AU777498B2

AU777498B2 - Enhancement phalloplasty

Info

Publication number: AU777498B2
Application number: AU31403/02A
Authority: AU
Inventors: Colin Campbell Marshall Moore
Original assignee: Individual
Current assignee: Individual
Priority date: 1997-02-11
Filing date: 2002-04-04
Publication date: 2004-10-21
Anticipated expiration: 2018-02-11
Also published as: AU3140302A

Description

I .MP. ZUU4 I4.M VVaI I In 6 1o n uumm er Y a ne Y NO0.-0 014 P/00/001 1 Regulation 3.2

AUSTRALIA

PawnLm Act 1990 COMPLETE SPECIFICATION FOR A STANDARD PATENT

ORIGINAL

Name of Applicant: Actual Inventor- Address for service Cohn Campbell Marshalli Moore Colin Campbell Marshall Moore in Australia: WAiLLIhNGTON-DUMMER GPO Box 3888, Sydney NSW 2001 (Suite 904, 3 7 Bligh Street, Sydney NSW 2000) Invention Title: Enhancement Phalioplasty i nis appIica~ion is a Eiivisional Patent Application 01 Australian k'atent Application -No.

53864/98.

The Molowing statcrnnt is a full descyiption of this invenliuz, including the bcst rnxhod ofpcarforming it known to us 01/09 2004 WIED 14:52 [TX/RX NO 5820] 1aj003 26.Aus. 2004 19:34 Wallington-Dummer Sydney No.6288 P. 2 ENHANCEMENT PHALLOPLASTY This invention relates to enhancement phalloplasty, which is a surgical procedure to modify the human penis, normally by increasing the length of or widening the penis.

There are several reasons for persons requiring operations of this type. The first is for persons who are born with small penises. These persons can often believe that they are the subject of derision and ridicule and the lack of size of the appendage can be emotionally very difficult for 10o them.

A second is where persons, either for personal pleasure or .for professional reasons, such as strip-tease dancers, S* actors and the like, wish to be seen to have a large penis.

There have been previously proposed methods of enhancement 15 phalloplasty but these have not been fully successful.

The major object of the invention is to provide methods of :enhancement phalloplasty which provide satisfactory results and which are safe procedures and which result in lengthening the penis in both the flaccid and erect states.

Brief description of invention.

Accordingly, in one broad form of the invention there is provided a method of lengthening the penis of a male which includes the steps of dividing the suspensory ligament COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aus. 2004 19:34 Wallington-Dummer Sydney No.6288. P. 6 3 against the body of the symphysis pubis down to the inferior pubic arch while placing the suspensory ligament under tension in the inferior direction, effecting suturing to retain the suspensory ligament in an extended position, dividing the fundiform ligaments, drawing the skin of the junction site of the scrotum and the perineum mediosuperiorally thereby pushing the skin adjacent thereto along the newly exposed shaft of the penis and suturing this to retain this position.

10 More particularly there is provided a method of lengthening 0 the penis of a male and which includes the steps of placing 0* the suspensory ligament under tension in the inferior direction while dividing the suspensory ligament against the body of the symphysis pubis down to the inferior pubic 0**O 15 arch and along the inferior surface of both the right and left conjoined inferior pubic rami; effecting suturing to retain the penis released from the suspensory ligament in an inferior position by coapting the proximal medial attachments of the right and left gracilus muscle together cephalad to the released penis, dividing the fundiform ligaments, drawing the skin of the junction site of the scrotum and the perineum mediosuperiorally so as to attach it to the symphysis pubis thereby pushing the skin adjacent COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:34 Wallington-Dummer Sydney No.6288 P. 7 4 thereto along the newly exposed shaft of the penis and suturing this to retain this position.

Preferably this is followed by the insertion of additional sutures through the anterior surface of the symphysis pubis; said sutures also placed through the margins of the pubic skin wound and tied in such a manner as to pull suprapubic skin down infrapubically.

