{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:27:42Z","timestamp":1791228462958,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T00:00:00Z","timestamp":1534982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T00:00:00Z","timestamp":1534982400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Silicone blocks and sleeves are simple devices used in cosmetic surgery. They are generally viewed as safe and effective; however, there is little information on their use in the penis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study evaluates a large single-surgeon series using a novel silicone sleeve penile implant (Penuma) to cosmetically correct the flaccid penis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>526 patients underwent elective cosmetic penile surgery using a silicone sleeve penile implant between 2009 and 2014. Institutional Review Board approval was obtained for a retrospective analysis, and study consent was obtained from 400 patients. Penile circumference was measured before surgery, immediately after surgery, and 30\u201390 days after the implant surgery. Using the nonvalidated Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI), changes in self-confidence, self-esteem, and satisfaction scores were assayed 6\u20138 weeks postoperatively. Scores were again assayed 2\u20136 years postoperatively in 77% of patients. The questionnaires rated patient self-confidence, self-esteem, and satisfaction as very low, low, medium, high, or very high.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure<\/jats:title>\n                    <jats:p>Outcomes include changes in penile measurements; changes in APPSSI satisfaction, self-confidence, and self-esteem scores; and incidences of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the 400 patients, the implantation of the Penuma silicone implant increased midshaft circumference from an average of 8.5 \u00b1 1.2 cm to 13.4 \u00b1 1.9 cm (56.7% increase; P &amp;lt; .001). A 2-category improvement in self-confidence and self-esteem was noted in 83% of patients 6\u20138 weeks postoperatively. On long-term follow-up (2\u20136 years; mean 4 years), 72% patients remained improved (2-category improvement in APPSSI scoring), and 81% of subjects reported \u201chigh\u201d or \u201cvery high\u201d levels of satisfaction. The most frequently reported postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%). No patients reported any changes in sexual function, erections, or ejaculation. 3% experienced adverse events necessitating device removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>The Penuma silicone implant can help patients cosmetically correct the penis with increased flaccid penile girth and achieve enhanced self-confidence and self-esteem over the short- and long term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>Strengths include the large number of subjects (400 men) and the long-term follow-up period (2\u20136 years). Limitations include the retrospective and single-surgeon (inventor) nature of the study; the presence of 126 non-consenting subjects, potentially impacting the complication rate; and the APPSSI\u2019s lack of validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Retrospective analysis of 400 men electing to have penile cosmetic correction with the Penuma device demonstrates improvements in girth (56.7% increase) and high and sustained patient satisfaction, self-confidence, and self-esteem with minimal and manageable adverse events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jsxm.2018.07.006","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T07:01:51Z","timestamp":1535007711000},"page":"1216-1223","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":55,"title":["A Single-Surgeon Retrospective and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis"],"prefix":"10.1093","volume":"15","author":[{"given":"James J.","family":"Elist","sequence":"first","affiliation":[{"name":"Department of Urology \u00a0 , Los Angeles, CA , USA"},{"name":"Cedars-Sinai Medical Center \u00a0 , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"Department of Urology \u00a0 , New York, NY , USA"},{"name":"Icahn School of Medicine at Mount Sinai \u00a0 , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Hillelsohn","sequence":"additional","affiliation":[{"name":"Department of Urology \u00a0 , New York, NY , USA"},{"name":"Icahn School of Medicine at Mount Sinai \u00a0 , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Urology \u00a0 , Los Angeles, CA , USA"},{"name":"Cedars-Sinai Medical Center \u00a0 , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Department of Urology \u00a0 , Beverly Hills, CA , USA"},{"name":"MEC \u00a0 , Beverly Hills, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,8,23]]},"reference":[{"key":"2023012309360882500_bib1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.eururo.2008.07.080","article-title":"A\u00a0critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications","volume":"54","author":"Vardi","year":"2008","journal-title":"Eur Urol"},{"key":"2023012309360882500_bib2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1159\/000347044","article-title":"Evaluation of surgical outcome of penile augmentation and lengthening