Cosmetic Urology

Educational Objectives

The goal of this program is to improve the management of cosmetic problems of the male genitalia. After hearing and assimilating this program, the clinician will be better able to:

1. Evaluate the efficacy of cosmetic procedures of the male genitalia.

Summary

Cosmetic surgery of male genitalia: procedures include penile augmentation (length and girth), reduction scrotoplasty (may also be indicated in patients with functional symptoms), and injection of botulinum toxin

Surgical procedures: suspensory ligament — provides stability of base of penis; ligation may be combined with cutaneous plastic surgery techniques and insertion of prosthesis to prevent scarring; scrotum — excision of web on ventral surface results in more exophytic penis; suprapubic fat pad — procedures performed by urologist usually limited to excision of dorsal fat pad; performing excision concomitantly with insertion of penile implant not recommended; tunica albuginea — circumferential excision with patch graft not recommended; modification of sliding technique involves denuding penis, elevating neurovascular bundle dorsally, ventral manipulation of corpus spongiosum, and staggered incision of tunica albuginea (allows penis to slide forward); original series included insertion of inflatable prosthesis; current technique involves insertion of 2 malleable implants; incisions of tunica albuginea (previously left uncovered) now covered with patch grafts (technique in development [not in standard algorithms])

Mechanical modalities: successful penile traction therapy requires constant traction to mold tissue (impulse session-based vacuum therapy not effective); weights may be used

Enhancement of penile girth: wraps — soft membranous and hard prosthetics available; implanted deep to skin and dartos fascia; additional scrutiny regarding patient safety necessary; injections — many agents available; silicone injections may migrate with time; therapy not standardized; available guidance minimal; demand from patients high

Readings

Borges F et al: Surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via infrapubic approach. J Sex Med 2006 May;3(3):550-3; Miranda-Sousa A et al: Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med 2007 Sep;4(5):1494-9; Mulcahy JJ: The development of modern penile implants. Sex Med Rev 2016 Apr;4(2):177-89.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Carrion was recorded at the 69th Annual Meeting of the Florida Urological Society, presented by the Florida Urological Society and held August 31 to September 3, 2017, in Orlando, FL. For information about the 70th Annual Meeting of the Florida Urological Society, please visit flaurological.org. The Audio Digest Foundation thanks the speakers and the Florida Urological Society for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

UR402401

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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