Penile Girth Restoration Using Bovine Pericardium Matrix In Simultaneous Penile Prothesis Implantation

Mendes, J., Monzato, M., Schuh, M., Favorito, L., Vieiralves, R., Cavalcanti, A.

Penile prosthesis, Girth restoration, Bovine pericardium, Erectile dysfunction, Penile augmentation, Male sexual health

Postoperative dissatisfaction after penile prosthesis implantation is frequently linked to perceived loss of length and girth, with studies reporting dimensional reduction in up to 72% of patients.¹⁻³ While prostheses restore rigidity, they often fail to address the corporal atrophy and aesthetic deficits that impact self-esteem and partner satisfaction.⁴ Emerging techniques have sought to enhance penile girth concurrently with implantation to improve overall outcomes.⁵ This video presents a novel approach for restoring penile circumference using a bovine pericardium matrix, aiming to reverse post-implantation narrowing and preserve preoperative girth, as determined by saline infusion.

A penoscrotal incision is made, followed by dissection to the tunica albuginea. A Penrose drain is applied as a tourniquet for hemostatic control, and saline infusion determines maximum pre-implantation girth. The penile prosthesis is inserted, and girth is reassessed, confirming significant reduction (p=0.001, Cohen’s d=3.82). The Kulkarni maneuver is performed to create a subdartos plane for matrix placement. The matrix is positioned in two sections, ensuring porous surfaces face native tissues while preserving the urethral surface. Fixation is performed with interrupted 4-0 Vicryl sutures at cardinal points. Final measurement confirms girth restoration. The incision is closed in layers, and a compression dressing is applied. Postoperative care includes a 24-hour urinary catheter and a 7-day antibiotic regimen.

The introduction of the bovine pericardium matrix successfully reversed girth reduction, demonstrating a statistically significant improvement (p=0.001, Cohen’s d=-3.82). This approach provides an innovative solution for penile girth preservation, mitigating post-implantation atrophy. This video details key procedural steps, matrix placement, and fixation techniques. Given the increasing prevalence of erectile dysfunction and prosthetic surgeries, standardized strategies for girth preservation are essential. Further studies with larger cohorts and long-term follow-up are needed to confirm these findings and refine protocols.

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