Reconstructive Urology Penile Advancement and Lengthening for the Management of Post-circumcision Traumatic Short Penis in Adolescents Ibrahim A. Mokhless, Hussein M. Abdeldaeim, Abdel Rahman, M. Zahran, and Amr Safwat OBJECTIVES To report on the safety of combing suprapubic fat liposuction, penile suspensory ligament severing, and Z-plasty of penoscrotal webbing for penile lengthening in cases of post-circumci- sion traumatic short penis in adolescents. METHODS This prospective study was conducted in 9 male patients with a mean age of 15.6  1.4 years. All patients had a short penis because of traumatic amputation of the glans in 7 patients and both glanular and partial distal corporal loss in 2 patients during circumcision. All were initially treated in childhood by penile skin advancement for phallic coverage. Penile length and circumference were measured pre- and post-operatively, both in the flaccid state at maximal stretch and in the erect state. Operative technique included Z-plasty of penoscrotal web, release of suspensory ligament, and suprapubic fat liposuction. RESULTS Average functional penile length measured 3 months post-operatively had significantly increased by 18-30 mm (mean: 23  4 mm) in the provoked, erect state. All patients had normally developed penile corpora cavernosa and wide circumference (mean: 11.7  0.2 cm). No post-operative complications occurred in any of the patients. No patients had sexual partners or were sexually active. CONCLUSIONS The described technique of penile advancement and lengthening can be safely applied to patients with post-circumcision traumatic short penis. UROLOGY 76: 1483–1487, 2010. © 2010 Elsevier Inc. M ale self-esteem can be affected by external gen- italia image; if a man perceives his penis as inadequate, whether real or imagined, then such feelings invade his interaction with his sexual part- ners and social associates. 1 Increasing the length of the penis has long been a goal for the inconspicuous phallus. Some patients seek advice for penile enlargement for esthetic and functional purposes. 2 Several authors have proposed penile lengthening and girth enhancement in the normal penis. 3 Penile lengthening has also been proposed for a variety of abnormal conditions, including epispadias, 3 Peyronie’s disease, 4 traumatic phallic de- fects, 5 retracted phallus, spinal cord injuries, 6 and buried penis. 7,8 The reported normal length and girth of an adult flaccid penis ranges between 7.6 and 13.0 cm in length and 8.5 and 10.5 cm in circumference, and the reported normal length and girth of an erect penis ranges between 12.7 and 17.7 cm in length and 11.3 and 13.0 cm in circumference. 9-11 Currently, there is no reliable tissue to substitute for the normal corpora cavernosa or for the glans to achieve an actual increase in phallic length or girth. Different techniques manipulate local tissues to achieve apparent or functional lengthening of the penile tissue for esthetic reasons. Most of these techniques are either very aggres- sive, or conversely, too gentle, resulting in either esthetic or functional deficiency. Combining some of the estab- lished techniques provides an easy and effective way to improve the length of the penis. This study aimed at accessing the safety of combined suprapubic fat liposuc- tion, Z-plasty and penile suspensory ligament severing for penile lengthening in adolescent patients with post-cir- cumcision traumatic short penis. MATERIAL AND METHODS The study was prospectively conducted in 9 male patients between 14 and 18 years of age, with a mean age of 15.6  1.4 years. Local ethics committee approval was obtained before the start of the study. Parents of all patients provided signed in- formed consent for the procedure and for the use of induced erection. All patients presented with acquired traumatic phallic From the Department of Urology, Alexandria University and Alexandria University Hospital, Alexandria, Egypt Reprint requests: Hussein M. Abeldaeim, M.D., Department of Urology, Alexan- dria University, Alexandria, Egypt; e-mail: h_abdeldaeim@hotmail.com Submitted: January 1, 2010, accepted (with revisions): June 9, 2010 © 2010 Elsevier Inc. 0090-4295/10/$36.00 1483 All Rights Reserved doi:10.1016/j.urology.2010.06.018