{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T19:04:44Z","timestamp":1786993484938,"version":"build-2736575974"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T00:00:00Z","timestamp":1593820800000},"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":[[2020,7,4]],"date-time":"2020-07-04T00:00:00Z","timestamp":1593820800000},"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":[[2020,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peyronie\u2019s disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie\u2019s disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>In accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample of 416 patients included 287 cases of Peyronie\u2019s disease having a mean axial deviation of 51\u00b0 (0\u201390\u00b0) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2\u20136) was measured intraoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Diagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient\u2019s subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>The TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jsxm.2020.05.010","type":"journal-article","created":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T07:39:13Z","timestamp":1593848353000},"page":"2093-2103","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures"],"prefix":"10.1093","volume":"17","author":[{"given":"Paulo H.","family":"Egydio","sequence":"first","affiliation":[{"name":"Egydio Medical Center , Sao Paulo, , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,4]]},"reference":[{"key":"2023011111100109200_bib1","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.urology.2012.07.060","article-title":"The natural story of penile length after radical prostatectomy: a long-term prospective study","volume":"80","author":"Vasconcelos","year":"2012","journal-title":"Urology"},{"key":"2023011111100109200_bib2","doi-asserted-by":"crossref","first-page":"3214","DOI":"10.1111\/j.1743-6109.2011.02364.x","article-title":"The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: a single-centre, prospective, open-label, observational study","volume":"8","author":"Park","year":"2011","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.4103\/1008-682X.172822","article-title":"Comparison of the patient and partner satisfaction with 700CX and Titan penile prostheses","volume":"19","author":"Otero","year":"2017","journal-title":"Asian J Androl"},{"key":"2023011111100109200_bib4","doi-asserted-by":"crossref","first-page":"3775","DOI":"10.1111\/j.1743-6109.2010.01971.x","article-title":"Inflatable penile prosthesis placement in men with Peyronie\u2019s disease and drug-resistant erectile dysfunction: a single center study","volume":"7","author":"Levine","year":"2019","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib5","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/bju.12968","article-title":"International multiple psychometric evaluation of patient-reported outcome data for the treatment of Peyronie\u2019s disease","volume":"115","author":"Kueronya","year":"2015","journal-title":"BJU Int"},{"key":"2023011111100109200_bib6","doi-asserted-by":"crossref","first-page":"E213","DOI":"10.1111\/j.1464-410X.2012.11582.x","article-title":"Penile length and girth restoration in severe Peyronie\u2019s disease using circular and longitudinal grafting","volume":"111","author":"Egydio","year":"2013","journal-title":"BJU Int"},{"key":"2023011111100109200_bib7","first-page":"965","article-title":"A new, innovative lengthening surgical procedure for Peyronie\u2019s disease by penile prosthesis implantation with double dorsal-ventral patch graft: the \"sliding' technique\u201d","volume":"116","author":"Rolle","year":"2015","journal-title":"BJU Int"},{"key":"2023011111100109200_bib8","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1111\/bju.13065","article-title":"Penile lengthening and widening without grafting according to a modified \u2018sliding technique\u2019","volume":"116","author":"Egydio","year":"2015","journal-title":"BJU Int"},{"key":"2023011111100109200_bib9","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1111\/jsm.12911","article-title":"Modified sliding technique (MoST) for penile lengthening with insertion of inflatable penile length","volume":"12","author":"Egydio","year":"2015","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib10","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jsxm.2017.11.223","article-title":"The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration","volume":"15","author":"Egydio","year":"2018","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib11","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The International index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"2023011111100109200_bib12","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S0090-4295(98)00582-2","article-title":"EDITS: development of questionnaires for evaluating satisfaction with treatment for erectile dysfunction","volume":"53","author":"Althof","year":"1999","journal-title":"Urology"},{"key":"2023011111100109200_bib13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-dindo classification of surgical complications","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"2023011111100109200_bib14","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1111\/jsm.13054","article-title":"Why are men satisfied or dissatisfied with penile implants? A mixed method study on satisfaction with penile prosthesis implantation","volume":"12","author":"Carvalheira","year":"2015","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib15","doi-asserted-by":"crossref","first-page":"E0133079","DOI":"10.1371\/journal.pone.0133079","article-title":"Women's Preferences for Penis Size: A New Research Method Using Selection among 3D Models","volume":"10","author":"Prause","year":"2015","journal-title":"PLoS One"},{"key":"2023011111100109200_bib16","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jsxm.2016.01.017","article-title":"Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine","volume":"13","author":"Levine","year":"2016","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jsxm.2015.12.016","article-title":"Sub-coronal inflatable penile prosthesis placement with modified no-touch technique. a step-by-step approach with outcomes","volume":"13","author":"Weinberg","year":"2016","journal-title":"J Sex Med"},{"key":"2023011111100109200_bib18","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.urology.2011.11.076","article-title":"Coated implants and \u201cno touch\u201d surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%","volume":"79","author":"Eid","year":"2012","journal-title":"Urology"},{"key":"2023011111100109200_bib19","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.urology.2017.06.020","article-title":"Glans Necrosis Following Penile Prosthesis Implantation: Prevention and Treatment Suggestions","volume":"107","author":"Wilson","year":"2017","journal-title":"Urology"},{"key":"2023011111100109200_bib20","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/00006534-199709000-00017","article-title":"Implementation of parameters in the expansion ratio of mesh skin grafts","volume":"100","author":"Vandeput","year":"1997","journal-title":"Plast Reconstr Surg"},{"key":"2023011111100109200_bib21","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.ijsu.2012.08.013","article-title":"Skin graft meshing, over-meshing and cross-meshing","volume":"10","author":"Henderson","year":"2012","journal-title":"Int J Surg"},{"key":"2023011111100109200_bib22","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/ijir.2016.12","article-title":"Penile intracavernousal pillars: lessons from anatomy and potential implications for penile prosthesis placement","volume":"28","author":"Pagano","year":"2016","journal-title":"Int J Impot Res"},{"key":"2023011111100109200_bib23","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.juro.2009.11.048","article-title":"Inflatable penile prosthesis implantation without corporeal dilation: a cavernous tissue sparing technique","volume":"183","author":"Moncada","year":"2010","journal-title":"J Urol"},{"key":"2023011111100109200_bib24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/01.prs.0000225430.42531.c2","article-title":"The basic science of wound healing","volume":"117","author":"Broughton","year":"2006","journal-title":"Plast Reconstr Surg"},{"key":"2023011111100109200_bib25","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/01.prs.0000437224.02985.f9","article-title":"Wound healing: part I. Basic science","volume":"133","author":"Janis","year":"2014","journal-title":"Plast Reconstr Surg"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609520306469?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609520306469?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/17\/10\/2093\/48526985\/jsm_17_10_2093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/17\/10\/2093\/48526985\/jsm_17_10_2093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T09:47:10Z","timestamp":1675936030000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/17\/10\/2093\/6973767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,4]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,7,4]]},"published-print":{"date-parts":[[2020,10,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2020.05.010","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2020,10]]},"published":{"date-parts":[[2020,7,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2020.05.010","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}