title: Penile Improvement Protocol in Postoperative Management of Patients Undergoing Metoidioplasty.
abstract: OBJECTIVE
  To introduce a postoperative protocol to optimize the final size of the penis in patients undergoing metoidioplasty.
  
  
  METHODS
  Fourteen patients with the mean age of 29.3 years (8-40 ± 11.7), ten female transsexuals (46 xx karyotype) and four with 5-alpha-reductase deficiency syndrome (5ARDS) who had undergone extensive metoidioplasty entered a penile improvement protocol (PIP) between 2007 and 2015 at a specialized clinic in a general hospital in Tehran, Iran. Subjects were thoroughly instructed, rehearsed on the protocol and closely followed for 24 weeks. Written informed consent was obtained from all participants. We adapted a popular device, the so-called penile traction device, to accommodate the size of the neo-penis.
  
  
  RESULTS
  All patients achieved an increase in their penile length with a mean of 28.42 mm (21-47 ± 6.86). Two subjects developed penile bruises and edema during the protocol implementation. No significant procedural complications were detected in the remaining 12 participants.
  
  
  CONCLUSIONS
  PIP can be an effective step in increasing the size of the neo-penis in patients who have undergone metoidioplasty. We suggest this procedure to be seriously considered in postoperative management of well-informed and motivated patients to improve the final penile length and function in this population. Larger studies are needed to further validate this protocol.
  
  
  METHODS
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authors.affiliation: Sexual Dysfunction and Abnormalities Clinic, Pars General Hospital, Keshavarz Blv., Tehran, 1415944911, Iran. shahryarcohanzad26@gmail.com.
authors.forename: Shahryar
authors.identifier: http://orcid.org/0000-0002-6186-641X
authors.initials: S
authors.lastname: Cohanzad
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D010413:Penis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D057830:Gender-Affirming Surgery / Q000379:methods*; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000706:statistics & numerical data*; D014189:Transsexualism / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gender identity disorder; Metoidioplasty; Penile extender; Penile traction device; Sex reassignment surgeries; Surgical technique; Transsexualism