Floppy Glans-Classification, Diagnosis and Treatment

Abstract

Introduction: Glans hypermobility presents a rarely observed complication of penile prosthesis implantation. It may result in patient dissatisfaction because of painful intercourse, difficulties during penetrative sex, and a poor cosmetic result. This problem may prevent the patient from using an otherwise fully functional implant.

Aim: To summarize current knowledge, clarify terminology, and review treatment options of multifaceted diagnosis of floppy glans.

Methods: Analysis of published literature and experience of authors' institution.

Main outcome measure: We reviewed publications that outlined incidence, pathophysiology, diagnostics, and management strategies of floppy glans phenomenon.

Results: Floppy glans phenomenon can result from the soft glans, incorrect position, or size of the implant cylinders or the anatomy of the glans. A careful physical examination with a fully inflated implant will indicate the direction of the droop and can be very helpful in distinguishing the underlying cause of the deformity. In ambiguous cases obtaining a correct diagnosis will often involve imaging-magnetic resonance imaging or penile ultrasound scanning of the inflated device. Cooperation with an experienced uroradiologist is invaluable in such cases. The glanspexy procedure should be performed according to the surgeon's experience and preference.

Conclusions: Understanding the different glans abnormalities and unified terminology is crucial for optimization of the treatment. Medical therapy can always be tried before revision surgery, as long as it is safe for the patient and function of the implant. The accuracy of the position and size of the implant should always be thoroughly assessed before a diagnosis of the real glans hypermobility is made and treatment provided. Skrodzka M, Heffernan Ho D, Ralph D. Floppy Glans-Classification, Diagnosis And Treatment. Sex Med Rev 2020;8:303-313.

Keywords: Erectile Dysfunction; Floppy Glans Syndrome; Glanspexy; Penile Prosthesis; Real Glans Hypermobility; Soft Glans.