35 Review Received Date: 11.04.2015 Accepted Date: 16.04.2015 © Copyright 2015 by Gaziosmanpaşa Taksim Training and Research Hospital. Available on-line at www.jarem.org DOI: 10.5152/jarem.2015.727 Address for Correspondence: Dr. Özkan Onuk, Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, İstanbul, Türkiye Phone: +90 506 594 27 59 E-mail: drozkanonuk@gmail.com Phalloplasty and Penile Prosthesis Implantation for Micropenis Murat Dinçer 1 , Özkan Onuk 2 1 Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey 2 Clinic of Urology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey ABSTRACT Since pre-historical times, small penis has been a major topic of discussion among males. Adult males and parents of small children consult physicians with a self-diagnosis of micropenis. This potential diagnosis creates signifcant anxiety in parents. However, simply by conducting a urogenital examination and by measuring the penis size, diagnosis can be validated. Determining whether the penis size is within a normal range can serve to reduce anxiety and protect patients from redundant surgical operations. In recent years, various tissue faps are being used for the surgical treatment of micropenis. In parallel to developments in microsurgery, free faps incorporating sensory nerves are being preferred. Prosthetic implantations are currently the best solution for generating erection after the application of tissue fap. However, these implantations differ signifcantly from penile prostheses used for erectile dysfunction. We must wait for the sensation recovery of the phallus prior to the implantation of the prosthesis, and three-piece infatable prostheses must be preferred. Even though contemporary successful operations provide suffcient results for patients, obtaining an erection in phalloplasty patients remains to be the subject of ongoing research. (JAREM 2015; 5: 35-8) Keywords: Micropenis, phalloplasty, penile prosthesis INTRODUCTION Penis has the functions of urinating standing up and sexual inter- course. For performing these functions, the length of penis must be 7.5 cm and above. With regard to age, a penile length below the nomogram specifed by Schonfeld and Beebe (1) is called micropenis. Furthermore, patients whose urethras are not ortho- topic are classifed as microphallus (2). In a newborn, the normal length of penis is accepted to be 3.4±0.37 cm. The measurement values of <2.5 cm are evaluated as micropenis (3). Although long- term data are unavailable, most patients are unsatisfed with their penile appearance; however, they mostly have suffcient sexual function (4). Real micropenis develops because of hormonal abnormalities af- ter the 12 th gestational week. This condition is basically classifed into three groups as follows: hypogonadotropic hypogonadism (pituitary/hypothalamic insuffciency), hypergonadotropic hypo- gonadism (primary testicular insuffciency), and idiopathic. The reasons for developing micropenis are given in the following table in detail. Etiologies I. Testosterone secretion defciency A. Hypogonadotropic hypogonadism 1. Isolated Kallmann’s syndrome 2. Pituitary hormone defciency 3. Prader–Willi syndrome 4. Laurence–Moon syndrome 5. Bardet–Biedl syndrome 6. Rud’s syndrome B. Primary hypogonadism 1. Anorchidism 2. Klinefelter and poly-X syndromes 3. Gonadal dysgenesis (incomplete form) 4. Luteinizing hormone receptor defects (incomplete form) 5. Testosterone steroidogenesis genetic defects (in- complete form) 6. Noonan syndrome 7. Trisomy 21 8. Robinow syndrome 9. Bardet–Biedl syndrome 10. Laurence–Moon syndrome II. Testosterone activity defects A. Growth hormone/insulin-like growth factor-I defciency B. Androgen receptor defects (incomplete forms) C. 5-α-reductase defciency (incomplete forms) D. Fetal hydantoin syndrome