Ligamentotomy surgery

The most effective of all currently known methods of increasing the size of the penis is its surgical correction. Other methods either do not work (miraculous ointments, compresses, dietary supplements) or give a short-term effect (vacuum pump - disposable, injections - up to 12 months + the possibility of side effects). A conservative method is the use of a special device for penis lengthening, an extender, which subjects the soft tissues of the cavernous body and blood vessels to gradual stretching, but it must be worn for a long time (more than six months) without surgery. [ 1 ]

Ligamentotomy of the penis is a relatively simple phalloplastic surgery that allows increasing the length of a normally functioning reproductive organ.

The surgical intervention consists of releasing the internal part of the penis shaft, hidden in the subcutaneous fatty tissue, by cutting the cartilaginous ligament that fixes it to the pubic bone. The restriction removed in this way allows the penis to be lengthened by 3-5 cm. After the operation, in order to prevent the ligament from growing back into its original position along the incision line, traction devices are used, but for a much shorter period than with conservative treatment. [ 2 ]

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

An estimated 15,414 ligamentotomy procedures were performed worldwide, with almost one in five of all operations performed in Germany.[ 3 ]

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

Indications for the procedure

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

• congenital or acquired proliferation of connective tissue of the penile ligament, which prevents the erect penis from straightening and makes erection painful (Peyronie's disease);
• replacement of cavernous tissue cells of the body of the penis with connective tissue cells (cavernous fibrosis);
• micropenis, when most of its shaft is hidden in the subcutaneous fat tissue - the visible part of the erect organ is small in size, which objectively complicates sexual life; [ 4 ], [ 5 ]
• penile trauma;
• dysmorphophobia – obsessive dissatisfaction of a man with the size of his penis (quite normal from an anatomical point of view) in the absence of more serious mental illnesses (if the length of the penis in an erect state is 180 mm or more, the patient may be denied surgical correction). [ 6 ]

Men who complain of a small penis despite having adequate length usually have either penile dysmorphic disorder (PDD) or small penis anxiety (SPA). In both of these disorders, men consistently 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 genital organ may be the patient's desire, caused by his aesthetic considerations (in the absence of contraindications), for example, the visible length of the erect penis is less than 120 mm.

Preparation

The preparatory process begins with a consultation with a urologist, who will examine the patient, find out the reasons that prompted him to resort to surgical correction, and make sure that he has no diseases of the genitourinary organs. As part of the preoperative examination, the patient takes blood tests: clinical, for glucose content, biochemical composition, coagulation, blood group and Rh factor, the presence of syphilis, hepatitis B and C, HIV infection. Beforehand, he will undergo fluorography and electrocardiography.

The list of pre-operative examinations may be expanded depending on whether the patient has chronic diseases.

The patient will talk to the anesthesiologist and will be warned that since the operation is performed under anesthesia, to avoid asphyxiation from vomit, he should not eat or drink for the next eight hours.

The day before the operation, you need to shave your pubic hair.

Technique ligamentotomy

The actual surgical intervention consists of cutting the superficial cartilaginous ligament that holds the penis in a certain position. This manipulation allows the penis to be pulled out from under the pubis without violating its anatomical integrity.

The operation is performed in an open manner through an incision, which is most often made in the scrotum (along the midline) or in the lower part of the pubis, when the greatest release of the hidden part of the penis shaft is required. Usually, the access is discussed before the surgical intervention and is determined depending on the solution of the task at hand.

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

The classic method involves cutting the ligament and stretching the penis to a certain length of up to 25-50 mm (depending on the length of the hidden part of the trunk). Suturing and fixing the elongated organ with a stretcher.

A more modern method involves using the patient's fat, taken from the places where it accumulates during the operation. The fat is placed in the cavity of the dissected ligament (lipofilling), which promotes tissue healing and prevents adhesions. After which a suture is applied. The second type of intervention takes a little longer. [ 8 ]

Complete release of the corpora cavernosa from the pubic ramus is associated with a significant risk of disrupting the neurovascular bundles of the penis, causing denervation and devascularization of the penis.[ 9 ]

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 stage of penis lengthening.

Contraindications to the procedure

The possibility of performing surgery is not considered until the patient is 18 years old.

He should not have any mental illnesses, a tendency to bleeding, genitourinary diseases, malignant tumors or diabetes.

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

Consequences after the procedure

After ligamentotomy, the functions of the genital organ (urination and erection) are usually fully preserved, the muscle tissue, ligaments and vessels responsible for these functions are not affected during the operation. Lymphatic drainage should not be impaired during ligamentotomy, since the lymphatic vessels should not be damaged if the operation is performed correctly. However, slight swelling in the area of the operation is possible, as well as hematomas. [ 10 ] Access through the scrotum is easier to tolerate, the suture heals faster, while an incision on the pubis is often complicated by hematomas and swelling.

The result of using general anesthesia is drowsiness, impaired coordination of attention usually goes away within 24 hours 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 of the penis during erection, leading to difficulties with intercourse and penetration [ 11 ].

Complications after the procedure are certainly possible. After all, it is an operation. If any undesirable consequences occur, you should consult a doctor for advice on taking the necessary measures.

Seam compaction after ligamentotomy is a normal process. The forming scar is always dense, later it softens. The sutures heal in about three weeks. For some, earlier, for others, later.

Suppuration of the sutures indicates a bacterial infection, and it is not necessarily that "the infection was brought in during the operation." Perhaps the patient had a chronic infectious process. Antibacterial drugs usually cope with the infection. To prescribe them, you need to see a doctor.

Plaques should not appear after ligamentotomy. They, causing curvature of the penis and its pain, are eliminated surgically during this operation. This is the growth of fibrous tissue in the protein shell of the cavernous bodies. The main reason for their appearance is called microtrauma of the penis (usually during sexual intercourse) with the development of microhemorrhages, in place of which connective tissue areas are formed. If plaques appear again, you should, firstly, see a doctor, and secondly, think together with the doctor about what causes their appearance.

A scar after ligamentotomy may well appear, since 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 skill of the surgeon. Physiotherapy and other methods are used to dissolve postoperative scars. If the scar bothers you a lot, you can consult a doctor about it.

Care after the procedure

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

A mandatory postoperative stage for any method of performing the operation is wearing a stretcher first (the first three weeks, sometimes longer), then an extender, without which the operation may be pointless, since the ligament will grow together along the rupture line and the penis will return to its original position. In addition, stretching the penis allows it to be lengthened by an additional 15-25 mm.

The minimum period of wearing the extender is two months. In postoperative days, it is put on for only one or two hours, later it is worn for six to eight hours daily. It is always taken off at night.

The ligament heals under the influence of the stretcher, but not along the incision line, but in a stretched position. The presence of the patient's own fat in the incision cavity promotes rapid tissue granulation.

The penis should be pulled out gradually, carefully, without causing pain, strictly following the doctor's recommendations. Only a slight tension should be felt.

Reviews

Reviews of the operation are different. Some complain of complications, hematomas, fever. Basically, such complaints are typical in the early postoperative period and you need to see a doctor about them. Each organism is individual, and it takes at least 10-14 days for the sutures to heal.

The results of ligamentotomy have not always been favorable. Patient and partner satisfaction rates range from 30 to 65%. On average, the surgery increases flaccid penis length by 1–3 cm. [ 13 ] Low satisfaction rates make this surgical technique unprofitable for many patients.

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