In 2017, a professor from South Africa, Andre van der Merwe, performed a successful penile transplant operation. A 40-year-old patient, who as early as the age of 19 after unsuccessful circumcision, lost his penis, managed not only to engraft the donor organ, but also to restore all its functions – urinary and erectile. On account of André van der Merwe is the third such transplant (first operation was carried out in 2014), and despite the development of plastic surgery, no one else in the world has not been able to repeat his success. Yet the plastic of the male genital organs, although less radical, is becoming increasingly popular. MedAboutMe will talk about the most common operations and how modern medicine can help.

Indications for genital plastic surgery

Plastic surgery   – A specific section of surgery, since the operations here are carried out both for medical reasons, and at the request of the patient. And a change in the male genital organs is no exception. According to American clinics, more and more patients are seeking correction plastic surgery – a change in the shape of the penis, its size and other things. However, among the entire array of manipulations carried out, operations are still mostly medically necessary. So, the reason for the surgical intervention can be:

• Congenital pathologies of various kinds, in particular, cryptorchidism.
• Underdevelopment of the penis.
• Pathological phimosis.
• Erectile dysfunction associated with vascular problems.
• Erectile dysfunction in the face of Peyronie’s disease.
• Impotence caused by endocrine disorders.
• Cavernous fibrosis (a pathology in which penile tissue is replaced by connective, non-elastic tissues).
• Complications of genital injuries.
• Correction of defects after surgical manipulations on the genitals, bladder, prostate.
• Reconstructive surgery after surgical treatment of penile cancer.
• Sex change operations.

Plastic bridle and circumcision

Frenulotomy – surgical dissection of the foreskin frenum is one of the most common operations for the correction of male genital organs. It takes only 15-20 minutes, hospitalization after the procedure is not required, and the man can return to daily business on the same day. The stitches are removed, as a rule, on the 7-10th day, after which all functions of the penis are restored completely.

The operation is prescribed for defects of the bridle, which are particularly pronounced during intercourse. Patients often complain of discomfort, pain, and sometimes even bleeding due to small tears of tissue. If a man is slow to consult a doctor, psychogenic erectile dysfunction may develop against the background of such symptoms.

It is possible to determine the defects of the bridle in boys, even before the onset of sexual activity. Most often, the surgeon draws attention to the pathology at a general examination. Since frenulotomy is not a complicated operation, it has no age limit — it can also be done by adolescents.

Another common operation is circumcision (circumcision). The procedure is ritual in some traditional societies and in this case is done to all boys, often still in infancy. But for circumcision there is also a medical indication – pathological phimosis. It is important to distinguish pathology from the physiological state, because the narrowing of the foreskin to about 7 years is considered the norm of development. According to statistics, phimosis is observed in:

• 50% of boys in the first year of life.
• 11% of boys up to 3 years.
• 8% of boys 6-7 years old.
• 1% of adolescents aged 16-18.

Therefore, frenulotomy is considered an extreme measure and is used only if phimosis is diagnosed in an adult patient and is not eliminated by other methods of treatment.

Change in penis size

Changing the size of the genital organ – in most cases only cosmetic procedure, which is carried out at the request of the patient, and not for medical reasons. The only exceptions are cases of underdevelopment of the penis, if the defect does not require major surgery, but is eliminated with the help of fillers and implants.

All resizing procedures can be divided into three categories:

• Thickening of the penis.
• Increase the diameter of the head.
• Correction of the bridle of the head (volume increase).

In modern plastic surgery for such operations, various filler materials are used. Including hyaluronic acid injections and silicone implants, which are popular in cosmetology. It should be noted that the use of non-encapsulated fillers, that is, simply injections of various biogels without silicone capsules, is officially banned throughout the world in plastic surgery. The patient’s own tissue can also be used as a filler. But most often, this method surgeons resort to operations to lengthen the penis.

Correction of the curvature of the penis

Curvature of the penis, as a rule, are noticeable only in the erect state. With a small defect, surgery is rather a cosmetic procedure. However, if the deformity is pronounced, during sexual intercourse, the man experiences discomfort and   pain that can result in sexual dysfunction.

There are two ways to eliminate the defect – shortening the healthy part and lengthening the deformed part of the penis. Despite the fact that 70-80% of patients prefer the second option, such an operation is considered more difficult. The fact is that to lengthen the penis, surgeons will need a special insert – a piece of skin and a fragment of a vein. If, for any reason, after the operation, complications begin and the tissues do not take root, this will affect the erection. The period of rehabilitation of the patient after such surgery will be 3-4 weeks.

When shortening a healthy part of the genital, its length changes by an average of 1.5 cm, rarely by 2 cm. The operation takes place with a lower risk of complications, and recovery takes 2-3 weeks.

Plastic frenulum, circumcision and resizing with fillers are done under local anesthesia. But the correction of the curvature will require general anesthesia, therefore, in itself, such an operation is considered more complex. The patient will have to undergo preoperative preparation, and after the manipulation, he will need to stay in the hospital for another 2-3 days.

Phalloprosthetics and potency

Modern prosthetics helps to solve a number of problems associated with pathologies and diseases of the penis. So, the indications for falloprotezirovanii are:

• Erectile disfunction.
• Damage to the nerve pathways responsible for erections.
• Injuries to the penis or scrotum.
• Any abnormalities in the blood supply to the penis.
• Congenital or acquired defects.
• Damage to the organ, for example, due to radical cancer treatment or injury.

Unlike transplantation, penis prosthetics is a common operation that has been practiced in plastic surgery for several decades. At first, rigid foundations were used as prostheses, but since this greatly complicated the daily life of the man, they were eventually abandoned. Today, surgeons offer two options:

• Plastic prostheses that can be given a different shape. This is ensured by a metal rod inside.
• Inflatable prostheses, in which you can change the stiffness, and therefore completely imitate the state of rest and erection. Foreign clinics almost completely switched to this type, and all modern research related to prosthetic penis, go in that direction.

