title: Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function.
abstract: BACKGROUND
  Most men seeking penile enhancement techniques have a normal penile size. They are either misinformed or suffer from penile dysmorphophobia and should be discouraged from undergoing invasive procedures. Less invasive techniques including penile extenders are not associated with major complications and may be beneficial from a psychological perspective.
  
  
  OBJECTIVE
  We conducted this study to assess the efficacy and safety of AndroPenis (Andromedical, Madrid, Spain) penile extender.
  
  
  METHODS
  Between December 2010 and December 2013, 163 men presented to our institution complaining of small penile length and/or girth. All patients received structured psychosexual counseling. Fifty-four patients were willing to use the AndroPenis penile extender after counseling. Patients with major psychiatric disorders were excluded from enrollment. The patients were instructed to wear the device between 4 and 6 hours per day for 6 months. Penile dimensions including flaccid stretched and erected lengths were measured at baseline and after 1, 3, 6, and 9 months. Erectile function was assessed at baseline and 9 months after treatment using the simplified International Index of Erectile Function (IIEF-5). An institutional nonstandardized questionnaire was used to evaluate patient satisfaction at the end of study.
  
  
  METHODS
  Penile length and girth enhancement as well as satisfaction rate and improvement in erectile function were assessed during follow-up.
  
  
  RESULTS
  At 6-month follow-up, a mean gain of 1.7 ± 0.8, 1.3 ± 0.4, and 1.2 ± 0.4 cm was noted for the flaccid, stretched, and erected penile lengths, respectively (all P values < 0.001). During the off treatment period, there were no significant changes in penile lengths. No effect on penile girth was observed. Patient satisfaction survey revealed modest satisfaction. From 13 patients with mild baseline erectile dysfunction, nine patients reported normal erectile function after 9 months.
  
  
  CONCLUSIONS
  Penile extender as a minimally invasive technique is safe and provides modest benefits and patient satisfaction.
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mohammad Reza
authors: MR
authors: Nowroozi
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Erfan
authors: E
authors: Amini
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mohsen
authors: M
authors: Ayati
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Hassan
authors: H
authors: Jamshidian
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Kayvan
authors: K
authors: Radkhah
authors: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Shahab
authors: S
authors: Amini
mesh_terms: D000328:Adult; D057215:Body Dysmorphic Disorders / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D003142:Communication; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000523:psychology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D018579:Patient Selection; D015917:Penile Prosthesis; D010413:Penis / Q000503:physiopathology / Q000601:surgery*; D010549:Personal Satisfaction; D012649:Self Concept; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Body Dysmorphic Disorders; Erectile Dysfunction; Penis; Traction