Penile hypoplasia (small penis) Treatment in Germany

A small penis causes a man psychological discomfort and disrupts the quality of sexual life. The penis can be enlarged. In childhood, this can be done with conservative methods, and adult men need penis enlargement surgery. When you opt for treatment at German hospitals, penis enlargement surgery will be successful even if the initial size of the organ is less than 2.5 cm. Doctors will restore the aesthetics of the penis and all its functions. You can find out the cost of treatment and make your treatment appointment at a German hospital on the Booking Health website.

Content

1. Causes of a small penis
2. Diagnostics
3. Conservative treatment
4. Penis enlargement surgery
5. Where to undergo treatment?

Causes of a small penis

The size of the penis does not matter for fertility and usually does not affect the function of urination. A little cock, however, gives rise to psychological complexes and disrupts the quality of sexual life. Many men, therefore, want to undergo treatment.

From the point of view of medicine, a small penis is considered to be up to 9.5 cm in length. If the size is less than 2.5 cm, the diagnosis of hypoplasia of the penis (micropenis, microfallia, or microphallus) is established. In addition, even a dick larger than 9.5 cm can be perceived by a man as an organ of insufficient size. The relationship to the required length is subjective. Sometimes a patient has a medically normal dick but still visits a doctor for penis enlargement surgery.

The organ reaches its final size at the end of puberty. This happens under the influence of hormones. The size of the organ is genetically determined and also depends on hormonal levels. During life, it does not change significantly.

An acquired reduction in the size of the dick is also possible. For example, it occurs in men with prostate cancer as a result of treatment. After prostate removal surgery, the length of the penis decreases by an average of 1 cm. When using hormone (androgen deprivation) therapy for prostate cancer, the size of the organ decreases by an average of 2 cm. This method of treating prostate cancer involves prescribing drugs that block the production of male sex hormones. The therapy slows down the progression of prostate cancer, prevents recurrence, or shrinks an existing tumor, but it also causes changes in the body associated with androgen deficiency.

Hypoplasia of the penis is a congenital disease. The condition originates during intrauterine development due to gonadotropin deficiency. Gonadotropins ensure the maturation of the reproductive system. Hypoplasia of the penis is not inherited, since the causes of hormone deficiency are usually external but not genetic. As a rule, this is a consequence of the influence of toxins or drugs on the mother's endocrine system during her pregnancy. Less commonly, chromosomal mutations may lead to hypoplasia of the penis.

In childhood and adolescence, the cause of a little cock may be hypogonadism, which is impaired production of male sex hormones in the testicles. The condition can be primary or secondary. In the primary form, the testicles are damaged, so they cannot produce enough hormones. In the secondary form, the production of pituitary gonadotropins, which stimulate the production of testosterone in the testicles, is disrupted. The consequences of both types of the disease are the same, but the treatment methods are different. Hormone therapy can usually solve the problem of a small penis without any surgery when the endocrine disorder is timely detected and corrected, that is, during genital development (puberty).

Diagnostics

The fact of a decreased penis size relative to the norm is easily determined by the results of a clinical examination. No additional tests are needed for this. Doctors can measure the penis and make a diagnosis.

Additional diagnostics with laboratory and instrumental methods serve to determine the causes of a small dick, identify concomitant disorders (hypospadias, cryptorchidism, etc.), and plan treatment. Differential diagnostics of small penis syndrome are made with intersexuality and a hidden penis (normal dick size but hidden due to changes in the tissues of the pubis and scrotum).

If there are any signs of genetic pathology, karyotyping and other genetic tests will be performed. They will help identify chromosomal rearrangements and gene mutations.

All patients undergo laboratory diagnostics aimed at assessing sex hormone and gonadotropin (FSH and LH) levels in the patient's blood. These tests can detect hypogonadism as well as determine its form and severity.

Ultrasound is considered the main method in urology for imaging diagnostics of the genital organs. Doctors can evaluate the structure of the penis and scrotal organs. If an ultrasound scan is not informative enough, an MRI can be performed, but the need for it rarely occurs.

Conservative treatment

The best results of conservative treatment of hypoplasia of the penis can be achieved in the first 3 months of life. Short courses of testosterone treatment can enlarge the dick. If treatment is prescribed later, it will also be effective, albeit to a lesser extent.

As for the treatment for adult men, there are no reliable non-invasive methods to thicken the penis. The length can be increased with the help of expanders. This method of treatment is long, causes discomfort, and sometimes even leads to complications. Treatment continues for 3 to 8 hours a day. The lengthening will be modest (about 1.5 cm on average), so patients with a significantly decreased penis size may not benefit from this treatment option.

Penis enlargement surgery

Doctors use different types of surgery for the enlargement of a subjectively small penis or the repair of the organ in patients with hypoplasia of the penis. In the first case, only a slight penile lengthening and thickening are sufficient. The second case implies that the penis practically has to be created anew from other tissues.

The main types of surgery are as follows: 

Ligamentotomy. This surgical procedure can be performed for penis lengthening. The suspensory ligament holds part of the dick inside the pelvis. It is cut through, as a result of which another 3-5 cm of length is released. Previously, this operation was performed through the pubic bone. But this intervention is excessively traumatic, so many hospitals now perform it through a scrotal incision.

