Rigi10™ Malleable Penile Prosthesis
Also Known As
Ligamentum suspensorium penis, Penile suspensory ligament, PSL
Definition
The suspensory ligament of the penis is a crucial anatomical structure primarily responsible for providing support to the penis and maintaining its position, particularly during an erection.¹ It is a triangular, midline ligament that anchors the penis to the anterior surface of the pubic symphysis, effectively holding the penis close to the pubic bone.² This ligament plays a significant role in the biomechanics of erection by stabilizing the penile shaft and ensuring its proper orientation for sexual function.¹ The suspensory ligament, along with the fundiform ligament, forms the suspensory apparatus of the penis.³ Its integrity is vital for normal erectile function, and damage or congenital absence of this ligament can lead to functional impairment and penile instability.¹
Clinical Context
The suspensory ligament of the penis is clinically relevant in several contexts, particularly in relation to penile stability, erectile function, and surgical procedures aimed at penile augmentation or reconstruction.¹ Abnormalities of the PSL, whether congenital or acquired (e.g., due to trauma), can result in penile instability, which may impair sexual intercourse.¹ Patients with such conditions may present with complaints of a ‘floppy’ or unstable penis during erection, or a perceived shortening of the penis.²
Surgical intervention may be considered for patients with significant PSL abnormalities leading to functional impairment. Patient selection criteria typically involve a thorough history and physical examination to confirm the diagnosis and rule out other causes of erectile dysfunction or penile deformity.¹ Imaging studies, such as MRI, may be used to visualize the ligament and assess its integrity.²
The surgical repair of PSL defects often involves a transverse infrapubic incision to access the ligament. The procedure aims to re-anchor the penis to the pubic symphysis, often using non-absorbable braided sutures placed between the tunica albuginea of the corpora cavernosa and the symphysis pubis.¹ In some cases, a fascial graft may be used to reinforce the repair.¹ The expected outcome of successful PSL repair is improved penile stability during erection, which can lead to enhanced sexual function and patient satisfaction.¹ Success rates for PSL repair, defined by penile stability and patient satisfaction, are reported to be between 85-100% in some case series, although these figures can be influenced by co-existing conditions like Peyronie’s disease or penile dysmorphic disorder.¹
Division of the suspensory ligament (ligamentolysis) is a procedure sometimes performed as part of penile augmentation surgery to increase flaccid penile length. However, this procedure can lead to decreased penile stability during erection and may not result in a significant increase in erect penile length that satisfies the patient.² Therefore, its use is controversial and requires careful patient counseling regarding potential risks and benefits.¹
Recovery after PSL repair typically involves a period of rest and avoidance of strenuous activity. Complications can include de novo erectile dysfunction (reported in 3-5% of cases in some series, though often manageable medically), penile shortening, infection, or suture-related issues.¹ Long-term follow-up is necessary to assess functional outcomes and patient satisfaction fully.¹