Trans-Scrotal Suspensory Ligament Release: A Novel Technique for Penile Length Augmentation Publisher



B Karimian BABAK ; A Shamshirgaran AMIRREZA ; Rm Farsani Reza MOHAMMADI ; A Mohammadi ABDOLREZA ; Smk Aghamir Seyed Mohammad KAZEM
Source: Aesthetic Plastic Surgery Published:2025

Abstract

Background: Penile size concerns are prevalent among men, often linked to self-esteem and masculinity. Alongside many pathological condition, small penis anxiety (SPA) and penile dysmorphic disorder (PDD) can also lead to dissatisfaction even in those with normal sizes. Various enlargement methods, both invasive and non-invasive, have emerged. While penile enlargement procedures aim to improve size and esthetics, they carry potential risks that require careful consideration. Objective: We aimed to introduce a novel suspensory ligament release method by trans-scrotal approach. Materials and Methods: The study involved 21 men with concerns about penile size who underwent trans-scrotal penile enlargement surgery from February 2022 to July 2023. Patients received comprehensive evaluations, including medical history, physical exams, and psychological assessments for body dysmorphic disorders. The surgery aimed to enhance penile size using a novel trans-scrotal technique. Postoperative outcomes including flaccid penile length (FPL), stretched penile length (SPL), complications, and patient satisfaction were assessed. Patients also were provided with the Male Genital Self-Image Scale (MGSIS) and International Index of Erectile Function-5 (IIEF-5) questionnaires. Results: This study consists of 14 body dysmorphic disorder (BDD), 2 hypospadias, and 5 micropenis patients. The average age was 38.8 years, with surgical procedures lasting about 145.7 minutes. All patients were discharged within 24 hours, with no major complications reported. There were significant increases in both flaccid and stretched penile lengths (2.6 ± 1.66 cm and 2.4 ± 0.57 cm, respectively, p < 0.05). MGSIS score significantly increased, while IIEF-5 scores showed no significant change. Conclusion: Trans-scrotal approach for penile enlargement is a safe and effective technique that could be administered to patients seeking penile augmentation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2025 Elsevier B.V., All rights reserved.