Operation ligamentotomy

The most effective among all currently known methods of increasing the size of the penis is its surgical correction. Other methods either do not work (miracle ointments, compresses, bio-additives), or give a short-term effect (vacuum pump - one-time, injections - up to 12 months + the possibility of side effects). The conservative method is the use of a special device for lengthening the penis, the extender, which exposes the soft tissues of the cavernous body and blood vessels to a gradual stretching, but it is necessary to wear it without an operation for a long time (more than six months).[1]

Ligamentotomy of the penis is a relatively uncomplicated phalloplastic operation, allowing to increase the length of a normally functioning genital organ.

Surgical intervention is the release of the inner part of the penis hidden in the subcutaneous fatty tissue by dissecting the cartilaginous ligament fixing it to the pubic bone. The restriction removed in this way makes it possible to lengthen the sexual organ by 3-5 cm. After the operation, in order to prevent the ligament from growing together along the incision line to the previous position, devices for stretching are used, but for a much shorter period than with conservative treatment.[2]

Penile ligamentotomy allows you to change the physiological parameters of the penis for life. This has a positive effect on the psycho-emotional sphere of the man and his sex life.

It is estimated that a total of 15,414 ligamentotomy procedures were performed worldwide, almost one in five of all operations was performed in Germany. [3]

This operation is much simpler, safer and cheaper than phalloprosthetics, however, when a man suffers from severe forms of erectile dysfunction in addition to small penis size, it may not be effective.

Indications for the procedure

Ligamentotomy is performed only for patients who have reached the age of majority, and can be indicated for health reasons in pathological cases:

• congenital or acquired proliferation of the connective tissue of the penile ligament, which does not allow the erect member to straighten and makes the erection painful (Peyronie's disease);
• replacement of the cells of the cavernous tissue of the body of the penis with connective tissue cells (cavernous fibrosis);
• micropenis, when a large part of its trunk is hidden in the subcutaneous fatty tissue - the visible part of the erect organ is small in size, which objectively hampers sex life; [4], [5]
• penile injury;
• dysmorphophobia - obsessive dissatisfaction of a man with the size of the penis (quite normal in terms of anatomy) in the absence of more serious mental diseases (if the length of the erect penis is 180 mm or more, the patient may be denied surgical correction). [6] 

Men who complain about a small penis, despite being of sufficient length, usually suffer from either a penile dysmorphobia disorder (PDD) or anxiety about the small penis (SPA). In both of these disorders, men constantly underestimate the size of their penis and overestimate the average size for other men. [7]

An indication for plastic surgery to increase the length of the male sexual organ may be the patient’s desire caused by his aesthetic considerations (if he has no contraindications), for example, the apparent length of the erect penis is less than 120 mm.

Preparation

The preparatory process begins with the consultation of the urologist, who will examine the patient, find out the reasons that prompted him to resort to surgical correction, make sure that he has no diseases of the urinary organs. In the framework of the preoperative examination, the patient undergoes blood tests: clinical, glucose, biochemical composition, clotting, blood group and Rh factor, the presence of syphilis, hepatitis B and C, HIV infection. Previously, he will do a fluorography and electrocardiography.

The list of studies before the operation can be expanded, based on the presence of a patient of chronic diseases.

The patient will talk with the anesthesiologist, he will be warned that since the operation is performed under general anesthesia, in order to avoid asphyxiation of the vomitus, you should not eat or drink for the next eight hours.

On the eve of the operation you need to shave pubic hair.

Technique of the ligamentotomies

Directly surgical intervention lies in the incision of the superficial cartilaginous ligament holding the penis in a certain position. This manipulation allows you to pull the penis out from under the womb, without violating its anatomical integrity.

The operation is carried out in an open way through an incision, which is often done in the scrotum (in the midline) or in the lower part of the pubis, when the greatest release of the hidden part of the penis is required. Usually, access is discussed before surgery and is determined depending on the solution of the task.

Modern operating theaters are often equipped with endoscopic equipment, in which case micro incisions are made.

The classic method is to cut the ligament and pull the penis to a certain length up to 25-50mm (depending on the length of the hidden part of the trunk). Suturing and fixation of the elongated organ with a stretcher.

A more modern method involves the use of the patient's fat, taken from the places of its accumulation during the operation. Fat is placed in the cavity of the dissected ligament (lipofilling), which promotes tissue healing and is a prevention of adhesive cords. Then the seam is imposed. The second type of intervention takes a little longer.[8]

A complete release of the cavernous bodies from the pubic branch is associated with a significant risk for the disruption of the neurovascular bundles of the penis, causing denervation and devascularization of the penis. [9]

Immediately the operation itself lasts about 30-60 minutes, the patient stays in the clinic for 24 hours, however, its success is facilitated by proper postoperative care, which is the second and necessary step of lengthening the penis.

