Mechanically Activated Stretch Reflex (M.A.I.R) Exercises

[marinera]

.........The xenograft is placed
circumferentially, dorsally, from the groove
between the cavernous and spongious bodies from
one side to the other. The spongious body is not
covered so as not to limit its expansion during
erection. The graft is then sutured to Buck’s fascia,
with 2/0 polyglycolic acid stitches, starting distally.
It may be applied in multiple layers to obtain a
major increase in circumference, even though in
our series we only used one-layer grafts..
...........
During graft positioning, maximaltraction of the penis is mandatory to obtain adap-

tation to the cavernous body.
.....

Not that clearly written and the pics don't help much either, but my understanding is that they actually cut the tunica, otherwise I don't see how the graft was sutured to the Buck's fascia; placing the graft outside the tunica would likely limit the expansion impairing erection. That is confirmed in that very same paper:

Technically, the girth of the penis can be surgi-

cally enhanced through two techniques: pericaver-

nosal or albugineal surgery [1–3,5,17].
Pericavernosal surgery consists of subcutaneous
enhancement around the corpora cavernosa.
Autologous dermal graft or dermis-fat graft sutured
around the corpora cavernosa may provide an excel-
lent increase in girth, with a low complication rate
[1–3]. This technique provides excellent enhance-
ment of the penis in the flaccid state, but the result
is much less significant during erection [1].
Free-fat transplantation, after purification [18],
can be used to increase the penile circumference.
The variability of fat survival (from 10% to 80%)
[2,18,19], along with several complications
reported in the medical literature [19,20], such as
uneven distribution and palpable lumps, persuaded
us to avoid using this technique [18].



Albugineal surgery implies enlargement of the
cavernous body [1–3,5,7,15], using alloplastic
materials or saphenous-patch grafts to increase the
volume of the corpora cavernosa.
.....

It could very well be that you are right though. Anyway, since you agreed that the other abstract confirms my point, and since this very same study confirms that girth enhancement can be obtained in the same way, we can go over this specific paper. The one I posted on ************* is way more clear, but it doesn't seem to be free in the full text anymore.







I

[marinera]

....
Here's my question though: How much can the cavernous tissue expand without the restraint of the tunica under PHYSIOLOGICAL pressures.

What I'm asking is: Assume you deglove the cavernosa of it's tunica. You occlude the drainage veins externally, to the amount they are occluded normally. How much would the cavernosa expand when the intracavernosal pressure is at physiological levels of erection?
....

I am not sure I understand your question. The intracavernosal pressure is about 3 hg in flaccid state, about 10 hg in erect state. When you Kegel it can maybe go up a bit, but not that much; enlarging the tunica, would either lower intracavernosal pressure in erect state or leave it unchanged. I don't see it's likely higher pressures can be achieved, neither that they change that much the size. As any experienced pumper knows, the best way to achieve maximum expansion neat of fluids is to use low pressure for prolonged periods. Due to the viscoelastic properties of tunica albuginea, the CC gets theirs maximum expansion. Adversely, using higher pressure in a short span of time twill trigger the elastic response of tunica, which will fight the stretching force.

[marinera]

....
Also, are we only changing the size of the tunica and not the cavernosa with PE?

Well, the point I am trying to make is actually that enlarging the tunica and expanding the cavernosa are pretty much the same thing. Authors in the quoted papers also speak of the two things as the same.

If what you are wondering is instead: 'Do smooth muscle increases with PE?', I think it will increase at some degree, like any other component of the penis. Mechanical stretching makes any human tissue longer when properly applied for enough time. What I am saying is : a) increasing smooth muscle alone will not make the penis bigger; b) increasing tunica size alone will make the penis bigger. So focusing on smooth muscle growth is not worth.

The OP' idea that the two tunica layers could be separated stretching the penis without training the smooth muscles is also pretty fantastic to me, and is a based on a wrong knowledge of the tunica structure.

[INS]

If you look at their surgical technique in the porcine dermal graft one, they never once mention the tunica. They don't cut it at all. The just layered a graft on the buck's fascia. The left a strip (longitudinatl) on the ventral side open (the part where the spongiosum can be felt) so that the penis can expand properly.
IF you pay attention to the surgical technique, they don't even cut into the buck's fascia.

THey just incise the skin at the base, then do a blunt dissection with fingers and blunt scalpel and forceps to separate the colle's from the buck's fasica, and then they put a layer. They even mention trying to preserve the bucks fascia.

