What is penile shortening? Penile shortening syndrome is a common disease in men, and the causes include 1. congenital factors such as hypogonadism, hypogonadism, disorders of sex hormone secretion, androgen insensitivity, 2. acquired diseases such as penile sclerosis, penile trauma, spinal cord injury and other causes of penile shortening; 3. some adult men, although their penis size falls within the lower limit of the normal range, are overly concerned about their penis size due to 3, some adult men, although the penis size is within the lower limit of the normal range, but due to excessive concern about their penis size, triggering anxiety, low self-esteem and fear, and even lead to erectile dysfunction and significantly reduce the quality of life, such patients can also be treated according to penile shortening. Some scholars have found that only about 55% of adult men are satisfied with the size of their penis. Patients with short penis are usually perceived as lacking in manhood and creativity, they easily close themselves off, affecting their social and self-confidence, lack of security and safety, and may affect their work mood and social status, significantly reducing their quality of life and sometimes even causing psychogenic erectile dysfunction. How is penile shortening diagnosed? The penis grows and develops under the action of growth hormone, gonadotropin and testosterone produced by the pituitary gland. If there is insufficient testosterone production during the 6th-9th months of maternal gestation, the fetal penis will develop at a lower than normal rate and will be smaller at birth. In addition, such as penile androgen receptor deficiency and 5-a reductase deficiency can also cause small penis. Micropenis is often combined with congenital bilateral cryptorchidism, testicular hypoplasia, hypopituitarism, and hermaphroditism. Idiopathic micropenis of unknown origin, this condition accounts for about 20% of all cases of micropenis. Measurement statistics show that the normal adult male penis in China ranges from 4.5 to 8.5 cm in length in the weak state, with an average of about 6.5 cm, and from 7 to 18 cm when erect, with an average of 10.6 cm being considered a normal penis, and the circumference is 8.3 cm and 12.1 cm, respectively. In infancy, when the length of the penis is less than 1 cm when stretched, it is a small penis, and the penis of children before the age of 9 is less than 3 cm If the penis is less than 4 or 5 cm in adults, it can be identified as abnormal penile development. Some scholars suggest that penile lengthening is suitable for patients whose penis length is less than 4 cm in a weak state or shorter than 7 or 5 cm when the penis is stretched, while penile enlargement surgery can be performed if the circumference of the penis is less than 2O% of the average value of normal peers. The patient’s history should include the presence of bile depression during the neonatal period. The physical examination should pay attention to whether the patient has obvious short stature or obesity, whether there is a combination of multiple skin pigmented nevi, ichthyosis, cryptorchidism, testicular ectopia, syndactyly, polydactyly and other deformities (including small head, small ear deformity, widened orbital distance, small mouth, cleft palate, etc.), and pay special attention to the family history of the patient and the birth history of the patient’s mother, such as the medical history of patients with Kallmann syndrome. If the mother has reduced fetal movement during pregnancy or the patient is born with hypotonia, we should be alert to the possibility of Pradewilli syndrome (obesity and hypogonadism syndrome); laboratory tests include pituitary screening test, hypothalamus-pituitary-gonadal axis function, androgen receptor or LH and FSH receptor testing, and if necessary, CT or MRI of hypothalamus and pituitary gland. Patients with craniofacial anomalies should pay special attention to the visual cross, the fourth ventricle and the corpus callosum; in suspected Kallmann syndrome, special attention must be paid to the olfactory groove. A 99Tcm renal scan, genitourinary tract x-ray, karyotype analysis, laparoscopy or surgical exploration to determine the location of the testes can be chosen according to the specific situation. Electrical audiometry and olfactory examination should also be performed if necessary. In addition, the patient’s psychological status, quality of life, and expectations of penile length and thickness should be understood. The patient’s psychological status and quality of life should be assessed using the Self-Assessment Scale for Anxiety (SAS), the Zung Depression Scale, the erectile function score (IIEF I 5), the ejaculatory function scale (CIPE), and the SF-36 quality of life scale. How to treat penile shortening? Do I need to do psychotherapy? Studies have found that 62.7% of patients with penile hypospadias experience anxiety during childhood, while 37.3% of patients experience anxiety during adolescence, so the importance of psychological counseling should be emphasized. In addition, a sex hormone level test and a careful physical examination are needed before treatment to differentiate it from occult penis, hypospadias, etc. When to do endocrine therapy? For patients with micropenis, it is important to try to understand the cause of its development in order to treat it symptomatically. Trying endocrine therapy before puberty, using growth hormone, gonadotropin or androgen therapy respectively, often has some effect on micropenis before puberty. If the penis does not develop even after correct treatment during puberty, further androgen treatment in adulthood is often ineffective. Patients with problems with the testicles themselves, whose underlying problem is androgen deficiency, can use androgens as long-term replacement therapy. After the use of the drug, it can mostly be found that secondary sexual characteristics improve and pubic hair and beard increase, but fertility cannot be improved and may be repeated after stopping the drug. Excessive use of testosterone during childhood may promote precocious puberty and may cause premature bone fusion, which may affect physical development and growth, so a treatment plan should be formulated by a specialist. Is physiotherapy effective? The difference in penile length assessment before and after physical therapy is not significant and is still controversial. The use of negative compression narrowing device suction and penile cavernous vasoactive agent injection has been effective for small penis complicated by impotence. Since there is no muscle tissue in the penis, mechanical approaches such as vacuum and massage to enlarge the penis are not exact, temporary enlargement is only slightly more blood filling, and improper operation can also lead to subcutaneous bleeding or damage to the cavernous tissue, but can be considered