(P20) results of 3 steps methodic for penile enlargement with penile prosthesis surgery

Background Male dissatisfaction with the penis size is the most common complaint after even fully successful Penile Prosthetic Surgery. Usually, patients note a decrease of penile size for 2-4 cm after implantation of a prosthesis. New inflatable prostheses like Rigicon InflaAX and AMS LGX give the opportunity to keep the penis size, but many patients are unsatisfied with the length of the penis, even before the operation. Many techniques of simultaneous elongation increase the time of implantation and the risk of surgery. Many reasons for ED (radical prostatectomy, corporal fibrosis after diabetes, priapism, or atherosclerosis) simultaneously decrease the penis size, and these patients want to have a solution to receive back the full size of their penis before a Penile Prosthetic Implant (PPI). This work examines the results of efficiency (elongation) and patient satisfaction with procedures for lengthening of the penis (Ligamentolysis and Penoplasty), with postoperative stretching of the penis before PPI. Methods in 2019-2024, 39 patients underwent complex treatment by this method (ligamentolysis, 3 months stretching and PPI) in Ukraine, Poland, and UAE. 32 Ligamentolysis were performed from the penopubical approach (above the penis) and 7 from the penoscrotal approach. Of the 32 upper access operations, 18 operations were supplemented with lipectomy (6-angle excision of the skin over the penis and suprapubic fat). All ligamentolysis surgeries were supplemented fixation of small silicone implant 2*2*0.5 cm between penis and pubic bones. After surgery, patients stretched the penis with an extender/stretcher for at least 2 hours a day for at least 3 months and used a vacuum pump. Then, 3 3-component hydraulic prosthesis Rigicon InflaAX were installed. In 10 days after PPI, patients started their cycling (inflation-deflation) of the prosthesis. Results Immediately after the operations, the lengthening of the flaccid penis ranged from 3 to 6 cm, with an average of 4.57 + 1.3 cm. The lengthening of the penis in a vacuum pump (maximal erection with 50 kPa of negative pressure) after surgery and 3 months of traction averaged 4.7 + 0.93 cm. 11 patients extended their penis 6 months or longer. They obtained +5.2 + 0.9 cm additional length in the pump. After prosthetic surgery, the average penile elongation (maximum inflated penis compared to maximum stretched penis before 1st surgery) was 3.7 + 0.8, and in 3 months of cycling of 3 months it enlarged an average 4.34 +0.53 cm. Conclusion 1. Ligamentotomy and post/op stretching can be safely used before implantation of penile prosthesis which gives additional 4.5 cm length of inflated penis. 2. Average penile shortening is 1.13 cm/year in the first 3 years after Radical Prostatectomy. Patients after radical prostatectomy with ED who want to prolong their sexual life and save the size of the penis should be consulted by an andrologist about implantation of a Penile prosthesis 3-6 months after RP for length preservation. 3. 97.4% of patients after Ligamentotomy are satisfied with the results of this method.