Abstract Background Dissatisfaction with penile size is one of the most frequent concerns after penile prosthesis implantation, even when surgery is technically successful. Many causes of erectile dysfunction—including diabetes, atherosclerosis, Peyronie’s disease, radical prostatectomy, and radiation therapy—also contribute to penile shortening. As a result, patients who previously had a penile length of 14–15 cm often present with only 10–11 cm to operation time. Aim To evaluate the safety and patient satisfaction associated with a three step penile length restoration protocol: (1) surgical elongation via ligamentolysis, (2) postoperative traction therapy using extenders and vacuum devices for 3–4 months, and (3) subsequent penile prosthesis implantation. Materials and Methods From 2016 to 2025, ligamentolysis was performed in 52 patients. 47 procedures used a penopubic approach, and five used a penoscrotal approach. 28 penopubic cases included lipectomy to enhance visible penile length. Postoperatively, patients performed traction for at least 2 hours daily and used a vacuum pump. Immediate postoperative flaccid lengthening ranged from 3–6 cm (mean 4.57 ± 1.1 cm). After 3 months of traction, vacuum assisted length averaged 5.2 ± 0.93 cm. Penile prostheses were subsequently implanted: Rigicon Infla AX in 45 patients and AMS LGX in 7 patients. Mean elongation comparing vacuum length to inflated prosthesis length was 4.34 ± 0.53 cm. Conclusion Ligamentolysis, with or without lipectomy, followed by structured postoperative stretching, is a safe and effective method for penile elongation prior to prosthesis implantation. This combined approach provides an additional ~4.5 cm of inflated penile length, improving postoperative satisfaction.
Oleksandr Knigavko (2026) studied this question.