Penis enlargement phalloplasty using hyaluronic acid injections provides quick results and is a good value investment. In complications such as mucosal necrosis of the glans penis, most cases occur from the use of non-HA gel or an unpurified form and misunderstanding of the management protocol for immediate side effects. Augmentation of glans penis using injectable hyaluronic acid gel. A quest for a bigger penis could leave you with a lumpy, bruised, discolored, thickened, painful, dysfunctional member. The study reported promising results, with retention of the added volume at 1-year follow-up, preservation of sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.
Penile Enlargement: Surgery & Non-Surgical Procedures
The pathophysiology of premature ejaculation is poorly understood. The effects of GPA using filler in premature ejaculation might be the result of reduced sensation of the glans penis by formation of a barrier between stimuli and receptors, combined with increased self-confidence due to the subjective benefit of the procedure.
To increase the efficacy of GPA by filler for premature ejaculation, proper patient selection is critical. As demonstrated in this study, the initial satisfaction rate at 6 months was maintained until 5 years despite the significant decrease in IELT and VT. The increased self-esteem and self-confidence from an enlarged glans may in itself have a positive effect. This means that proper patient selection and well-executed procedures can result in patient satisfaction.
In , Perovic et al [ 6 ] reported his results with GPA by submucosal injection of hydrogel in 9 patients with glans deformity. He reported that hydrogel was safe and effective in 8 of the 9 cases for 12 to 26 months of follow-up, but he recommended simple aspiration for excessive hydrogel, if necessary. Shaeer [ 7 ] also used polyacrylamide gel injection for enhancing glans size in 2 patients following implantation of a penile prosthesis with satisfactory results, although the results were short-lived, requiring reinjection.
The advantage of hydrogel is its lower price. However, polyacrylamide hydrogel has been shown to be a poor material for soft tissue augmentation in the long term. Hydrogel has been used in breast reconstruction. It has also been used for the correction of facial deformity. In and , various complications of hydrogel, including diffuse paranasal swelling and signs of cellulitis from the granulomatous inflammatory response were reported, and the warning was that hydrogel injection is not appropriate for facial plasty [ 34 , 35 , 36 ].
Despite of the proven safety of HA, with regard to both its unique characteristics and clinical outcomes, granulomatous foreign body reaction by protein contaminants and, rarely, ischemic necrosis can develop when injection is too superficial, too great a volume is injected, or intravascular injection occurs, causing immediate postinjection discoloration.
Brody [ 37 ] and Hirsh et al [ 38 , 39 ] reported the successful management of an unusual presentation of impending necrosis following a HA injection embolus and proposed an algorithm for management with hyaluronidase. In case of immediate postinjection discoloration, stopping the injection, applying gentle massage, and immediate application of heat and local nitroglycerine paste may be effective.
To avoid possible immediate ischemic necrosis, the use of a safe, appropriate filler and supplementation at postoperative 2 weeks instead of initial overinjection, and injection of hyaluronidase in case of HA gel are good alternatives.
Although not reported in the literature, several patients have been referred to us with complications Fig. The reason for local complications after filler injection are use of inadequate filler of unknown nature or poor purity and an incorrect injection technique such as too great a volume injected too superficially or misplaced injection, and local infection. BellaGen Hans Biomed Co. In case of discoloration after overinjection, it cannot be aspirated and hyaluronidase cannot digest the cellular fragments.
Nowadays, various kinds of fillers have been developed. As illustrated in Fig. After development of GPA using injectable HA gel, Shaeer [ 40 ] reported a glans augmentation method by grafting which he named "Shaeer's glans augmentation". He also noted the need for GPA in patients lacking glans tumescence in penile prosthesis implantation or during natural erection and for a small glans after shaft augmentation.
Shaeer's glans augmentation is insertion of a dermofat graft from the groin into the periurethral plane developed by dissection of a glans flap via two ventral incisions along the ventral aspect of the coronal sulcus.
In a pilot study of 10 patients, the maximum circumference of the glans increased by The self-reported impression of the augmented volume was high and well maintained over the follow-up period.
Glans sensation, engorgement, erectile function, and ejaculatory control were preserved. The study reported promising results, with retention of the added volume at 1-year follow-up, preservation of sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control.
Despite good results, major limitations of the study were invasiveness of the dermofat graft from the groin and lack of information on long-term results. Another similar method of GPA was reported in Korea but is unpublished.
