Recent studies have revealed the penile fibro-vascular assembly as an independent compartment of the cardiovascular system. Notably, the sinusoids of the glans penis differ from those in the corpora cavernosa and corpus spongiosum, a distinction first analyzed in 1994. Since 1986, 29-32 ligations of drainage veins at the retrocoronal level have been shown to induce glans enlargement, primarily during erection. This study aimed to address the research gap by conducting a retrospective analysis of a physiological method for enhancing the glans penis.

From 2019 to 2023, 35 men underwent a physiological penile glans enhancement strategy to address soft glans penis. All patients received dual cavernosography, confirming veno-occlusive dysfunction (VOD) in 71.4% (25/35), with 100% opacification. Acupoints Hegu (LI4), Shou San Li (LI10), and Waiguan (TE5) were routinely selected for acupuncture-assisted local anesthesia, performed on an outpatient basis. Penile venous stripping was conducted near the retrocoronal sulcus, ligating emissary veins of erection-related veins, including the deep dorsal vein, cavernosal veins, and para-arterial veins, using 6-0 nylon sutures. Surgery time, ligation number, and blood loss were recorded. Postoperative cavernosography was performed routinely. The abridged 5-item International Index of Erectile Function (IIEF-5) and Erection Hardness Scale (EHS) were used to assess erectile function preoperatively and postoperatively, with annual follow-up. No electrocautery or suction apparatus was needed during the procedure.

The average follow-up period was 3.1 ± 0.9 years. Surgery time averaged 45.7 ± 19.9 minutes, with negligible blood loss. Ligation numbers ranged from 29-33 for the venous plexus responsible for draining the glans and penis, and 95-109 for the corporeal sinusoidal blood. Glans opacity significantly improved, with its diameter increasing by 15% to 28%, indicating the independence of the glans. Significant improvements were noted in IIEF-5 and EHS scores (both P < 0.01): 9.8 ± 2.6 to 21.3 ± 2.2 for IIEF-5, and 1.8 ± 0.5 to 3.3 ± 0.0 for EHS. The diameter of the glans increased from 28.5 ± 2.3 mm to 35.8 ± 2.1 mm. Overall, 94.3% (33/35) of patients reported satisfaction with the procedure.

The study demonstrates that a physiological method of penile glans enhancement is effective, resulting in significant improvements in glans size, erectile function, and patient satisfaction. The procedure, involving venous ligation and acupunctured-assisted local anesthesia, proved practical with minimal complications.