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Also known as
Penile elongation, phalloplasty (lengthening), sliding technique for penile lengthening, penile length restoration, surgical penile lengthening, ventro-dorsal sliding technique, double dorsal-ventral patch graft technique, modified sliding technique (MoST), multiple-slit technique (MUST) for penile length restoration
Definition
Penile lengthening is an advanced surgical procedure designed to increase the length of the penis in patients experiencing penile shortening due to various conditions, most notably Peyronie’s disease, erectile dysfunction, post-radical prostatectomy, or other urological conditions.1,2 The “sliding technique” is a specific surgical approach that involves ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and strategic reconstruction to achieve penile elongation.3
This procedure is characterized by the creation of incisions in the tunica albuginea that allow the distal penis to be physically “slid” away from the proximal shaft, effectively increasing the overall length of the penis.4 The technique may include complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration, and closure of the newly created rectangular bow-shaped tunical defects.5
The primary purpose of the sliding technique is to safely restore penile length while simultaneously addressing erectile dysfunction through prosthesis implantation, with clinical studies demonstrating average length increases of 3.1-3.2 cm.6,7 This technique represents a significant advancement in reconstructive urology as it provides a solution for patients with severe penile shortening who also require treatment for erectile dysfunction.8
Clinical Context
Penile lengthening using the sliding technique is primarily indicated for patients experiencing significant penile shortening in conjunction with erectile dysfunction.1 This condition commonly occurs in several clinical scenarios:
1. Peyronie’s Disease
The most common indication (53.8-60.1% of cases), where fibrous plaques in the tunica albuginea cause penile shortening rather than just curvature.2,3 Patients typically report subjective penile shortening of 1-7 cm (average 3.2-3.4 cm).4
2. Severe Erectile Dysfunction
Patients with severe ED and unsuccessful response to pharmacological treatments (21-24.6% of cases) who also experience penile shortening.5
3. Post-Prostatectomy
Patients who have undergone radical prostatectomy for prostate cancer (10.1-14.7% of cases) often experience penile shortening as a complication.6
4. Other Conditions
Less common indications include patients who have undergone androgen-deprivation therapy with or without radiotherapy for prostate cancer (3.6-7%), post-penile fracture repair (2.1-2.2%), post-hypospadias repair (0.7%), and post-priapism (0.7%).7
Patient Selection Criteria
- Documented penile shortening (typically >1 cm)
- Presence of erectile dysfunction unresponsive to medical therapy
- Realistic expectations regarding outcomes
- Absence of active infection or uncontrolled diabetes8
Surgical Procedure
- Ventro-dorsal incision of the tunica albuginea
- Penile prosthesis implantation
- Strategic “sliding” of the distal penis away from the proximal shaft
- Closure of the created defects, either with grafting materials or, in modified techniques, with Buck’s fascia only9,10
Expected Outcomes
- Average penile length gain of 3.1-3.2 cm (range 2-7 cm)11
- Significant improvement in erectile function (average IIEF score increase from 22-24 points at baseline to 60-66 points at 6-month follow-up)12
- High patient satisfaction rates when appropriate expectations are set13
- Potential complications include prosthesis infection (rare), glans necrosis (very rare), and temporary glans hypoesthesia14