procedures","volume":"90","author":"Nabil","year":"2013","journal-title":"Urol Int"},{"key":"2023012309360882500_bib3","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.purol.2013.02.011","article-title":"La chirurgie esth\u00e9tique des organes g\u00e9nitaux masculins [Aesthetic surgery of male genital organs]","volume":"23","author":"Chevallier","year":"2013","journal-title":"Prog Urol"},{"key":"2023012309360882500_bib4","first-page":"100","article-title":"Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report","volume":"10","author":"Shirvanian","year":"2013","journal-title":"Int J Impot Res"},{"key":"2023012309360882500_bib5","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4236\/oju.2014.47016","article-title":"Surgical treatment of penile deformity due to curvature using a subcutaneous soft silicone implant: case report","volume":"4","author":"Elist","year":"2014","journal-title":"Open J Urol"},{"key":"2023012309360882500_bib6","article-title":"Retrospective analysis of the safety and effectiveness of the silicone block in penile surgery","author":"Kamrava","year":"29, 2015"},{"key":"2023012309360882500_bib7","author":"U.S. Food and Drug Administration. 510(k) premarket notification. Available at:"},{"key":"2023012309360882500_bib8","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s10508-015-0484-6","article-title":"Penile dysmorphic disorder: development of a screening scale","volume":"44","author":"Veale","year":"2015","journal-title":"Arch Sex Behav"},{"key":"2023012309360882500_bib9","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.anplas.2014.03.002","article-title":"Hypertrophie de greffon adipocytaire et lipop\u00e9nosculpture: gestion d\u2019une complication rare [Hypertrophy of fat graft and lipopenosculpture: management of a rare complication]","volume":"59","author":"Moullot","year":"2014","journal-title":"Ann Chir Plast Esthet"},{"key":"2023012309360882500_bib10","first-page":"2231","article-title":"Penile injection with silicone: case report and review of the literature","volume":"5","author":"Silberstein","year":"2008","journal-title":"J\u00a0Sex Med"},{"key":"2023012309360882500_bib11","doi-asserted-by":"crossref","first-page":"181","DOI":"10.4103\/0974-7796.102672","article-title":"Low-grade liquid silicone injections as a penile enhancement procedure: is bigger better?","volume":"4","author":"Sasidaran","year":"2012","journal-title":"Urol Ann"},{"key":"2023012309360882500_bib12","first-page":"3407","article-title":"The effects of penile girth enhancement using injectable hyaluronic acid gel filler","volume":"8","author":"Kwak TI Oh","year":"2011","journal-title":"J\u00a0Sex Med"},{"key":"2023012309360882500_bib13","first-page":"1945","article-title":"Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series","volume":"9","author":"Alei","year":"2012","journal-title":"J\u00a0Sex Med"},{"key":"2023012309360882500_bib14","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/SAP.0b013e318281aece","article-title":"Allograft materials in phalloplasty: a comparative analysis","volume":"71","author":"Solomon","year":"2013","journal-title":"Ann Plast Surg"},{"key":"2023012309360882500_bib15","first-page":"899","article-title":"Long-term infection outcomes of 3-piece antibiotic impregnated penile prostheses used in replacement implant surgery","volume":"188","author":"Nehra","year":"2012","journal-title":"J\u00a0Urol"},{"key":"2023012309360882500_bib16","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.urology.2014.02.028","article-title":"A\u00a0population-based analysis of contemporary rates of reoperation for penile prosthesis procedures","volume":"84","author":"Grewal","year":"2014","journal-title":"Urology"},{"key":"2023012309360882500_bib17","first-page":"1855","article-title":"Infection retardant coated inflatable penile prostheses decrease the incidence of infection: a systematic review and meta-analysis","volume":"188","author":"Mandava","year":"2012","journal-title":"J\u00a0Urol"},{"key":"2023012309360882500_bib18","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s00266-016-0715-9","article-title":"Avoiding psychological pitfalls in aesthetic medical procedures","volume":"40","author":"Wang","year":"2016","journal-title":"Aesthetic Plast Surg"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609518310890?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609518310890?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/15\/9\/1216\/48590338\/jsm_15_9_1216.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/15\/9\/1216\/48590338\/jsm_15_9_1216.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T05:02:15Z","timestamp":1674450135000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/15\/9\/1216\/6980475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,23]]},"references-count":18,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2018,8,23]]},"published-print":{"date-parts":[[2018,9,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2018.07.006","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2018,9]]},"published":{"date-parts":[[2018,8,23]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"A Single-Surgeon Retrospective and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2018.07.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}