as an adjunctive treatment after penile lengthening surgery. How is the surgical treatment done? In the past, penis lengthening and enlargement surgery was only used to treat various congenital diseases of the genitourinary system, but now it is considered that those who present short penis due to acquired diseases and defects, and those who have normal penis length and circumference and require improvement of the sexual life of couples are also indications for penis lengthening and enlargement surgery. Penis lengthening is mainly to remove the superficial suspensory ligament and part of the deep suspensory ligament of the penis without affecting the stability of erection and uplift, thus increasing the length of the penis body. Of course, there are also attempts to achieve penile lengthening by partial incision of the white membrane of the penis. Anatomical studies have shown that: the penile fixation device mainly has the superficial suspensory ligament and the deep suspensory ligament of the penis, the superficial suspensory ligament is shallowly located and is a dense connective elastic fiber bundle formed by the thickening of the deep layer of the superficial fascia of the abdominal wall in the midline, starting from the abdominal white line 5-6 cm above the pubic symphysis, and the fiber bundle is attached downward to the deep fascia of the penis, about 3,1 cm wide and 0,4 cm thick at the root of the penis, which can be cut off to make the penis The deep suspensory ligament is located in the deep part of the former, there is about lcm of loose connective tissue between the two ligaments, the deep suspensory ligament is a triangle of dense connective tissue fiber bundle with the bottom facing downward, attached to the lower part of the front of the pubic symphysis and the penile fascia between the two sides of the loose connective tissue gap, the ligament is strong and short, about 0, 5 cm wide, about 2, 5 cm thick, cut 1/3 to 1/2, can make the The penis can be lengthened by cutting off 1/3 to 1/2, which can make the penis lengthen about 1,0 cm; if the foot of the penile corpus cavernosum is stripped from 1/2 of its full length from the pubic bone branch, it can be lengthened about 2 cm more. The surgical methods of penile enlargement are mainly divided into two categories: (1) increase the amount of peripheral tissue of the penile corpus cavernosum, the main methods are autologous dermal transplantation, dermal fat flap transplantation, autologous fat injection and buried artificial materials, etc., all of which can only lengthen the circumference of the penis at rest; (2) increase the volume of the penile corpus cavernosum, such as saphenous vein patch or other patches sutured between the two traumatic edges of the incised and separated white membrane, the application of this method can However, it remains to be seen whether this invasive treatment of the penile tunica albuginea will lead to fibrosis of the tunica albuginea, penile sclerosis and erectile dysfunction in the long term. What materials are commonly used for penile enlargement surgery? 1, autologous fat injection: the method is simple, less traumatic and easily accepted by the patient, but the transplanted fat particles are easily absorbed, with an absorption amount of 4O ~ 7%, and many patients form irregular fat nodules or have unsatisfactory penile shape due to inconsistent absorption, which often requires another surgical treatment. 2.Liquid silicone injection: In the past, liquid silicone was injected into the penis subcutaneously to thicken the penis, but it was banned due to complications such as silicone granuloma, penile scrotal edema, painful penile erection and erectile dysfunction. 3.Dermal tissue implantation: autologous inguinal or iliac lumbar excision of dermal tissue implantation is likely to cause secondary injury and scar formation in the donor area, and there is a possibility of absorption of the implanted tissue. 4, dermal fat flap implantation: this method is simple and less invasive, the disadvantage is that the donor area has an incision scar, the transplanted fat is easily absorbed, the absorption amount is 3O-6O%, there is also the possibility of necrosis, calcification to form nodules or masses. The follow-up of 1l cases of penile lengthening and dermal fat flap enlargement in patients with conscious penile shortening showed that the average postoperative penis lengthening in the weak state was 1.6 cm (1-2.3 cm), the average penile root thickening was 2.3 cm, and the average penile circumference thickening was 2.6 cm at the subcoronal level. 5, flap application: the application of flap surgery is traumatic, the donor area is scarred and the flap can be extended during erection. The flaps used are inguinal flap, latissimus dorsi flap, etc. The penile circumference of the penis was 7 cm and 11 cm in the preoperative weak state and erect state, respectively, and grew to 16.5 cm and 19.5 cm at 6 months after surgery. 6. Artificial material implantation: the subcutaneous implantation of silicone rubber, pearls or even stones in the penis to thicken the penis is prone to skin breakdown or infection and should not be promoted. 7, allogeneic cell-free dermal matrix (ADM) transplantation: homogeneous AlloDerm has been approved by the U.S. FDA, non-antigenic, non-toxic, less absorption, soft and easy to shape, implantation of neovascularization and fibroblast migration, there are reports that the circumference of the penis in the natural state increased 1.3 to 3.1 cm, an average of 2.6 cm. disadvantage is that the degree of thickening is limited. 8, tumescent polytetrafluoroethylene: tumescent polytetrafluoroethylene (ePTFE) has good biocompatibility, since the 1980s, has been widely used in the treatment of facial soft tissue defects and depression deformities, repair and reconstruction of human blood vessels, in the thickening of the penis at the same time feasible penile lengthening. 9, autologous saphenous vein: the saphenous vein is made into a patch and sutured to the incised white membrane of the penile corpus cavernosum to increase the circumference of the penis. austoni E (1999) in 1995-1997, applied the saphenous vein graft to replace the white membrane in 39 patients, and measured the average increase in penile circumference of 1,1 to 2,1 cm at 9 months after surgery (p someone compared the effect of ePTFE and vein The results of postoperative enlargement of the cavernous cavity of the penis with ePTFE and vein sheets were compared, and no significant difference in efficacy was found between the two at 12 to 24 months of follow-up. The biggest advantage of the method of enlarging the cavernous cavity of the penis is that it really achieves the thickening of the cavernous body of the penis during erection, but objectively destroys the integrity of the white membrane and has the possibility of forming erectile dysfunction.