| BackgroundThe penis is the male urinary and reproductive organs , it is the primary sign of men. It has been attended by the relevant medical professionals and men themselves for a long time . Usually the penis with normal appearance but less than the average length of the same age for more than 2.5 standard deviations is called microphallus.Microphallus mainly caused by congenital dysplasia, trauma, animal bites, partial penile cancer, and the contraction of perineal burnt scar . Both its appearance and function will pay great impact on the paticnt's mentality and physiological function . It is necessary for surgical treatment . So the reconstruction of microphallus become a very meaningful job of genital reconstruction.In 1971 and 1974 , Kelly and Johnston disconnect the spongy body from the pubic and ramus of ischium for lengthening the phallus in boys with epispadias and bladder exstrophy , and from then on the penile lengthening is forming . For decades , penile lengthening has been greatly improved , and a variety of surgical flaps are also developed .Whether the doctor the patient himself, the most concerned problem is the efficacy of surgery . But it has not been reported that how long on earth can be extended by the surgery.The penis corpus cavernosum consists of two parts: the inner section and and the extra section .The length of the penis we usually talked about is the extra section of the penis corpus cavernosum . It is difficult for us to measure the inner section of the corpus cavernosum with living body .With the development of imageology and computer technology , three-dimensional visualization technology is increasingly being used in the medical disciplines. It is possible for us tu accurate measure the unknown target in vivo. In this study , we want to evaluate the efficacy of penile lengthening through the three-dimensional reconstruction of the penis corpus cavenosum and the measurement of relevant factors about penile lengthening . Penile girth enhancement is evolved in the 1990s. it has developed nearly 20 years , but both the patient selection, surgical approach and postoperative follow-up about penile girth enhancement have a lot of uncertainty factors . There is a lot of controversy among the various viewpoints . At present, some new technologies, new methods are showing broad prospects, such as the application of tissue engineering and biological materials on penile girth enhancement .However , these newly emerging technologies still do not solve the problem of penile girth enhancement with erection state . In this investigated we design a new type of materials about penile girth enhancement .we verify the thicking status of penile erection and static, and make a preliminary study on the penis before and after operation through animal experiments ,with a view to lay the foundation for clinical application .This research consiste four parts as follow:1. 40 patients with microphallus are from December 2006 to June 2009 of our department . To assess the advantages of the surgical method by a more perfect system.The length of the penis was measured in flaccid , flaccid stretched and erection condition respectively . We investigate the length of extension before and after surgery of different condition ,analyze the dependability between the length of extra section penis and the extension of the penis.2. We collect the pelvic MRI tomography images of the normal adult and the patients with short penis . Three-dimensional computer reconstructions were generated from these data by automatic segmentation and manual segmentation ,surface rendering and volume rendering . We rebuilt the penis ,adjacent pubis, spermatic cord, testis and epididymis .The database of penis and adjacent structure was established , and this can provide data sources for the measurement of each target .3. According to the visual data sets of penis corpus cavernous structure we have built , we can observe the change in form of the penis corpus cavernous before and after operation , measure the distance from the root of the penis to the coronal plane of through the lower edge of pubic symphysis ,measure the length of the penis corpus cavernous from he root of the penis to the coronal plane of through the lower edge of pubic symphysis .Then we can analysis the correlation between the extended length and each measured data. 4. To investigate the design and application of a new type of penis enlargement materials . The penis enlargement device is a unclosed"c"shaped tubular structure with a vertical incision .So it can open and contract with the penis . The animal membrane tissue , tendons , skin and blood vessels been used were fixed by cross-linking, multi-faceted antigen processing and surface activity modifying .It is high stability, good biocompatibility and can induce tissue ingrowth . Then we verify its feasibility through animal experiments.Results1. The patients of this experimental group was 97.5% general comments excellent. The extended length of 3-6 months after surgery is less than the immediate extended length ; the erectile growth multiple is 1.46±0.12 after operation and 1.63±0.19 before operation , it is lower than the preoperative growth rate .The extended length has no significant correlation with the length of the patient .2. We rebuilt the skin, penis, adjacent pubis, spermatic cord, testis and epididymis .The quality of the computerized 3D-reconstructed images was distinct and perfect. All reconstructed structures can be represented individually or jointly , any diameter and angle , whirl with arbitrary axis and arbitrary angle , and all the structures reconstructed could be measured conveniently.3. The normal adult cavernous structure is straight and no bending , while the corpus cavernosum of the microphallus has different degrees of bending rotation .After part of the corpus cavernosum is released , the bending part is pulled straight , and the shape tends to the normal adult sponge . C ' and B was significantly positively correlated ; B as the independent variable x, C 'as the dependent variable y, fitting the regression equation y = 0.165 +0.793 x; C and C' has no significant correlation.4. All animals in this group are primary healing.The flaps are all survived and no foreign body reaction , no infection necrosis ,no wound dehiscence happened .The shape of the penis is normal without obvious deformity .Surgery regional is very significant thickening than before in static and erectile state .The penile girth has no change with continuous observation of one month.The effectiveness of this method is very significant .Conclusion1. In various wound surface covered methods of extended penile corpus cavernosum, scrotum flap has the closest features with the penile penis skin both organizational structure and functional aspects . And it has the smallest changes on anatomical structure and the least trauma .From the poing of view of plastic surgery , it has obvious advantages and it is necessary to be developed and promoted .2. The length of the penis have varying degrees of retraction later ; The penis growth multiples decreased compared with preoperative . The extended length has no significant correlation with the length of the patient .3. We build the 3D database of the normal adult and people with microphallus successfully , and provide the data sources for the relevant measurement .4. The penis chorus cavernous of microphallus coiled in the subcutaneous tissue tin front of the pubic symphysis . Part of it is pulled straight ,which is the anatomic basis of penile lengthening .We can roughly estimate the extended length by preoperative pelvic MRI , 3D reconstruction and parameter measurement .5. We design a new type of penis enlargement materials . The penis enlargement device is a unclosed"c"shaped tubular structure with a vertical incision . It can open and contract with the penis . By dog's penile enlargement experiment shows that the penile enlargement device has good biocompatibility , and can make a significant effect on penile enlargement both normal and erectile state .So it is a safe and effective penile enlargement material .
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