title: Modified Penile Augmentation by Dermal-Fat Graft in Post-Hypospadias Adults.
abstract: BACKGROUND
  Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety.
  
  
  METHODS
  From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18-24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale.
  
  
  RESULTS
  With 6 months' follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients' perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54.
  
  
  CONCLUSIONS
  This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Lisi
authors.initials: L
authors.lastname: Xu
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Muxin
authors.initials: M
authors.lastname: Zhao
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China. n2liyq@163.com.
authors.forename: Yangqun
authors.initials: Y
authors.lastname: Li
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Ma
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Weixin
authors.initials: W
authors.lastname: Wang
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Feng
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Qiyu
authors.initials: Q
authors.lastname: Liu
authors.affiliation: The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33, Ba-da-chu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Ma
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D008297:Male; D010413:Penis / Q000601:surgery*; D012189:Retrospective Studies; D016038:Skin Transplantation; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
keywords: Free dermal-fat graft; Hypospadias; Penile augmentation; Penile size