How Is Penile Atrophy Treated or Reversed?

According to the 2025 EAU Guidelines, penile atrophy or shortening can occur following various conditions including Peyronie’s disease, prostatectomy, or prolonged erectile dysfunction¹. When penile shortening is associated with erectile dysfunction that doesn’t respond to other treatments, penile prosthesis implantation is considered the standard surgical approach². The guidelines emphasize that patient selection is critical, with implants recommended for patients who are not suitable for other treatments or based on patient preference³. The EAU Guidelines identify two main classes of penile implants: inflatable (two- and three-piece) and semi-rigid devices⁴. While implantation primarily addresses erectile function rather than penile size, studies show varying outcomes regarding length. Most patients (72%) report a subjective decrease in penile length following standard implantation⁵. However, certain specialized expandable implant devices have shown modest improvements in stretched penile length from 13.1 ± 1.2 cm to 13.7 ± 1.1 cm at 12 months post-implantation⁶. For non-erectile dysfunction cases of penile shortening, the guidelines recommend considering penile traction therapy as a non-surgical option⁷. This approach has demonstrated efficacy in addressing penile shortening in certain conditions, though results vary based on patient compliance and underlying cause. The guidelines specifically caution against using testosterone or other hormonal therapies to increase penile size in adult men, as these are not supported by evidence and may carry risks⁸. For patients with buried penis (where a normal-sized penis is covered by prepubic, scrotal, or penile tissue), surgical approaches focusing on removing excess tissue rather than penile augmentation are recommended⁹. The guidelines note that techniques such as penile disassembly or sliding techniques are not recommended for routine penile lengthening due to insufficient evidence of efficacy and potential complications¹⁰. Regarding complications, the two main issues with penile prosthesis implantation are mechanical failure and infection¹¹. Several technical modifications are recommended to reduce infection risk, including antibiotic-coated implants and no-touch techniques¹². Patients with diabetes mellitus have been identified as having a higher risk for penile prosthesis infection, requiring additional precautions¹³. The guidelines emphasize realistic expectations, noting that penile prosthesis implantation is primarily for restoring erectile function rather than increasing size¹⁴. Patient and partner satisfaction rates remain high after penile implant surgery despite potential size concerns, with sufficient evidence to recommend this approach for appropriate candidates¹⁵.