There are numerous operations for removal of certain urogenital congenital deformities or non-functionalities and many insecurities can be eliminated through them.
Transsexual surgery represents the finest combination of plastic and urogenital surgery.
The procedures of the penis augmentation imply the surgical techniques which increase width or length of the male sexual organ.
There are several methods of increasing of the male sexual organ. On average, from 1/3 to ½ of penis are in the body connected to the pubic bone. One of the methods of the penis prolongation is based on liberation of the fundiform and suspensor ligament that link the erectile bodies of the penis with the pubic bone. This technique is called ligamentolysis and it provides that the part of the penis which was recessed inside of the body is liberated and the penis gets longer by some 2-3 cm.
The intervention results depend on several factors. The difference in length will be bigger in the patients with larger penis, as usually there is more tissue in the body liberated by intervention than in the patients with smaller penis. Also, if there is more fat tissue in the pubic region, it can conceal the part of the penis and thus reduce the result. Therefore a liposuction of this region often gets performed as well.
After the intervention, it is important to use the so-called vacuum devices, in order to achieve the best possible result.
A curved penis is a very common phenomenon and it can be congenital or acquired.
It can occur anywhere on the penile body and turn it in every direction. A congenital curvature of the penis can be downside/oriented and is caused by the scar tissue located under the penis surface, or it can be lateral to the left or to the right, caused by an uneven length of the erectile penile bodies.
The acquired penile curvature is caused by the disease called the PEYRONIE DISEASE, and results in creation of scar tissue on the very penile bodies. During erection, the scar tissue limits the extension of this part of the penis, and by that causes the bending of the penis to one side.
A surgical technique of treating this problem implies placing of certain sutures alongside the penile body, in order for the genital organ to retreat to the side which is opposite to the curve. This method can sometimes cause mild shortening of the penis, and s therefore often combined with the technique of enlargement of the genital organ.
Peyroni disease is characterised by creation of firm tissue (fibrosis) on the penis (tunica albuginea) which causes pain, curvature and deformation of the penis, usually during erection.
A surgical treatment implies several methods. The simpler one implies placing the sutures alongside the penile body until its full straightening and this method is recommended if there is not a big curve up to 90%.
A more complex procedure implies a removal of these firm fibrous plates, and straightening of the penis, and the defect is covered by special grafts.
It is sometimes necessary to embed the penile prosthesis as well, if the erection is weakened.
An epispadias represents a congenital urogenital anomaly in which the external aperture of the urethra is located on the dorsal-upper side of the penis. The anomaly is characterised by existing of the wide-gapping plate on the upper side of the penile body, while an excess of skin is located on the lower side, covering the glans penis. Often the incontinence-impossibility of retaining the urine is developed, and the most common combined anomalies are cryptorchidism (undescended testicles) and generation of an inguinal hernia. In the adult persons, sexual relations are practically impossible, as the penis is pressed against the anterior abdominal wall.
It is rare in women, and is manifested by a short split urethra and a bifid clitoris. Epispadias is often combined with the bladder extrophy.
An optimal time for surgical correction is around 2 years of age.
A surgical treatment implies a correction of the penile curvature, reconstruction of the missing part of the urethra and achieving of the normal appearance of the external genitals. A full reconstruction of all the parts of the penis is required, along with solving the incontinence problem.
The bladder extrophy represents a lack of a part of the anterior abdominal wall, combined with smaller or bigger defect of the bladder wall. It occurs as a consequence of the embryonic development, and, due to the separated pubic bones, a diastasis of the muscles of the anterior abdominal wall also occurs. This anomaly can be accompanied by inguinal hernias or cryptorchidism (undescended testicles). In boys, it is combines with the small, epispadic penis, and in girls there is epispadias with bifid clitoris.
The most frequent symptoms are constant leaking of urine from the urethral confluences which leads to irritation of the bladder mucous membrane and the surrounding skin, and due to disturbed static of the pelvic band, a so-called duck-walk is recognisable in children.
A surgical treatment implies reconstruction of the bladder and the genitals. It is necessary to put the separated pubic bones and the muscles of the anterior abdominal walls closer, and to close the anterior abdominal wall. Sometimes the bladder is formed by using certain segments of the gastrointestinal tract. The main objective is preservation of the renal function, forming of normal bladder and continence, as well as creation of normal appearance of the external genitals.
The enlarged inner or outer labia represent an aesthetic, psychosexual and functional problem in women. During sexual intercourses, pain and chronic irritation often occur and no adequate hygiene can be maintained. The enlarged inner labia are mostly a congenital problem, and they also occur due to hormonal therapy, after the childbirth, or as a consequence of an injury.
A surgical technique is used to remove the surplus and, if necessary, an additional reconstruction of inner labia is done or the asymmetry is corrected.
A dug-in penis represents a phenomenon in which the penis is hidden, dug in the skin of the pubic region, which significantly reduces its length, and the causes are lack of the skin of the penile body or excess of the fat tissue of the pubic region. It can also occur after overcircumcising or lack of skin.
The dug-in penis represents a functional, aesthetic and psychological problem.
The objective of the surgical intervention is to use the preputium for covering the penis in whole. Sometimes the best effect is achieved by liposuction – removal of the subcutaneous fat tissue of the pubic region. The intervention is completed with exteriorisation of the entire penile body and additional reconstruction of penopubic and penoscrotal angles.
Phimosis
A phimosis is a difficult or fully enabled pulling the foreskin over the glans penis, and the disease can be congenital or acquired. The glans penis cannot be liberated – sometimes only in erection, and sometimes in the loose state as well. Besides, there is a situation when the frenulum on the lower side of the glans penis is short, and at pulling the foreskin, this frenulum pulls the glans penis downwards and creates pain, interfering with normal sexual intercourse. The frenulum often breaks, which creates painful sores which heal with difficulty, and when they do, the frenulum can become even shorter. The acquired phimosis can occur due to scarring and narrowing of the preputium after the inflammation processes or due to the oedema after the acute inflammation. Due to the excess skin, there is a urine blockade, smegma secretion and secondary infection, which leads to chronic irritation.
Circumcision is a surgical technique by which an excess skin is removed partially or in whole, and is performed in local anaesthesia.
Paraphimosis
Paraphimosis is a condition in which the foreskin cannot be pulled back over the glans penis and cover it, but it remains under the glans penis and tights it firmly causing pain and swelling, and in a long-lasting one even a gangrene.
Paraphimosis occurs most often after masturbation or sexual intercourse, while the penis is still erected, and it can happen in children (although rarely), e.g. at maintaining hygiene or forced pulling over the foreskin.
The objective of the surgical intervention is to cut the foreskin and to free the glans penis. If there is gangrene, a radical circumcision of the foreskin is required.
Objective
Reduction or amputation of the breasts and forming of natural, flat male breasts (after a genital transformation of the female into male sex).
Operational technique
The mammary gland and the excess skin are removed through the circular incision around the nipple. The aspiration drainage is left and stays there for 48 hours.
Duration of procedure and anaesthesia
The operation is performed in total anaesthesia in duration of 1,5 – 2 hours, depending on the breast size.
Recovery
Wearing of elastic compressive bandage for a week is necessary. The sutures are removed gradually after 10 to 14 days.
Rare complications
A creased skin around the nipple, which gradually disappears completely after several months