Muscle plastic repair. Doctors implant a vascularized (containing feeding blood vessels) fragment of the skeletal muscle under the penile skin to thicken the dick. During the operation, the suspensory ligament is simultaneously cut to lengthen the penis. The technique allows surgeons to achieve moderate results. It is used for a subjectively small penis, but is not suitable for men with hypoplasia of the penis, as it does not allow for bringing the size of the organ to normal values.

Adipose tissue plastic repair. The technique involves the use of rotation groin skin-fat flaps. The flap is placed under the skin of the penis. This is a less traumatic operation, but the effect may be short-lived, as over time, adipose tissue atrophy occurs and the dick size decreases.

Injection techniques. This treatment option can be used for a small penis thickening, but it is not suitable for the treatment of hypoplasia of the penis. The essence of the method is the injection of fillers under the skin. As a rule, doctors use the patient's own adipose tissue or hyaluronic acid. Over time, the volume will still decrease. Injection methods began to be used back in the 1990s of the last century, when doctors used liquid paraffin and other mineral oils. In this case, severe complications occurred due to the presence of a foreign body, such as granulomas, ulcers, and inflammation. They then began to use silicone, fat, and hyaluronate. In recent years, new materials have appeared. Polymethyl methacrylate microspheres are considered one of the most promising areas of injection treatment for small penis syndrome. They provide a permanent effect and a low risk of complications. At the same time, they allow doctors to increase the circumference of the penis up to 4 cm. Studies show that the microspheres do not migrate, even several years after their implantation.

Microsurgical phallourethroplasty. This is a general name for many types of micropenis operations. In fact, this is the restoration of a dick from other tissues. It is aimed at organ enlargement, the achievement of acceptable aesthetics and functionality, and the possibility of standing urination. At the same time, it is important that the penis performs its sexual function after treatment and that a man retains the ability to have an erection.

There are many methods of phalloplasty. Whenever possible, doctors preserve as much of the patient's own penis tissue as possible, including the corpora cavernosa, urethra, and a neurovascular bundle. Glans penis is formed from displaced or pedicle musculocutaneous grafts. The urethra is lengthened with the help of plastic repair with a skin-fascial flap, for example, from the palmar surface of the forearm. A tube is formed from it, which is inserted into the body of the penis, forming an anastomosis with its own urethra. The operation is complex and lengthy. Physicians have to use microsurgical techniques to suture the nerves and blood vessels, thereby ensuring reinnervation and revascularization of the reconstructed dick.

Some patients require more than one operation. Once all wounds have healed and the neophallus has reached its final size, an intervention may be required to adjust the length of the urethra to match the size of the penis.

A two-stage phalloplasty technique is often used in surgery, in which the dick is initially restored without urethral lengthening. The opening of the urethra after the first stage of the operation does not occur at the head but closer to the base of the penis. Some doctors choose to form a cystostomy, that is, the outer opening from the bladder to let urine out. Six months later, the second stage of the operation will be performed, namely the urethroplasty. The urethra is formed from a skin-fascial flap, and then implanted into the penis, connected to the patient's own urethra, nerves, and blood vessels.

Falloprosthetics. This is a stage of the operation that sometimes complements phalloplasty. The difference is that endoprostheses are used to restore the erectile mechanism. They are placed inside the dick. Fluid is pumped into the prostheses from the reservoir. The reservoir itself can be placed in different places depending on the design of the prosthesis, for example, in the scrotum or above the pubis. This is a rare solution to the problem of hypoplasia of the penis. This treatment option may be resorted to only when erection cannot be restored with other methods.

Where to undergo treatment?

You can undergo your treatment in Germany. Doctors at German urology clinics achieve good results even in patients with a very small penis. The most complex operations are performed here, restoring the organ from scratch while maintaining an erection and urination function. Operations provide good aesthetic results, so a man can have a normal sexual life without any psychological discomfort.

There are a few reasons for you to undergo your treatment at a German hospital. These are as follows: 

• accurate diagnostics for determining the cause of a little cock or underdevelopment of your penis;
• effective conservative treatment of penile hypoplasia in children;
• German hospitals offer conservative treatment for a moderate penis enlargement in adult men;
• minimally traumatic and safe operations to lengthen and thicken a subjectively small penis;
• surgeons at the German hospitals perform operations of any complexity for the treatment of a micropenis, ensuring the restoration of the aesthetics of the organ, and all its functions.

You can find out the cost of treatment and make an appointment for your treatment in Germany at a favorable price on the Booking Health website. Our website presents the best German hospitals specializing in penile surgery. The Booking Health service allows you to sort hospitals by their rating, cost of treatment, patient reviews, or the nearest free treatment date. The company's specialists will advise you on all issues, help you choose a hospital, and organize your trip. When you choose a medical care program at a German hospital through Booking Health, the cost of treatment will be lower due to the absence of taxes for foreign patients.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

MedicineNet

The Lancet

Johns Hopkins Medicine