Penile Lengthening; Penile and Testicular Implants; Penile Straightening (Peyronie’s Disease; Scrotoplasty; Complications of Circumcision; Webbing

Masculine genital surgery may be performed for function, aesthetics or hygiene. Plastic surgery techniques can be employed for penile lengthening, Peyronie’s disease, scar contractures or webs, straightening and use of implants. Penile lengthening surgery is a procedure that increases the length of the phallus. This can be accomplished in the context of cosmetic indications through a combination of suspensory ligament release, harvesting skin grafts, or implementing a penile prosthesis. Suspensory ligament release detaches the phallus from the surrounding supportive structures, giving the appearance of increased penile length. Most established and widely used surgical technique involves a suspensory ligament release in combination with a V-Y plasty. However, recent literature suggests modern adaptations of this technique are becoming increasingly more popular. In addition to cosmetic concerns, lengthening and straightening procedures may be indicated in the context of pathologies that interfere with sexual functioning. Examples include plication/corporoplasty or partial excision/grafting in the context of Peyronie’s disease and specialized scrotoplasty procedures to treat webbed or buried penis. While penile lengthening surgery can greatly improve one’s quality of life as well as physiological function, it does not come without risks. Possible complications include permanent tissue scarring, sensation loss, erectile dysfunction, and infection. As with any medical procedure, it is crucial to weigh the risks and benefits. An experienced urologist and/or plastic surgeon must be consulted in order to help the patient make an informed decision. Aims of this chapter are to review the indications, techniques, and complications associated with penile lengthening, prosthetic implants, and straightening.