preoperative predictions of lengthening outcomes remain elusive. This study aimed to identify readily measurable anatomical parameters associated with post-ligamentolysis penile length gain, facilitating more reliable preoperative estimations.
Methods: An experimental cross-sectional study was performed on 16 adult cadavers. Data collected before dissection included: age at death, ethnicity, height, length of the penis before dissection and width of the suspensory ligament of penis. Following the complete dissection of the suspensory ligament of penis, the depth of the pubic symphysis and the penile length after the procedure were measured. The absolute and relative length differences pre- and post-ligamentolysis were calculated. Correlation coefficients were used to study relations between these variables.
Results: Penile length increased uniformly after complete division of the suspensory ligament (average gain: 26.38 mm, SD = 14.83 mm; range 4-60 mm). Pearson correlation revealed a significant negative correlation between pre-ligamentolysis penile length and post-ligamentolysis increase (r = - 0.601; p = 0.014), suggesting greater gains in individuals with shorter pre-ligamentolysis lengths. Age, ligament width, and pubic arch depth showed no significant correlations. Ethnicity did not impact post-ligamentolysis length increase (t = - 0.135; p = 0.894).
Conclusions: This study highlights the potential to predict penile length gain post-ligamentolysis through measurable anatomical parameters. The ability to anticipate the outcome of this procedure could empower surgeons to provide informed counseling, potentially elevating patient satisfaction. An experimental cross-sectional study was performed to investigate the outcomes of penile lengthening surgery Penile lengthening was achieved in all subjects via complete dissection of the suspensory ligament of the penis Penile length increase may be predicted preoperatively using easily measurable anatomical parameters NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Keywords: Anatomy; Dissection; Elective surgical procedures; Esthetics; Penis; Sexuality.
© 2024. The Author(s).
Conflict of interest statement
The authors declare that they have no conflict of interest.
Figures
Coronal view of the fundiform ligament. Note that it embraces the circumference of the penis. Legend: a fundiform ligament; b hip bone; c corpora cavernosa; d scrotum; e glans penis
Anterolateral view of the suspensory ligamentous system of the penis. Note that, after encompassing the perimeter of the penis, the fundiform ligaments’ two bundles rejoin in the ventral aspect of the penis and constitute the superior part of the scrotal septum. Legend: a fundiform ligament; b suspensory ligament of penis; c hip bone; d inferior pubic ligament; e corpora cavernosa; f scrotum; g glans penis
Sagittal view of the suspensory ligamentous system of the penis, offering another perspective on the relations between the different structures. Legend: a fundiform ligament; b suspensory ligament of penis; c hip bone; d inferior pubic ligament; e corpora cavernosa; f scrotum; g glans penis
Sagittal (a) and coronal (b) views of the relevant structures and measurements: (1) pubic symphysis; (2) suspensory ligament the penis; (3) inferior pubic ligament; (4) corpora cavernosa; (5) corpus spongiosum. D represents the anteroposterior dimension (depth) of the pubic symphysis. L represents the length of the penis, measured from the pubo-penile junction to the tip of the glans. W represents the width of the suspensory ligament of penis
Measuring the initial penile length, using a disposable measuring tape
The suspensory ligament of penis is exposed, following careful dissection of the subcutaneous tissue of the abdomen and the membranous layer of abdominal subcutaneous tissue. A piece of disposable measuring tape was placed next to the anterior border of the ligament
Using the ImageJ program to measure the width of the suspensory ligament of penis
The closed incisions, following the V-Y advancement skin advancement flap
Pre (a) and postoperative (b) photographs of one of the subjects. Notice the V-Y skin plasty incision located just above the penis in picture b. For this subject: pre-ligamentolysis penile length = 90 mm, post-ligamentolysis penile length = 120 mm, absolute penile length increase = 30 mm and relative penile length increase = 33%
Pre (a) and postoperative (b) photographs of one of the subjects. For this subject, pre-ligamentolysis penile length = 80 mm, post-ligamentolysis penile length = 100 mm, absolute penile length increase = 20 mm and relative penile length increase = 25%.
Pre (a) and postoperative (b) photographs of one of the subjects. For this subject, pre-ligamentolysis penile length = 120 mm, post-ligamentolysis penile length = 145 mm, absolute penile length increase = 25 mm and relative penile length increase = 21%.
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