Preferably the number of said additional sutures inserted is 1 or more.

10 Preferably the number of said additional sutures is determined by the width of the symphysis pubis.

Preferably the method further includes the step of dividing the fundiform ligament prior to said step of drawing the skin of the junction site of the scrotum.

15 In yet a further broad form of the invention there is provided a method of lengthening and widening a penis, the 6 6666 lengthening using the above described method and the widening using a method of widening a penis wherein a block 0* of fat and attached dermis (dermal fat graft) is excised from the patient, the penis is degloved, the dermal fat graft is sutured to the exposed Bucks fascia and then reducing the penile skin; and wherein the dermal fat graft is sutured to the exposed Bucks fascia prior to the tying of the sutures which maintain the lengthening of the penis.

COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:35 Wallinston-Dummer Sydney No.6288 P. 8 5 Preferably the dermal fat grafts are harvested from either the buttocks, lower back or lower abdomen.

In order that preferred embodiments of the invention may be more readily understood, I will describe certain procedures in greater detail below.

The first of these has to do with penile enlargement. This involves suprapubic (or other type) incision and exposure S S 10 of the suspensory and fundiform ligaments of the penis and their division under direct vision from the suprapubic area and the inferior bodies of the pubic arch all of the Santerior surface of the pubic symphysis. The penis is depressed posteriorly by approximating the medial edges of 15 the upper ends of the right and left Gracilis muscle in

S

front of the penis. The suprapubic skin is rearranged (by Zplasty, excision or a combination of both) and sutured together and to the superior and anterior surfaces of the body of the pubis right and left.

To aid in the full understanding of the invention, I will more fully describe the procedures of preferred embodiments: COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:35 Wallington-Dummer Sydney No.6288 P. 9 6 Penile Lengthening With the patient under general aesthesia and in the supine position the lower abdomen, perineum and thighs are prepared and draped. In the classic procedure, a transverse suprapubic incision is made measuring approximately 3cm in length. Various other incision can be used such as W plastys, Z plastys, vertical and penoscrotal incisions and the like.

The incision site and the adjacent mons tissues are S* 10 infiltrated with local anaesthetic and adrenalin. The tissues overlying the mons veneris are separated laterally and the fundiform and suspensory ligaments of the penis are S* visualized.

Dissection is carried down by a blunt technique on either 15 side of the suspensory ligament which is then divided under 9 direct vision using diathermy. The dissection is carried out against the body of the symphysis pubis down to the :...inferior pubic arch level and along the conjoined rami of ischium and pubis for a short distance. During the maneuver the assistant pulls the penis in an inferior direction placing the ligament under tension and it can be seen under direct vision and the neurovascular bundles can also be directly visualized and preserved.

COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:35 Wallington-Dummer Sydney No.6288 P. 7- At this point, an O Maxon (or other suture material) deep stay suture is inserted into the deep surface of the pubic symphysis and then carried around the right Gracilis fascia and muscle across to the left Gracilis fascia and muscle and the suture left loose. A second O Maxon (or other suture material) is then inerted distal to the first suture so as to further coapt the right and left Gracilis muscles in front of the penis. Two more deep stay sutures of 0 Maxom (or other suture material) are then inserted into the pubic bone inferior surface laterally and left untied. A fifth, sixth and seventh 0 Maxon (or other suture material) suture are placed into the very superior edge and anterior surface of the exposed symphysis pubis and left untied.

The first deep stay suture of O Maxon is then tied 15 commencing with the one involving both Gracili which can be o observed to approximate in front of the inferiorly o: depressed shaft of the penis followed by tying the second O S Maxon Gracilis suture. The tissues on each side of the *o* mons veneris at this point are then dissected and the fundiform ligaments which are now clearly outlined as a result of this dissection are also divided under direct vision down to but not including the tissues overlying the spermatic cords on either side. The junction of the perineal and scrotal skin on either side is then identified COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:35 Wallington-Dummer Sydney No.6288 P. 11 8 approximately 3cm lateral to the midline and one each of the remaining third and fourth 0 Maxon (or other suture material) sutures is/are inserted into the deep layers of the dermis of the scrotum on each side and the sutures tied. This draws the skin of the junction side of the scrotum and perineum mediosuperiorally pushing the skin adjacent to it along the newly exposed shaft of the penis.

