The scientific novelty of the study
For the first time in Ukraine, the latest methods of aesthetic correction of the penis were applied. The effectiveness of these methods was proved. A comparison with the most commonly used methods was made.
For the first time, the effect of aesthetic correction of the penis on the patient's psychosexual state was studied, which will improve the results of medical care for men with small penis syndrome. Validated scales were used to assess the psychosexual state, in contrast to the already available studies.
For the first time, the small penis syndrome was considered from a clinical point of view. A sequence of actions was created to help patients with small penis syndrome.
Main content and results
There is some uncertainty among scientists about the appropriateness of such interventions for certain categories of patients. One of these categories is men who are dissatisfied with the size of their penis, but their penis is of normal size. There is a certain difficulty in diagnosing such patients and establishing the correct diagnosis. At this stage, most leading scientists have concluded that such men should be divided into two groups: those with small penis syndrome and those with penile dysmorphophobia. Several scales for assessment and diagnosis have been developed and validated.
Despite this, there is currently no single defined algorithm for diagnosing and treatment for such men. Science is now moving towards the introduction and development of certain methods for the diagnosis and management of men with small penis syndrome. To date, the bulk of scientific work has focused on studying penis enlargement techniques and evaluating their ability to improve anthropometric data. However, only a small part of them evaluate the psycho-emotional side, and most of them do not use validated scales, but rather simple analogue ones.
This is a double-centre case series clinical study involving 62 men who were dissatisfied with the size of their penis (small penis syndrome) and request correction of the penis shape. The observation period for all patients lasted 3 months. The subjects were divided into two groups depending on the intervention performed. The first group consisted of 31 men who underwent division of the penile suspensory ligament (ligamentolysis). The second group also included 31 men who underwent injectable penis augmentation with fillers. The study was performed according to the "before and after" scheme. Measurements and questionnaires were taken before the intervention and three months after the intervention in both groups. In order to assess psychosexual well-being, this study used questionnaires as the main data collection tool. Anthropometric measurements were also taken: penile length, shaft and glans of penis girth.
The mean increase in penile length after surgery was 2.8 ± 0.74 cm, which represents an increase of 33.3%, in the first group. The overall improvement in the mean total SEAR score was 13.7 ± 3.04 points, or 24.1%.
The mean increase in shaft girth was 1.8 ± 0.42 cm (or 18.9% increase from baseline), and for the glans of the penis, 1.7 ± 0.48 cm (or 17.5% increase from baseline), in the second group. The improvement in the mean total score of the SEAR questionnaire is 17.2 ± 3.7 points or 28.8%.
Comparative analysis of these two methods determines that the best average result is observed in the group where injectable penis enlargement was performed. We see a more significant improvement, 28.8% versus 24.1% compared to the group that used surgical correction.
We did not find a statistically significant correlation between increases in shaft, glans girth, penile length and psychosexual satisfaction scores. This result indicates that the increase in absolute penis size (expressed in centimetres) does not have a proportional impact on the number of points scored on the SEAR questionnaire and, therefore, on the overall level of satisfaction of the survey participants.
Thus, the results of this study are:
1. It has been proven that injectable and surgical methods of augmentation do have a significant effect, which is reflected in a significant improvement in anthropometric indicators.
2. A modified technique for surgical division of the penile suspensory ligament was developed and applied.
3. The dependence of the psychosexual state of men on the appearance of the penis before and after the intervention was established.
4. A new method that makes it possible to calculate the expected changes in penis size after the injection penile augmentation procedure using fillers has been developed and tested.
5. An algorithm for the adequate use of methods of aesthetic correction of the penis, which has proven its effectiveness during experiments, has been developed.
6. The safety of aesthetic correction of the penis by ligamentolysis and injection of hyaluronic acid has been proved.