With the help of inflatable implants that are implanted in the cavernous (cavernous) body, sexual dysfunction can be treated. According to statistics, this method gives a positive result in 92-95% of cases, and therefore is the most effective among all methods of treating impotence. Moreover, now such operations are carried out even for men with psychogenic sexual dysfunction, that is, in the case when there are no medical reasons for the lack of an erection. Such a prosthesis is completely invisible, which is very important for patients with psychological problems.

Testicular implantation

Implantation of the testes is not able to restore their function. Therefore, it refers to a cosmetic, rather than a medical procedure, because in this case it is only necessary to recreate the healthy appearance of the scrotum. Prostheses come in different sizes, but the choice of a suitable option is the prerogative of the doctor alone. If the implants are too large, they will cause discomfort, in severe cases, can lead to impaired blood circulation in the scrotum, and this in turn will lead to inflammation, erosion or tissue necrosis.

Implantation is prescribed in the following cases:

• Congenital absence or underdevelopment of the testicles (anorchism, monorchism).
• Testicular atrophy in case of myocardial infarction.
• The consequence of injuries and accidents.
• Resection for cancer or testicular tuberculosis.

Prostheses are made of polymeric materials, as a rule, they take root well and quickly. After the operation, the man does not need inpatient treatment, but must regularly come to the attending physician for checkups.

Phalloplasty: sex change and other cases

One of the most difficult operations in plastic surgery of the male genital organs is phalloplasty. In essence, this is a complete restoration of the organ, in which the patient’s tissue is taken as the material. In addition, to recover   potency   in this case prosthetics are additionally performed.Such an operation is prescribed to patients who want to change their sex, as well as in the event of a traumatic loss of the sexual organ.

Such operations are becoming more common – according to the American Plastic Surgery Society, only in 2015 the number of patients wishing to change their sex increased by 20%. In 2016, more than three thousand phalloplasty and vaginoplasty were performed in the USA alone.

As a material for the reconstruction of the sexual organ, skin grafts are taken from different parts of the body. Studies show that the use of forearm tissue is most effective. Doctors get especially good results if penis restoration is performed not for transgender people, but for patients who have suffered injuries. So, British researchers from University College London (University College London) evaluated the results of phalloplasty on the basis of the radial artery (tissue from the forearm) in 10 men who had lost an organ as a result of accidents. After 4 years after the operation, all patients were satisfied with the result, they also had their urinary function. To achieve an erection, inflatable implants were installed in such patients, but over time, some of them showed problems with them. According to researchers, prostheses should be periodically replaced, and this should be prepared by men who go for such an operation.

A similar study was conducted based on data from patients in a hospital in Virginia (USA). The case histories of 93 patients who were operated from 1983 to 2015 were studied. Among them were both men who had suffered injuries and people who had undergone a sex change operation. It is in the latter that the urethra was more often observed – this diagnosis was made in 56% of patients. The high frequency of complications may be due to the fact that when the sex is changed, the urethra is formed “from scratch”.

25% of the studied patients of the clinic in Virginia said that after surgery are active in intimate terms. However, today with phalloplasty, this can only be achieved with the help of prostheses, since the replacement of the unique erectile tissue of the penis has not yet been found. At the same time, after the organ transplantation operations performed by the surgeon Andre van der Merwe from South Africa, the patient’s erectile function was restored.

Child surgery

Plastic surgery of the genital organs in childhood is associated primarily with developmental pathologies. One of the most common today is hypospadias – the location of the opening of the urethra is not in place, shifting it towards the perineum. Over the past few decades, doctors have noted a significant increase in the number of newborns with such a diagnosis. For example, in the 1980s, hypospadias occurred in 1 of 500 male babies, and today it occurs in 1 of 150 newborn boys. In addition, most often the pathology of the urethra is accompanied by various curvatures of the penis. With this diagnosis, the operation is carried out as early as possible, and the defect is eliminated in the first year of life, the optimal age for treatment is 6-18 months of a child’s life.

With other pathologies, the situation is somewhat different. For example, cryptorchidism, undescended testicle into the scrotum, is treated later. During the first half of life, 75% of boys with such a pathology have an independent prolapse of the testicles. And if at birth a diagnosis is made of 4-5% of full-term and almost 20% of premature male babies, then by the age of 1 year their number will decrease to 1%. After the first year of life, an independent drop in the testicle is unlikely. The European Association of Urology in 2016 imposed a ban on such operations for up to 6 months, and the ideal age is considered to be 12-18 months. But if the surgical intervention is carried out after 24 months, the risks of complications (including infertility) increase significantly.

The most severe cases of plastic surgery of the genital organs in infancy are associated with the birth of hermaphrodites, children with male and female sexual characteristics. According to statistics, one out of 2,000 newborns has pathologies that do not make it possible to unambiguously determine which sex a child is. At the same time, true hermaphroditism, the presence of male and female genital organs, is extremely rare.

The choice of gender in this case is the task of the parents, but doctors do not recommend rushing. Moreover, in some countries, in order for adults to have enough time to decide, they will introduce various special rules for the registration of children. So, in Australia, you can enter floor X, and later, after the operation, change to the selected one. In Germany, it is allowed not to enter in the documents data on the field to 18 years. Doctors believe that it is possible to determine which sex is best left to the child during the first half of the year – during this time the necessary tests and examinations are done. It is ideal to perform a surgical procedure up to 9 months, but in the extreme case, the decision can be postponed until 1.5 years.