Contraindications to the procedure

The ability to perform the operation is not considered until the patient is 18 years old.

It should not have mental illness, bleeding tendency, urogenital diseases, malignant tumors and diabetes mellitus.

The operation is not performed during the period of acute infectious diseases in a patient and / or exacerbation of chronic ones.

Consequences after the procedure

After ligamentotomy, usually the functions of the sexual organ (urination and erection) are completely preserved; the muscle tissue, ligaments and vessels responsible for these functions are not affected during the operation. Lymph drainage during ligamentotomy should not be disturbed, since the lymphatic vessels, when correctly performed, should not suffer. However, a slight swelling in the area of operation is possible, as well as hematomas. [10]It is easier to transfer access through the scrotum, the suture heals faster, the incision on the pubis is often complicated by hematomas and puffiness.

The result of the use of general anesthesia is drowsiness, a lack of attention coordination usually disappears within a day even in the most sensitive patients.

Complications after the procedure

Paradoxically, the main side effects of this procedure are relapse, shortening of the penis and lack of support for the penis during erection, which leads to difficulties during sexual intercourse and penetration [11]. 

Complications after the procedure are certainly possible. All the same - this is an operation. In case of undesirable consequences, it is necessary to consult a doctor for advice on taking the necessary measures.

Consolidation of the suture after ligamentotomy is a normal process. The forming scar is always dense, later it softens. The stitches heal in about three weeks. Someone earlier, others later.

Suppuration of stitches speaks of bacterial infection, and it is not at all necessary that "they carried the infection during the operation." The patient may have had a chronic infection process. Antibacterial drugs usually deal with the infection. For their appointment, you need to consult a doctor.

Plaques after ligamentotomy should not appear. From them, causing the curvature of the penis and its pain, get rid of the operational way when performing this operation. This is the growth of fibrous tissue in the albumen of the cavernous bodies. The main cause of their occurrence is called penile microtraumas (most often during intercourse) with the development of microchromosomes, in the place of which connective tissue sites are formed. If plaques appear again, it is necessary, firstly, to appear to the doctor, and secondly, to think together with the doctor what causes their appearance.

A scar after ligamentotomy may well appear, as postoperative scars are formed during any operations. Over time, they become softer and diverge. Much depends on the quality of the patient's skin and the art of the surgeon. For the resorption of postoperative scars used physiotherapy and other methods. If the scar is very troubling, you can consult a doctor about this.

Care after the procedure

In the postoperative period, analgesics may be prescribed to relieve pain. Dressings are done every 2-3 days, sutures are usually removed 14 days after surgery. Avoid sexual contact is recommended for 1-1.5 months.[12]

Obligatory postoperative stage with any method of operation - wearing first stretcher (first three weeks, sometimes longer time), then - extender, without this operation may be meaningless, because the ligament grows along the rupture line and the penis returns to its original position. In addition, the stretching of the penis allows it to extend an additional 15-25 mm.

The minimum period of wearing the extender is two months. In the postoperative days, it is worn for only one to two hours, and later worn for six to eight hours every day. At night, be sure to take off.

The ligament under the influence of the stretcher heals, but not along the incision line, but in the stretched position. The presence of the patient's own fat in the cavity of the incision contributes to the speedy granulation of tissues.

Pull the penis to gradually, carefully, avoiding pain, just following the recommendations of the doctor. Only light tension should be felt.

Reviews

Reviews of the operation are different. Some complain of complications, hematomas, fever. Basically, such complaints are characteristic in the early postoperative period and they should be treated by a doctor. Each organism is individual, and for the healing of sutures you need 10-14 days, at a minimum.

The results of ligamentotomy were not always favorable. The level of satisfaction of patients and partners ranges from 30 to 65%. On average, the operation increases the length of the penis in a relaxed state by 1–3 cm. [13] Low satisfaction rates make this surgical technique unprofitable for many patients.

In addition, it is often asked whether it is possible to simultaneously lengthen the penis and increase its thickness. This is not recommended. Experts first recommend a ligamentotomy and, only after all the measures to stretch the penis in length using an extender, which clamps the organ tightly, are stopped, which is unacceptable after increasing the thickness of the penis, you can proceed to the next step.