The.fifth, sixth and seventh 0 Maxon suture are inserted into the deep layers of the suprapubic incision in the centre and on either side and are tied so as to gently curve the skin of the mons veneris down over the top of the *e symphysis pubis further aiding the movement of the S. abdominal skin onto the new penile shaft.

After trimming the wound is closed in layers and dressings *00* S 15 are applied.

Penile Widening by Dermal Fat Graft With the patient under satisfactory general aesthesia and in the prone position, the buttock, anal area and thighs are prepared and draped. The areas of incision at the buttock/thigh fold on both legs, which were previously marked, are infiltrated with a mixture of local anaesthetic and adrenalin and then the outer layers of the epidermis are dissected off over an area measuring of the order of x 10cm or more cms. The actual size will be determined by COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aus. 2004 19:36 Wallington-Dummer Sydney No.6288 P. 12 9 the initial size of the penis measured preoperatively.

Once the epidermis has been dissected free it is discarded.

The exposed dermis, together with its layer of subtenant fat measuring approximately 2cm deep is excised en bloc using a mixture of cautery and sharp dissection.

The graft is then wrapped in a pack soaked in Ringer's solution and kept at room temperature. The wound is closed in layers. Dressings are applied.

The patient is then turned from the prone to the supine 10 position while still anaesthetized and the lower abdomen, perineum and thighs prepared and draped.

*0 The area of the incision is then infiltrated with a mixture of local anaesthetic and adrenalin.

If widening is done in conjunction with lengthening, the *0 15 incision is usually transverse though it may be any combination of the incisions described under lengthening, S: above including the peno-scrotal incision. If widening is S. done alone then a transverse suprapubic incision is usually 0* used although any of the above incisions may be used.

If the patient is already circumcised, infiltration of the old circumcision scar in its anterior half may also be carried out. If the patient is not circumcised it is necessary to proceed to circumcision usually, as this is a requirement for dermal fat grafting usually (though not COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aus. 2004 19:36 Wall ington- ummer Sydney No.6288 P. 13 10 always), then the entire circumference of the penis at the proposed circumcision site is infiltrated with local anaesthetic and adrenalin.

If the peno-scrotal approach is being used with degloving of the penis, then a completely circumferential infiltrate with local anaesthetic is used whether the patient is circumcised or not.

Once the incision, be it peno-scrotal, or more commonly transverse suprapubic, has been carried down to the deeper es 10 layers by blunt dissection, the skin and superficial fascia o .oof the penis is separated from the shaft of the underlying *e penis in its entire length and circumference.

SAt this point, the anterior half of the old circumcision scar may be reopened (in the case of the suprapubic 15 transverse incision) or the entire old circumcision scar or a new circumcision site is opened in the case of the uncircumcised who require circumcision, and in the case of the peno-scrotal approach in the former. The penis is then degloved. The dermal fat graft is then sutured to the exposed Bucks fascia commencing on the coronal groove distally and going as far proximally as is possible with the wound exposure. This should be at least well down into the infra pubic region of the symphysial or mid-portion of the penile shaft. The graft is attached all around the COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:36 Wallinston-Dummer Sydney No.6288 P. 14 11 shaft of the penis leaving only the corpus spongiosum exposed.

The penile skin is then reduced, the circumcision wound (if applicable) is then closed as is the peno-scrotal incision if it has been used after the dartos fascia has been closed.

If the suprapubic incision has been used it is closed in layers. Telfa is applied to the wounds and the penis is encased in a crepe bandage as a moderately compressed dressing.

