title: Penile enhancement using autologous tissue engineering with biodegradable scaffold: a clinical and histomorphometric study.
abstract: BACKGROUND
  Autologous tissue engineering with biodegradable scaffolds is a new treatment option for real penile girth enhancement.
  
  
  OBJECTIVE
  The aim of this article is to evaluate tissue remodeling after penile girth enhancement using this technique.
  
  
  METHODS
  Between June 2005 and May 2007, a group of 12 patients underwent repeated penile widening using biodegradable scaffolds enriched with expanded autologous scrotal dartos cells. Clinical monitoring was parallel to histological investigation of tissue remodeling. During second surgical procedure, biopsies were obtained 10-14 months after first surgery (mean 12 months, N=6) and compared with those obtained after 22-24 months (mean 23 months, N=6), and control biopsies from patients who underwent circumcision (N=5). Blind evaluation of histomorphometrical and immunohistochemical finding was performed in paraffin sections.
  
  
  METHODS
  Penile girth gain in a flaccid state ranged between 1.5 and 3.8 cm (mean 2.1 ± 0.28 cm) and in full erection between 1.2 and 4 cm (mean 1.9 ± 0.28 cm). Patients' satisfaction, defined by a questionnaire, was good (25%) and very good (75%).
  
  
  RESULTS
  In biopsies obtained 10-14 months after first surgery, highly vascularized loose tissue with collagen deposition associated with small foci of mild chronic and granulomatous inflammation surrounding residual amorphous material was observed. Fibroblast-like hyperplasia and small vessel neoangiogenesis occurred intimately associated with the progressive growth of vascular-like structures from accumulation of CD34 and alpha-smooth muscle actin-positive cells surrounding residual scaffold-like amorphous material. Capillary neoangiogenesis occurred inside residual amorphous material. In biopsies obtained after 22-24 months, inflammation almost disappeared and tissue closely resembled that of the dartos fascia of control group.
  
  
  CONCLUSIONS
  Autologous tissue engineering using expanded scrotal dartos cells with biodegradable scaffolds is a new and promising method for penile widening that generates progressive accumulation of stable collagen-rich, highly vascularized tissue matrix that closely resemble deep dartos fascia.
authors.affiliation: Serbian Academy of Science and Arts, School of Medicine-University of Belgrade, Belgrade, Serbia. perovics@eunet.rs
authors.forename: Sava V
authors.initials: SV
authors.lastname: Perovic
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
authors.forename: Rados
authors.initials: R
authors.lastname: Djinovic
authors.forename: Amedeo
authors.initials: A
authors.lastname: Ferlosio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Augusto
authors.initials: A
authors.lastname: Orlandi
mesh_terms: D020341:Absorbable Implants; D000199:Actins / Q000378:metabolism; D000328:Adult; D018952:Antigens, CD34 / Q000378:metabolism; D001706:Biopsy; D002196:Capillaries / Q000378:metabolism; D005347:Fibroblasts / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D009130:Muscle, Smooth / Q000378:metabolism; D018919:Neovascularization, Physiologic; D017060:Patient Satisfaction; D010413:Penis / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D023822:Tissue Engineering; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous
chemical_list: D000199:Actins; D018952:Antigens, CD34; D019394:Ki-67 Antigen