[INS]

https://www.google.nl/url?sa=t&rct=j...mGsxyPGp-AlbMg


Copy and paste this, you'd find the whole paper for the tunica surgery for girth

[INS]

I am not sure I understand your question. The intracavernosal pressure is about 3 hg in flaccid state, about 10 hg in erect state. When you Kegel it can maybe go up a bit, but not that much; enlarging the tunica, would either lower intracavernosal pressure in erect state or leave it unchanged. I don't see it's likely higher pressures can be achieved, neither that they change that much the size. As any experienced pumper knows, the best way to achieve maximum expansion neat of fluids is to use low pressure for prolonged periods. Due to the viscoelastic properties of tunica albuginea, the CC gets theirs maximum expansion. Adversely, using higher pressure in a short span of time twill trigger the elastic response of tunica, which will fight the stretching force.

Okay, let me try and rephrase it. What would happen if the tunica was grown more than what the cavernosa could expand, under the normal pressure of erection?

[marinera]

Anyway, I can't seem to find the study on length... help me out here Marinera

The one that shows the penis length is determined only by the tunica albuginea length? I have only the abstract and the link works for me.

Or are you meaning the study about lengthenint through albuginea incision and grafts? Here you are one abstract:






J Urol. 1999 Apr;161(4):1141-4.

Lengthening shortened penis caused by Peyronie's disease using circular venous grafting and daily stretching with a vacuum erection device.

Lue TF¹, El-Sakka AI.

Author information

Abstract

PURPOSE:

We evaluated the results of chronic intermittent stretching with a vacuum erection device after circumferential tunical incision and circular venous grafting in 4 patients with penile shortening from severe Peyronie's disease.
MATERIALS AND METHODS:

We performed complete circumferential tunical incision and covered the defect with a circular venous graft in 4 patients with shortened penis as a result of Peyronie's disease. Preoperative evaluation included determination of patient and partner expectations, potency status, measurement of penile length after intracavernous injection and color duplex ultrasonography to determine possible vascular communication. Lower saphenous, upper saphenous and deep dorsal veins served as graft materials. We advised patients to use a vacuum device on a daily basis for 6 months starting 1 month after surgery. Postoperative evaluations were done at 6 and 18 months postoperatively.
RESULTS:

At 6-month followup 1 patient who did not use the vacuum device gained 1 inch in penile length and was not available for further followup. The other 3 patients each gained 2 inches but had decreased erectile rigidity due to narrowing in the grafted area (hourglass deformity). One patient who wanted a more natural erection elected penile prosthesis implantation about 1 year after grafting. The remaining 2 patients gained 3 inches at 18-month followup and regained partial penile rigidity similar to preoperative erections when the hourglass deformity improved. All patients were satisfied and indicated that surgery improved psychological well-being as well as relationships with partners.
CONCLUSIONS:

The results in this small group are satisfactory. Our technique offers a reasonable solution for correction of penile shortening in patients with Peyronie's disease.
Lengthening shortened penis caused by Peyronie's disease using circular venous grafting and daily stretching with a vacuum erection device. - PubMed - NCBI


This is one with full text,
Penile length and girth restoration in severe Peyronie's disease using circular and longitudinal grafting - Egydio - 2012 - BJU International - Wiley Online Library

it has excellent but disturbing pics. Both are on males with Peyronie' disease, but that doesn't make them unuseful.

[marinera]

https://www.google.nl/url?sa=t&rct=j...mGsxyPGp-AlbMg


Copy and paste this, you'd find the whole paper for the tunica surgery for girth

Thanks! This is very enlightening:
.....If phalloplasty is performed by means of pericavernous
thickening through the application of grafts
or fiaps, the morpholog>' of the penis is only
altered during the stage of fiaccidity {¥\g. 8), i.e.
increase in total volume. Enlargement of the penis
during erection can only be achieved by surgery
on the tunica albuginea itself, as was previously
demonstrated by Nesbit (1965)
.....
Thickening phalloplasty as proposed by us for
patients with dysmorphophobia related to function
(Austoni, 1996; Austoni et ai, 1996a,b) allows an
increase in the volume of the corpora cavernosa
through enlargement of the tunica albuginea
(Fig. 9), which is achieved by placement of bilateral
saphenous grafts....

Nice pics too, although in black and white.

[marinera]

Okay, let me try and rephrase it. What would happen if the tunica was grown more than what the cavernosa could expand, under the normal pressure of erection?

You couldn't achieve an erection because the tunica wouldn't be tight enough. The veno-occlusive mechanism woud be fucked up.

[INS]

Yeah, that was my concern. The veno occlusive mechanism gettting fucked up if only the tunica grew, and not the caves.