From a Single Penile Suspensory Ligament to a Penile Suspensory Apparatus: Application to the Buried Penis Surgery
Bibliographic record
Abstract
Abstract Goals/Purpose The ligamentous system supporting the penis is widely called « penile suspensory ligament ». It supports and attaches the penis to the abdominal wall and the pubic bone. However, the complexity of the anatomy of the penile suspensory system was underestimated. The aim of this anatomical study was to describe the different ligamentous (features, insertion sites, path) and their functions. Methods/Technique The first step consisted in a description of the different components of the penile suspensory apparatus on two cadavers embalmed by the Thiel method. The second part was an evaluation of the function of each ligament on freshly dead cadavers. In the third stage, we applied those findings to an exploratory cohort of patients undergoing a penile lengthening surgery for buried penis. Results/Complications The penile suspensory apparatus consisted in four ligaments from anterior to posterior : the fundiform ligament, the suspensory ligament, dense vertical ligament and the arcuate ligament. The first two were loose, non-stabilizing and the two posterior ones were dense and stabilizing. In our cohort, 12 patients were included. The mean BMI was 38. The mean pre-operative flaccid length was 4.1 cm [2.2 cm – 7 cm] and at 6 months 8.2 cm [5.2 cm - 11.5 cm] which represents a mean augmentation of 100%. The mean pre-operative circumference at a flaccid state was 8.2 cm [2 cm – 11.5 cm] and at 6 months post-operative was 12.6 cm [8.3 cm - 16 cm] which represents a mean augmentation of 85.7%. The most common complication was a phimosis. Conclusion We have described the detailed anatomy of the penile suspensory apparatus. It is the first time that the dense vertical ligament was brought to light. To avoid instability in penile lengthening, the posterior part of the dense vertical ligament and the arcuate ligament must be spared.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".