Penile augmentation with injectable hyaluronic acid gel:an alternative choice for small penis syndrome

There is no well-established procedure for the management of small penis syndrome(SPS),especially when psychological interventions fail.This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation(PA)using injectable hyaluronic acid(HA)gel.Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year.Penile size,erectile function,and psychological burden measured by the Index of Male Genital Image(IMGI),Index of International Erectile Function(lIEF),and Beliefs about Penis Size(BPAS),respectively,were assessed at the beginning and at 1,3,6,and 12 months postinjection.The volume of HA gel injected was 21.5±3.7 ml.Compared to baseline data,flaccid penile girth and length significantly increased by 3.41±0.95 cm(P<0.01)and 2.55±0.55 cm(P<0.01)at the 1^(st)month postinjection,respectively.At the endpoint,despite attenuations,statistically significant improvements in flaccid penis size were still obtained,namely 2.44±1.14 cm in girth(P<0.01)and 1.65±0.59 cm in length(P<0.01).Similarly,erectile penile girth statistically increased by 1.32±1.02 cm(P<0.01)at the 1^(st)month but were only 0.80±0.54 cm bigger than baseline(P<O.01)at the endpoint.At the 1^(st)month,the average score of IMGI and the mean score of IIEF statistically increased by 46.2±10.5(P<0.01)and 7.6±6.2(P<0.01),respectively;the score of BAPS significantly decreased by 18.3±4.5(P<0.01).These alterations remained steady during follow-up.Considering the significant penile size improvement,lasting psychological benefit,and low complication rate,PA with HA might serve as an appropriate alternative for patients with SPS.

Complications and management of penile augmentation with hyaluronic acid injection

Hyaluronic acid injection is becoming a popular way for penile augmentation.However,only few studies and follow-ups have investigated the various complications of hyaluronic acid injection and their corresponding management.In this study,a total of 230 patients who had penile augmentation with hyaluronic acid injection from January 2018 to December 2019 were examined on follow-up for penile girth,complications,and their corresponding management.At 1-month,3-month,and 6-month postoperative follow-ups,the penile circumference had increased by 2.66±1.24 cm,2.28±1.02 cm,and 1.80±0.83 cm,respectively.During the entire 6-month follow-up,4.3%had complications such as subcutaneous bleeding,subcutaneous nodules,and infection.There were no systemic or local allergic reactions among all the patients.All complications were treated accordingly,and no further deterioration or severe sequelae were observed.Although complications of hyaluronic acid injections are mild and rare,these may affect the patient's satisfaction postoperatively.Preoperative redundant prepuce may increase the incidence of penile edema or postoperative gel migration.Standardization of the surgery protocol and elucidation of the effects of other injection parameters are still lacking.Nevertheless,it still highlights the importance of preoperative preparation and surgical technique.