AB65. Experience in the use of synthetic fillers in phalloplasty

Abstract: Penis size has been a source of anxiety for men throughout history, and men often feel the need to enlarge their penises in order either to improve their self-esteem or to satisfy and impress their partners. Many different types of penile enhancement surgery are performed all over the world, although there are medico-legal issues and paucity of scientific data. An ideal procedure for phalloplasty should rely on two principles: minimal incision with limited scarring and no interference with the erectile function. Several techniques have been described to increase penile length, including cutting the suspensory ligament with or without V-Y plasty of the lower abdominal skin, possibly with fat, dermis, autologous rib cartilage, or synthetic material graft to prevent reattachment of the suspensory ligament. Liposuction or lipectomy has been used for patients with a large infrapubic pad of fat. Surgery to enhance the penile girth includes lipoinjection, dermal free or pedicle grafts, and venous grafting for the corpora cavernosa, injection of synthetic dermal filler. Currently, as the need for safer, effective and less-invasive procedures is increasing, enhancement procedures using injectable products are in high demand. Injectable soft-tissue substitutes provide an affordable, nonsurgical alternative for correcting contour defects and soft tissue augmentation with autologous fat, silicone, collagen, and hyaluronic acid, dextran filler, polylactic acid.

We have developed two synthetic fillers; Cross-linked dextran and polymethylmethacrylate mixture (Lipen-10), Polylactic acid (PLA) filler. Penile lnjection of; Cross-linked dextran and polymethylmethacrylate mixture (Lipen-10) and Polylactic acid filler led to significant increase in penile size, showed a good durability and was well-tolerated, without serious adverse events.

Glans penis augmentation has been performed in real practice, although it is not an established procedure. We evaluated the efficacy and safety of injectable cross-linked dextran gel for glans penis augmentation. Gel was injected into the lamina propria layer of the glans penis by the fanning technique in 18 patients. The glandular size was measured, at baseline and at 6 months after injection. As a result, there was a size increase of more than 45%. 16 subjects (88.8%) were satisfied, whereas only two (11.1%) were dissatisfied.

These procedures are still experimental nature and have complexity of the patient’s psychological status, selection of the surgical technique is still highly controversial, and none of the proposed methods has been unanimously approved. In spite of this, we report our experience with cross-linked dextran and polymethylmethacrylate mixture (Lipen-10), Polylactic acid (PLA) filler, for phalloplasty and glanduloplasty performed safely with good efficacy.

Keywords: Synthetic fillers; phalloplasty; penis