title: The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia.
abstract: OBJECTIVE
  To assess the use of an acellular collagen matrix (Pelvicol, Bard Medical, Covington, GA, USA), a successful agent for reconstructive surgery, for enhancing penile girth.
  
  
  METHODS
  Between June and December 2011, 18 patients (mean age 24 years, range 19-38) had their penis augmented with Pelvicol; the mean (range) penile circumference was 9.2 (7-13) cm before treatment. They were divided into two groups; the first (10 patients) had a Pelvicol sheet of 8 × 12 cm inserted through a V-Y suprapubic incision and wrapped around the shaft in a bilayer under the dartos fascia, but not covering the urethra, with division of the suspensory ligament. The second group of eight patients had the Pelvicol inserted through a subcoronal degloving incision and placed in one layer. The penile circumference was measured at 6 and 12 months after surgery. Patient satisfaction at 1 year after surgery was assessed as 'poor', 'unsatisfied', 'moderately satisfied', 'highly satisfied', or 'excellent'.
  
  
  RESULTS
  The mean (range) increase in girth (circumference) was 2.8 (2-3.2) cm in group 1 and 1.7 (1.2-2) cm in group 2. In group 1, two patients were highly satisfied, four moderately satisfied and four unsatisfied; in group 2, three were moderately satisfied and five unsatisfied. Complications were common in both groups, with five patients in group 1 and three in group 2 developing severe penile oedema and ischaemic shaft ulcers. Removal of the graft was required in two patients in each group.
  
  
  CONCLUSIONS
  This pilot study shows that Pelvicol is not an ideal option for enhancing penile girth, and the method of placement did not apparently influence the result.
authors.affiliation: Elaj Medical Centre, Jeddah, Saudi Arabia ; Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Tealab
authors.affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Aref M
authors.initials: AM
authors.lastname: Maarouf
authors.affiliation: Elaj Medical Centre, Jeddah, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Habous
authors.affiliation: St Peter's Andrology, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Safwat
authors.initials: S
authors.lastname: Abohashem
keywords: Collagen matrix; Dysmorphophobia; Penile augmentation