Aesthetic Andrology: Surgical Interventions

Surgery on the external male genitalia has developed for the management of congenital (hypospadias, epispadias) and acquired (Peyronie's disease, penile injuries and neoplasms) diseases of the penis; its main purpose is the achievement of functional and aesthetic results. In the past 10 years penile lengthening and augmentation have been proposed as a cosmetic procedure for the normal penis and great interest in these procedures has been generated in the media. Penile size varies with ethnicity and this has to be remembered when evaluating a man with concerns about penile adequacy. Most men have a misconception about normal penile size and many patients interested in surgical penile augmentation have a penis within the normal size range. Surgical procedures aimed at increasing penile size are not standardized. Various complications have been reported. The most common procedures to lengthen the penis improve only its visual aspect because the length of penile structures remains unchanged. Men seeking penile augmentation surgery should be offered full counselling on the reliability and outcome of these procedures to avoid unrealistic expectations and post surgical disappointment. Phalloplasty: Surgical reconstruction of the penis is a major challenge because of the functional and aesthetic targets that have to be addressed. Surgical procedures have to be tailored to the aetiology and entity of the mutilation. Flap transfer and subsequent penile prosthesis placement offer the best results in patients who have undergone partial or total penectomy for cancer. Testicular prosthesis: The placement of a testicular prosthesis is not considered a merely aesthetic issue. The absence or the loss of a testis is a traumatic experience at any age and the restoration of the normal scrotal silhouette may prevent the psychological consequences of having an empty scrotum. Testicular prostheses have an excellent record of safety and efficacy and a low rate of post operative adverse effects. Because testicular cancer has become one of the most curable solid neoplasms, the placement of a testicular prosthesis represents an important step in counselling men undergoing surgery for testicular cancer. Scrotal skin redundancy: The visual aspect of a normal penis may be affected by congenital or acquired abnormalities of the penile shaft and prepubic fat pad resulting in a hidden or concealed penis. This situation causes hygiene problems, predisposing to urinary infections and, in the adult, affecting vaginal penetration. Surgical correction of these situations has to be considered as a rehabilitative rather than a cosmetic procedure. © 2006 Springer-Verlag Berlin Heidelberg.