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Comment On: Applying Extender Devices in Patients with Penile Dysmorphophobia: Assessment of Tolerability, Efficacy, and Impact on Erectile Function

      Among conservative techniques, penile extenders are the only devices for which efficacy is supported by some scientific evidence, being capable of elongating the penis by 1.5–2.5 cm, with minimal side effects [
      • Oderda M.
      • Gontero P.
      Non-invasive methods of penile lengthening: Fact or fiction?.
      ,
      • Gontero P.
      • Di Marco M.
      • Giubilei G.
      • Bartoletti R.
      • Pappagallo G.
      • Tizzani A.
      • Mondaini N.
      A pilot phase-II prospective study to test the “efficacy” and tolerability of a penile-extender device in the treatment of “short penis”.
      ]. Up to date, however, only a few well-designed studies have been conducted; in this light, the study of Nowroozi et al. is most welcomed, being the largest reported series to assess the use of traction devices on patients with penile dysmorphophobia. According to the authors, penile extenders significantly improved penile length, without affecting the girth, at the cost of minimal morbidity. More importantly, this study was the first to demonstrate some medium-term efficacy, with no decline in length at 32-month follow-up. Despite promising, however, these results are far from being conclusive. Firstly, to date, a clear definition of a “normal penile size” is lacking, and differences in the normal length threshold across different ethnic origins should be taken into consideration [
      • Mondaini N.
      • Ponchietti R.
      • Gontero P.
      • Muir G.H.
      • Natali A.
      • Di Loro F.
      • Caldarera E.
      • Biscioni S.
      • Rizzo M.
      Penile length is normal in most men seeking penile lengthening procedures.
      ]. Secondly, a sharp distinction has to be made between patients with true short penis and those with dysmorphophobia, a false perception of inadequacy of their genitalia. Perceived efficacy of penile extenders may vary across these two categories. Thirdly, the development of validated questionnaires investigating patient satisfaction should be attempted, considering that patients with dysmorphophobia often have unrealistic expectations regarding the outcome of any lengthening procedure and might be disappointed by it. Keeping in mind these limitations, penile traction devices can became a first-line minimally invasive treatment option for selected patients seeking a penile lengthening procedure, after a proper psychological evaluation.
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      References

        • Oderda M.
        • Gontero P.
        Non-invasive methods of penile lengthening: Fact or fiction?.
        BJU Int. 2010; 107: 1278-1282
        • Gontero P.
        • Di Marco M.
        • Giubilei G.
        • Bartoletti R.
        • Pappagallo G.
        • Tizzani A.
        • Mondaini N.
        A pilot phase-II prospective study to test the “efficacy” and tolerability of a penile-extender device in the treatment of “short penis”.
        BJU Int. 2009; 103: 793-797
        • Mondaini N.
        • Ponchietti R.
        • Gontero P.
        • Muir G.H.
        • Natali A.
        • Di Loro F.
        • Caldarera E.
        • Biscioni S.
        • Rizzo M.
        Penile length is normal in most men seeking penile lengthening procedures.
        Int J Impot Res. 2002; 14: 283-286