Here is the patent:
Penile LengtheningWith the patient under general aesthesia and in the supine position the lower abdomen, perineum and thighs are prepared and draped. In the classic procedure, a transverse suprapubic incision is made measuring approximately 3 cm in length. Various other incision can be used such as W plastys, Z plastys, vertical and peno-scrotal incisions and the like.The incision site and the adjacent mons tissues are infiltrated with local anaesthetic and adrenalin. The tissues overlying the mons veneris are separated laterally and the fundiform and suspensory ligaments of the penis are visualized.Dissection is carried down by a blunt technique on either side of the suspensory ligament which is then divided under direct vision using diathermy. The dissection is carried out against the body of the symphysis pubis down to the inferior pubic arch level and along the conjoined rami of ischium and pubis for a short distance. During the maneuver the assistant pulls the penis in an inferior direction placing the ligament under tension and it can be seen under direct vision and the neurovascular bundles can also be directly visualized and preserved.At this point, an O Maxon (or other suture material) deep stay suture is inserted into the deep surface of the pubic symphysis and then carried around the right Gracilis fascia and muscle across to the left Gracilis fascia and muscle and the suture left loose. A second O Maxon (or other suture material) is then inserted distal to the first suture so as to further coapt the right and left Gracilis muscles in front of the penis. Two more deep stay
Sutures of O Maxom (or other suture material) are then inserted into the pubic bone inferior surface laterally and left untied. A fifth, sixth and seventh O Maxon (or other suture material) suture are placed into the very superior edge and anterior surface of the exposed symphysis pubis and left untied.The first deep stay suture of O Maxon is then tied commencing with the one involving both Gracili which can be observed to approximate in front of the inferiorly depressed shaft of the penis followed by tying the second O Maxon Gracilis suture. The tissues on each side of the mons veneris at this point are then dissected and the fundiform ligaments which are now clearly outlined as a result of this dissection are also divided under direct vision down to but not including the tissues overlying the spermatic cords on either side. The junction of the perineal and scrotal skin on either side is then identified approximately 3 cm lateral to the midline and one each of the remaining third and fourth O Maxon (or other suture material)
Sutures is/are inserted into the deep layers of the dermis of the scrotum on each side and the
Sutures tied. This draws the skin of the junction side of the scrotum and perineum mediosuperiorally pushing the skin adjacent to it along the newly exposed shaft of the penis. The fifth, sixth and seventh O Maxon suture are inserted into the deep layers of the suprapubic incision in the centre and on either side and are tied so as to gently curve the skin of the mons veneris down over the top of the symphysis pubis further aiding the movement of the abdominal skin onto the new penile shaft.After trimming the wound is closed in layers and dressings are applied.
