What is it about?
This paper reports a clinical series evaluating a venous ligation technique performed during penile prosthesis implantation to prevent or reverse postoperative glans shrinkage and coldness and to enhance glanular fullness. Methods Population and procedure Consecutive men receiving penile implants were divided into an enhancing group (implant plus selective ligation of the retrocoronal plexus, deep dorsal vein, and cavernosal veins) and a control group (implant only). Measurements included glenoid circumference and radius (measured manually and on X-ray), operative time, and patient satisfaction. An acupuncture‑assisted local anesthesia protocol was used in many cases. Key findings Anatomic and functional outcomes The enhancing group showed larger postoperative glanular circumference and radius at 1 day and 1 year than controls. Patient satisfaction was higher in the venous‑ligation .group; complaints of cold glans were reduced. Operative tradeoffs The venous‑ligation procedure increased operative time but produced measurable glans enhancement. Clinical implications The technique offers a reconstructive option to mitigate glans shrinkage and coldness associated with penile implants. Patient selection and surgical skill are important: careful dissection, avoidance of excessive thermal injury, and awareness of prior fibrosis or embolic material are essential. Limitations Small, nonrandomized series from a single center; measurement variability between manual and radiographic methods; longer and larger studies needed to confirm durability and safety. Bottom line Selective venous ligation during penile prosthesis implantation appears to enhance glans size and patient satisfaction in this series; however, broader validation is required before routine adoption.
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Why is it important?
This study addresses a common and distressing postoperative problem after penile prosthesis implantation: glans shrinkage and coldness. By describing a targeted venous ligation technique that increased glanular circumference and radius and improved patient satisfaction, it offers a practical surgical strategy to preserve or restore penile appearance and sensation.
Perspectives
Venous ligation offers a targeted solution for glans shrinkage and coldness after penile prosthesis implantation by reducing venous outflow and preserving glanular fullness. It can improve patient satisfaction and functional appearance, but benefits must be balanced against longer operative time and the single‑center nature of current evidence.
Dr. Geng Long Hsu
The Surgeon's View (Dr. Hsu): A penile implant solves the problem of shaft rigidity perfectly, but it often leaves an unfinished result: a soft, "floppy" glans. This aesthetic and sometimes functional mismatch can be a source of patient dissatisfaction. This new technique addresses that directly. By strategically ligating (tying off) specific drainage veins, we can "supercharge" the glans with the patient's own residual blood flow. It’s an anatomical bio-hack that turns a good prosthetic outcome into an excellent, more natural-looking and feeling one. This isn't just about placing hardware; it's about holistic restoration. The Patient's View: "I was so happy to have my ability to get an erection back with the implant, but the soft head bothered me. It didn't look or feel quite right, and sometimes it felt unstable. Knowing there is a surgical step to fix that, to make the whole thing look and feel complete and natural, is a huge relief. It gives me much more confidence in the final result." The Clinical Innovation View: This represents a significant refinement in penile prosthetic surgery. For decades, the focus was solely on the mechanical pump and cylinders. This strategy acknowledges that the glans is a crucial part of the erectile complex and offers a reproducible, physiological method to enhance it. It moves the bar for what is considered a "successful" implant surgery from simple rigidity to comprehensive cosmetic and functional restoration.
Professor Geng-Long Hsu
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology
Read the Original
This page is a summary of: Venous Ligation: A Novel Strategy for Glans Enhancement in Penile Prosthesis Implantation, BioMed Research International, January 2014, Hindawi Publishing Corporation,
DOI: 10.1155/2014/923171.
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