Combined Penile Lengthening and Widening With the patient in the prone position, the dermal fat grafts are harvested as described above. The patient is C0 15 then turned to the supine position and the operation proceeds as described under penile lengthening to the point where all of the deep stay sutures are in place but not tied. At this time, the distal circumferential incision (circumcision site incision if required) is performed, the penile skin is developed and the penis degloved. The dermal fat graft is then sutured into place as described above.

Once the penile skin has been reduced, the deep stay sutures are then tied as described above in regard to COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:36 Wall ington-Dummer Sydney No.6288 P. 12 penile lengthening and attached to their other structures.

All wounds are then closed as described above.

Whilst I have described herein certain embodiments of the concept of the present invention, it is to be understood that modification can be made in the specific surgical techniques by the use of other known techniques.

*9

S

0* *o ee COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26

Claims

26.Aug. 2004 19:36 Wallington-Dummer Sydney No.6288 P. 16 13 The claims defining the invention are as follows: l.A method of lengthening the penis of a male which includes the steps of dividing the suspensory ligament against the body of the symphysis pubis down to the inferior pubic arch while placing the suspensory ligament under tension in the inferior direction, effecting suturing to retain the suspensory ligament in an extended position, dividing the fundiform ligaments, drawing the skin of the junction site of the scrotum and the perineum o;o 10 mediosuperiorally thereby pushing the skin adjacent thereto S" along the newly exposed shaft of the penis and suturing this to retain this position. 2.The method of lengthening the penis of a male as claimed in claim 1 and which includes the steps of placing the 15 suspensory ligament under tension in the inferior direction while dividing the suspensory ligament against the body of the symphysis pubis down to the inferior pubic arch and along the inferior surface of both the right and left conjoined inferior pubic rami; effecting suturing to retain the penis released from the suspensory ligament in an inferior position by coapting the proximal medial attachments of the right and left gracilus muscle together cephalad to the released penis, dividing the tundiform ligaments, drawing the skin of the junction site of the COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:37 Wallinston-Dummer Sydney No.6288 P. 17 14 scrotum and the perineum mediosuperiorally so as to attach it to the symphysis pubis thereby pushing the skin adjacent thereto along the newly exposed shaft of the penis and suturing this to retain this position. 3.The method of Claim 1 or claim 2 followed by the insertion of additional sutures through the anterior surface of the symphysis pubis; said sutures also placed through the margins of the pubic skin wound and tied in such a manner as to pull suprapubic skin down 10 infrapubically. 4. The method of Claim 3 wherein the number of said 9* additional sutures inserted is 1 or more. 5. The method of Claim 4 wherein the number of said additional sutures is determined by the width of the 15 symphysis pubis. o• 0 6. The method of any of Claims 1 to 5 including the step of :dividing the fundiform ligament prior to said step of drawing the skin of the junction site of the scrotum. 7. A method of lengthening and widening a penis, the lengthening using the method as claimed in any one of claims 1 to 6 and the widening using a method of widening a penis wherein a block of fat and attached dermis (dermal fat graft) is excised from the patient, the penis is degloved, the dermal fat graft is sutured COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26 26.Aug. 2004 19:37 Wallinston-Dummer Sydney No.6288 P. 18 15 to the exposed Bucks fascia and then reducing the penile skin; and wherein the dermal fat graft is sutured to the exposed Bucks fascia prior to the tying of the sutures which maintain the lengthening of the penis. g 00000* 0 S* 0* 0 S 00 S o 8. The method of claim 7 wherein the dermal fat grafts are harvested from either the buttocks, lower back or lower abdomen. 9. A method of lengthening the penis of a male substantially as herein described. 10. A method of lengthening and widening a penis substantially as herein described. DATED this 2 6 th day of August 2004. Colin Campbell Marshall Moore By His Patent Attorneys WALLINGTON-DUMMER COMS ID No: SBMI-00887881 Received by IP Australia: Time 19:47 Date 2004-08-26