LAUSR

INTRODUCTION Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery, and aging. Elasticity of the tunica albuginea is adversely affected by any of the above. Fibrosis then triggers progressive erectile dysfunction OBJECTIVES: When a penile prosthesis is indicated, it is important to determine whether the penis has already diminished in size prior to insertion of the implant. Because a prosthesis only provides axial rigidity and is not associated with the enlargement of the penis, reflection of strategies to simultaneously enlarge the size of the penis while implanting a device is recommended. MATERIAL AND METHODS A systematic review of current scientific literature regarding procedures and tactics currently available for penile implants and enlargement was conducted. RESULTS The literature demonstrates that the evolution of penile implant surgery, accompanied by consideration of enlargement, has evolved through 5 fundamental techniques: Incision with Grafting; Sliding with Grafting; Modified Sliding without Grafting (MoST); Multiple Slit without Grafting (MUST); and the Egydio Paradigm for Tunica Expansion Procedures (TEP), a further evolution of previous strategies to achieve state of the art penile implantation accompanied by maximum penile enlargement. Evolving technology of tunica expansion procedures has led to diminution of the size of tunica defects and avoidance of grafts to prevent bulging and indentation, while developing solutions to preserve the strength of the tunica albuginea for firm positioning of the cylinders in the interior of the corpora cavernosa. CONCLUSIONS The evolution of these techniques is the transformation of larger tunica defects into smaller ones. While grafts are often used to reinforce the penile structure due to large defects, multiple incisions of the tunica albuginea are gaining popularity to promote girth and length enlargement without grafts and without the loss of tunica strength necessary to support the cylinders inside the corpora.