| 評 論 |
綜觀古今，男子氣概經常被和陰莖的尺寸作聯結。生殖器矯正手術往往在手術的技巧選擇、適應症以及倫理議題一直以來都爭議不休。然而當今尋求陰莖整形增大術 (augmentation phalloplasty) 的患者多數沒有先天性的陰莖短小症，相反的，多數人是遭受陰莖畸形畏懼症 (penile dysmorphophobia) 所苦。
根據Loeb於1899年在德國的數字統計，男性於陰莖疲軟的狀態下平均長度為9.4cm; 而美國性學學會 (American Institute for Sexology) 公佈的數據則顯示疲軟時的長度平均為7.5公分而勃起時的長度約為14.5公分。儘管在不同時期不同區域所做的陰莖平均長度測量有如此大的變異性，從生理學的觀點上來看只要陰莖長度有5公分即有完全的生理及生育的功能。
目前陰莖擴大整形術的類別與手術方式約有下列幾種：
- 陰莖增長：韌帶鬆解術合併皮膚推進 (Ligamentolysis with skin advancement)、陰莖拆卸 (Penile disassembly)、恥骨上脂肪切除術 (Suprapubic lipectomy)、陰莖植入物置放 (Implant placement)
- 周長擴大：移植 (Graft)、皮瓣 (Flap)、填充物 (Filler)、注射 (Injection)
在系統性的回顧中，陰莖增增長術最廣為使用的術式分別為韌帶鬆解術合併皮膚推進(7篇文獻共339位患者, 94.6%)及陰莖拆卸術(1篇文獻共19位患者, 5.4%)。韌帶鬆解術合併皮膚推進術及陰莖拆卸術於術後陰莖長度的增長由0.8-3.4公分/ 8-83%不等;於周長擴大術方面一共收錄了14篇文獻、1002位患者(9篇文獻共219位患者使用移植或皮瓣;4篇文獻共311位患者使用填充物或注射; 1篇文獻共400位患者使用矽膠植入物)，其周長的擴大由1.2-5.2公分/ 16-56.5%不等。
常見的副作用包含陰莖攣縮(penile retraction)、纖維化(fibrosis)、不對稱(asymmetry)、彎曲(curvature)。其餘像是感染(infection)和神經性傷害(neurological injury)導致敏感度下降也曾被報導。
其副作用的報告由0-77%不等，且於不同的研究間有明顯的差異。舉例來說： 患者接受單一的陰莖增長術約0-26%、單一的周長擴大術約0-40%(使用移植或皮瓣的0-77% vs使用填充物或注射0-13%);合併陰莖增增長術與周長擴大術約0-77%(韌帶鬆解術合併移植或皮瓣0-77% vs單純韌帶鬆解術0%)。
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| abstract |
Background:
Aesthetic augmentation phalloplasty is a set of procedures aimed at increasing penile length and/or girth; many of these procedures are investigational.This systematic review set out to summarize available literature on these procedures in patients with normal penile anatomy.
Methods:
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE/PubMed, Scopus, and Cochrane Databases were used to identify articles on aesthetic augmentation phalloplasty in cis-gender men without penile deformity from 1990 to 2018. Data on outcomes, complications, and patient-reported satisfaction were collected.
Results:
Sixteen articles, involving 1192 patients, met our inclusion criteria.Mean age ranged from 23 to 44 years, and follow-up time ranged from 6 to 48 months. The quality of the studies was poor regarding methodology for patient selection and outcomes reporting. Surgical interventions included suspensory ligament incision, grafting, flaps, and penile disassembly. Augmentation was performed for length only in 16 percent of patients, girth only in 70.6 percent, and combined in 13.4 percent. Length gain ranged from 8 to 83 percent in the flaccid state and 12 to 53 percent in the erect state. Girth gain ranged from 16 to 56 percent in the flaccid state and 19 to 30 percent in the erect state. The pooled complication rate was 14.6 percent, with those undergoing combined augmentation having the highest complication rate. Patients were generally satisfied; reported satisfaction rates ranged from 50 to 100 percent.
Conclusions:
Enhancement procedures are controversial and investigational.Data point to inconsistent methodology when reporting penile dimensions, outcomes, and patient satisfaction. Despite the reportedly high satisfaction rates, patients should be counseled regarding high complication rates. Best-practice guidelines will be critical to achieve safe and reliable outcomes.
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