A group of Korean andrologists developed an indirect GPA method. Compared to direct enhancement of the dermal layer of the glans penis in direct GPA by superficial injection of HA gel, indirect GPA involves implantation of a collagen scaffold of Lyoplant B. Braun Melsungen AG, Melsungen, Germany between the glans and corporal tip, which can produce general enlargement and elevation of the glans penis as illustrated in Fig.
As reported by Perovic et al [ 41 ], a potential space between the corpus spongiosum of the glans penis and the distal tip of the corpus cavernosum can be developed by blunt dissection via incision at the coronal sulcus. Simple closure and normal wound care is sufficient. At first, they also used a dermofat graft but changed to Lyoplant to avoid the invasiveness of the dermofat. Lyoplant implantation showed good results but resorption was a problem.
This novel method appears to be very simple but the limitations are invasiveness, no proven efficacy, and a lack of other reports on the method. For efficacy in premature ejaculation, selection of appropriate patients is critical. GPA is not harmful to erectile function and is less invasive and irreversible than dorsal neurectomy. To refine the procedure, greater interest and proper studies are needed for the establishment of the procedure. GPA is an appropriate procedure for the relevant indications.
No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U. World J Mens Health.
Published online Aug Find articles by Du Geon Moon. Find articles by Tae Il Kwak. Find articles by Je Jong Kim. This article has been cited by other articles in PMC. Abstract Glans penis augmentation GPA has received little attention from experts despite the existence of a subset of patients who may be dissatisfied with a small glans or poor tumescence of the glans during erection.
Characteristics of the ideal filler and injectable hyaluronic acid gel Injectable soft-tissue substitutes provide an affordable, nonsurgical alternative for soft-tissue augmentation and correcting contour defects.
Establishment of an injection technique and histological study Although HA has already been used in its native form as an implant for more than 30 years and in millions of individuals without causing adverse reactions in various areas of medicine, no reports of penile augmentation have been published.
Open in a separate window. B Implanted basophilic amorphous materials Alcian blue stain. C Alcian blue stain after treatment with hyaluronidase reveals the digestion of hyaluronic acid gel. Human glans penis injection technique For human glans penis injection, local anesthesia 30 minutes after topical application of anesthetic cream Emla lidocaine 25 mg, prilocaine 25 mg; AstraZeneca, London, UK is tolerable for most patients, but a few experience penile pain and require local injection of anesthetic.
Effects of glans penis augmentation on volume To estimate the volume effects of GPA by injectable HA gel or other kinds of fillers, the long-term residual volume should be assessed. Feasibility and efficacy of glans penis augmentation for premature ejaculation The current treatment choice for premature ejaculation is medical treatment.
Efficacy of glans penis augmentation for premature ejaculation Kim et al [ 8 ] compared the efficacy of GPA with dorsal neurectomy in a total of patients with primary premature ejaculation.
Complications of fillers for glans penis augmentation After the development of GPA using injectable HA gel, various kinds of fillers have been used. Preparation and procedures for indirect glans penis augmentation by Lyoplant B. Lacking tumescence of glans during penile erection.
Use of transurethral alprostadil MUSE prostaglandin E1 for glans tumescence in a patient with penile prosthesis. Int J Impot Res. Augmentation of glans penis using injectable hyaluronic acid gel. Human glans penis augmentation using injectable hyaluronic acid gel.
Enlargement and sculpturing of a small and deformed glans. Supersizing the penis following penile prosthesis implantation. Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation. Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: Silicone, fibrel, and collagen implantation for facial lines and wrinkles.
J Dermatol Surg Oncol. The first clinical study using a new biodegradable implant for the treatment of lips, wrinkles, and folds. Injectable hyaluronic acid gel for soft tissue augmentation. A clinical and histological study. Goa KL, Benfield P. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing.
J Biomed Mater Res. Non-immunogenicity of purified hyaluronic acid preparations tested by passive cutaneous anaphylaxis. Int Arch Allergy Appl Immunol.
Non-immunogenicity of a purified sodium hyaluronate preparation in man. Unsourced material may be challenged and removed. March Learn how and when to remove this template message. This section needs expansion. You can help by adding to it. From medication to surgery" , J Sex Marital Ther , ; 36 2: Retrieved July 28, The Journal of Sexual Medicine. Retrieved July 14, European journal of dermatology: A Clinical Guide , 2nd edn Humana Press, , p Retrieved 6 January Talk Sex with Sue Johanson.
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