Tissue engineering is a branch of science that deals with the production of damaged organs or tissues under laboratory conditions and transferring them to humans. Interest in this field has been increasing in recent years. Tissue engineering, which works in many fields in medicine, also conducts research on urological diseases. Treatment with genitourinary system diseases and tissue engineering is not a routine study yet.

Researches in this field are carried out in few centers in the world. One of these issues is penis enlargement and lengthening surgery. Today, these operations are mostly performed in the form of applying the fat taken from the patient’s own adipose tissue around the penis. These are day-to-day surgeries in operating room conditions. In tissue engineering, a small piece taken from the patient is reproduced under special laboratory conditions and transferred to the patient. This process takes weeks, is expensive and requires a team.

In this article, I will give general and up-to-date information about tissue engineering and penis enlargement surgery.

What is tissue engineering?

Tissue engineering is a biomedical engineering discipline. Tissue engineering is concerned with restoring, healing or replacing damaged tissues in the human body. It is a new field of biomedical engineering that utilizes the combination of cells, engineering, materials methods, and biochemical and physicochemical factors for this purpose. Today, it stands out as a branch of science on its own.

Briefly, in practice, tissue engineering is a science that consists of a combination of medicine and different engineering disciplines, which deals with the repair or reconstruction of damaged organs or tissues in the human body. Sometimes regenerative medicine is used synonymously with tissue engineering, but regenerative medicine uses stem cells or progenitor cells to regenerate damaged tissues.

Tissue engineering has three components, or in other words, tissue engineering needs these 3 things:

• A matrix that can be the main function to be used for repair
• A mold or scaffold where these cells can be transplanted
• Bioactive molecules such as cytokines and growth factors to obtain the targeted tissue

Where is tissue engineering used in urology?

In the United States, studies on these areas are carried out in some developed centers. Regarding urology, studies are carried out for the following organs;

• Urethra
• Erectile tissue (penis)
• Incontinence
• Bladder
• Ureter
• Kidney

How is penis enlargement surgery performed with tissue engineering?

Approximately 1 cc of biopsy is taken from the patient’s own scrotal skin tissue. This biopsy is replicated in cell culture laboratories after undergoing special procedures. A certain amount of time is required for cells to be transferred to the patient. During this time, a large number of cells are replicated. The average number of cells required is 20×10(7), ie about 20 million. It takes an average of 2-3 months to obtain a cell of this number.

These cells are then transferred onto a poly(lactic-co-glycolic acid) (PLGA, PLG) scaffold shaped to be coated on the penis. This construct is then left in the culture medium for an additional 24 hours. This mold is then transferred to the patient under operating room conditions.

In the operating room, the patient is prepared under general anesthesia or spinal anesthesia (numbing from the waist down). The penis skin is opened and the penis is exposed. The pre-prepared mold (PLGA coated cells) is placed in accordance with the shape of the penis.

The operation takes approximately 1-1.5 hours. Patients stay in the hospital for one day. Surgery should be performed under very sterile conditions. After the surgery, the penis remains in the bandage for up to a week. Anti-infective antibiotics and pain relievers are started.

Briefly, we can summarize the stages of penis enlargement surgery using tissue engineering technique as follows:

• Reproduction of enough cells to be transplanted to the patient under laboratory conditions
• Cultivation of these replicated cells on PLGA plates.
• Keeping the PLGA-cell construct in culture medium for 24 hours
• Transfer of the PLGA-cell structure to the penis in the operating room environment

How long does tissue engineering penis enlargement surgery take, is it done everywhere?

With this method, penis enlargement surgery is not a one-day, short-term procedure. A very small piece taken from the patient is reproduced under laboratory conditions and transferred to the patient. This process takes 2-3 months. This process should be done under very sterile conditions. There is a risk of infection. If infection develops, the procedure must be done all over again. This also prolongs the time. It’s not something that can be done anywhere. A private laboratory requires trained personnel who are experienced in the field of cell and tissue culture.

Is penis enlargement permanent with this method or can it be repeated later?

There is no deformity in the penis in penile enlargement surgery performed with this method. It does not shrink over time. The same procedure can be done later if needed. Since the patient’s own tissue is used in this method, no adverse reactions are observed.

What are the advantages of penis enlargement with tissue engineering?

Penile enlargement and lengthening surgery using tissue engineering method has some advantages over other methods. These advantages or advantages are:

• Since the patient’s own tissue is used, there is no reaction or tissue rejection.
• The development of deformity and irregularity in the penis is very little or not seen at all.
• There is no loss or reduction in the thickening and lengthening of the penis over time, or it is extremely low.
• Possible if further thickening is required in later periods

How long should I wait after the surgery?

After penis enlargement surgeries, patients need to wait for a certain period of time. Tissues need a certain amount of time to heal. This period is usually 4-6 weeks. After 4-6 weeks, patients can have normal sexual intercourse.

What are the disadvantages/risks of this method?

Although penile enlargement surgery with the tissue engineering method is an effective method, there are some disadvantages that prevent the widespread use of this method. We can list them as follows:

• This method is a long process. The preparation of cells to be transplanted takes an average of 2.5-3 months.
• There may be a risk of infection during the procedure and it may be necessary to go back to the beginning.
• The cost of this method is high
• It is teamwork, requires infrastructure
• Can’t be done everywhere

Special permission from the Ministry of Health is required for all cellular procedures to be performed on the patient. The actions to be taken and their justifications are sent to the relevant units of the ministry in detail. Here, it is evaluated by the expert commission and if the compliance is obtained, the work begins. This is an application that prolongs the process.

Are penile enlargement surgeries really done with tissue engineering?

Most, or even all, of the available methods are not tissue-engineered penis enlargement surgeries. The operations performed for this purpose are generally transferring the fat tissues taken from the patient’s own body to the periphery of the penis by undergoing special procedures or in the form of grafts (patches). Or it is the process of thickening the penis by wrapping synthetic materials around the penis.

These methods are routine surgical methods. It is not a tissue engineering method. Unlike tissue engineering, these surgeries are performed directly in the operating room without the need for a laboratory. The procedure is completed with 2-3 hours of surgery. However, in tissue engineering, it takes 2-3 months to prepare the cells to be used to thicken the penis. These cells can only be prepared and used in a long time.

In summary: Tissue engineering is a new and developing discipline that includes biological sciences, medicine and various engineering disciplines. Penis enlargement and thickening surgeries are possible with biomedical engineering methods. However, it is an application that requires a team, is expensive and takes a long time. This method requires special permissions and ethics committee approval. Routine is not a technique that can be done everywhere. Long-term results are quite successful in studies conducted in a limited number of centers. The operations performed using existing fat injection, fat graft and synthetic materials are not tissue engineering methods. These are routine surgical applications.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY