Urology Questions Answered by Dr Perovic

TOPICS: AlloDerm® | Allograft | AMS | average penis size | breast reduction | buccal mucosa | buttocks liposuction | clitoral nerves | clitoris | complications of surgery | FFT | fistula | FtM sex change surgery | hysterectomy | glans enhancement | gynecomastia | Harry Benjamin International Gender Dysphoria Association Standards of Care for Gender Identity Disorders | HBIGDA | hormonal therapy | hormone replacement therapy | hyaluronic-acid gel | incontinence | InteXen LP | ligamentolysis | mastectomy | medical facility | metoidioplasty | musculocutaneous latissimus dorsi flap (MLD flap) | neophallus | nipple reduction | orgasms | partial suspensory ligament cut | penile implant | penile implant protrusion | penile prosthesis | penis enlargement surgery | penis enhancement surgery | penis lengthening | Perovic Metoidioplasty 2008 | Perovic Total Phalloplasty | PLGA scaffolds | psychiatric approval letters | pumps | scrotoplasty | Serbia | sex change surgery | SRS | Thai plastic surgeons | tissue engineering | urethroplasty | urinary problems | vaginal canal | vaginectomy | veins | vascular graft | weights | wet liposuction | World Professional Association for Transgender Health | WPATH

Penis Enlargement Surgery Questions
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How soon after penile enhancement surgery can a patient return to work?

How soon after penile enhancement surgery can a patient go swimming, play contact sports & have sex?

Can interested persons view more before and after photos and testimonials of penis enhancement surgery like those already published on the web site?

What have been the most recent patient complications with penis enhancement surgery? Infections? Scarring? How many have occurred?

Does penis enhancement surgery have any impact upon future possible surgeries to the penis or groin area such as the prostate or penile implants for impotence and erectile dysfunction?

During post-op therapy following penis enhancement surgery, why would weights be required only for some patients and can you increase length gains through the use of weights or traction devices?

How many days after surgery do patients begin using a vacuum device?

How many times per day must the vacuum device be used?

How long must the post-op therapy using the vacuum device be continued?

Do scaffolds for penile girth enhancement completely convert into newly generated tissue within 6 to 16 weeks?

Is the incision for ligamentolysis penis enlargement surgery in the pubic area?

Is it correct that no V-Y Plasty is used for ligamentolysis penile lengthening?

Are both the fundiform and suspensory ligaments cut during ligamentolysis penile lengthening?

Is something inserted between the cut ligaments to prevent their re-attachment after penile lengthening?

Will my erection angle be lower after ligamentolysis phalloplasty lengthening?

Is it correct that between the bucks fascia and the shaft skin there is another fascia called the dartos? And in Dr Perovic's tissue engineering penile girth enhancement is the PLGA scaffold placed underneath the dartos and on top of the bucks fascia so it doesn’t actually touch the skin?

If that is accurate, does that mean the dartos fascia is also cut and retracted to the base as well as the skin during penis enlargement surgery phalloplasty?

If during penile augmentation the PLGA biodegradable scaffolds are placed on the penis when stretched, what happens when it is no longer stretched? Could the scaffold buckle?

Is there a gap between the end of the scaffold and the glans after Perovic penis girth enlargement surgery using tissue engineering with biodegradable PLGA scaffolds?

Is the polylacti-co-glycolic acid (PLGA) scaffold tapered towards the glans during Perovic penile enlargement surgery?

Is there a medication to stop painful erections for a few weeks after Perovic penile enhancement surgery?

Should antibiotics be taken before arrival in Belgrade for surgery and after the procedure has been completed?

Does Professor Perovic still do penile lengthening using 'rib cartilage in the space between the glans cap and tips of the corpora cavernosa' as per the article in the British Journal of Urology International 2000; 86:1028-33 (ISSN: 1464-4096)?

Can Dr Sava Perovic do penile curvature correction at the same time he does penile enhancement surgery on a patient?

If the scaffold is placed in a flaccid penis during penile augmentation, how can it be long enough to cover the entire penile shaft when erect?

Why are scrotal dermal cells no longer required to seed the scaffolds during penis enlargement surgery?

Are the scaffolds used for penis enlargment placed between the penis skin and the buck's fascia?

During penis girth enlargement are the biodegradable scaffolds placed on top of or underneath the colles fascia?

Does the new tissue created from phalloplasty scaffolds to achieve penile augmentation attach to the skin or the fascia?

Where is the penile skin cut during Perovic penile enlargement surgery in order to deglove the penis for an uncircumcised patient who wants to retain his foreskin?

What is the difference between 'compliant' and 'non-compliant' penile skin when referring to penile enhancements?

What scaffold thicknesses are available for penis girth enlargement paitients to choose?

Can penis girth enlargement be performed under a local anaesthesia?

Does penile length become shorter after penis girth enlargement?

What are the possible complications of penis girth enlargement and what is done to remedy them?

What are the details and specifics of Dr Perovic's ligamentolysis penile lengthening?

Is it true that the secret to gaining the most from penile lengthening surgery is to make certain that the surgeon you choose does NOT re-attach ANY of the web or ligament structures but instead builds a flap behind those structures to prevent re-attachment and that this has the downside of changing erectile angle but the upside of allowing far greater length gains?

Would Dr. Perovic perform his girth enhancement procedure on an individual who has HIV but is in excellent health?

What is the advised treatment and cost for repairing penile fracture that was left untreated and resulted in corporal fibrosis and scarring? Can he get penis enhancement at the same time he gets the penile fracture corrected?

What happens to the veins that are prominent on a natural erect penis after tissue engineered scaffold surgery by Dr Perovic? Are they still visible?

Do you perform surgery to divert a vein or other source of blood flow into the penis so it has a greater amount of blood which makes the penis grow to hold the volume?

What is the risk of damage or numbness to a penis as a result of adding length or girth using Sava Perovic's tissue engineering with PLGA scaffolds?

Does Dr Sava Perovic's tissue engineering penis enlargement have any other advantages over dermal grafting, besides not cutting a portion out of one's body?

What kind of length gain have you seen typically from Sava Perovic penis enlargement surgery?

Does lengthening (ligamentolysis) result in the penis pointing downwards and a hairy base of the penis and slipping and shifting during intercourse?

Hasn't anyone developed a method for re-anchoring the penis after ligamentolysis to avoid the reported problems of slipping and shifting during intercourse?

What post-operative procedures must patients follow to get maximum results from the penis enlargement surgery? Pumps? Weights? What?

Where will the incision for the penis lengthening be done? Or is it done during degloving?

Why not put an Allograft (see AlloDerm® below) dermal matrix graft under the proximal glans cap for glans enhancement?

Why not use AlloDerm® for penis enlargement?

Why shouldn't I get 1-hour glans penis enhancement using hyaluronic-acid gel injected over the entire glans penis using a 30 gauge needle and local anesthesia which gives a 20% increase in girth for about 12 months?

Why doesn't Professor Perovic do autograft dermal fat grafts or porcine dermal matrix grafts?

What's the the effect of penis enhancement surgery on sensations, pleasure, orgasms, stiffness of the erection, and effect on ability to penetrate?

Why is flaccid, not erect penis size, usually used when talking about the results of penis enlargement surgery?

Does Dr Perovic's penis enlargement surgery produce “permanent” results that will last a life time?

What is the location and extent of scarring resulting from penis enlargement surgery by Dr Sava V. Perovic?

What stitching material does Dr Perovic use for penis enlargement surgery? Do patients need to have it removed later by a doctor in their local area? If so, when?

I had a partial suspensory ligament cut done in the past but it failed. Can Dr Perovic redo it?

I want buttocks liposuction when I get my penis enlargement phalloplasty. Can Dr Perovic do that? And does he use wet or dry liposuction?

Exactly how many cases of penis enlargement surgery has Dr Perovic done?

Are there any girth gains when the penis is erect through the tissue engineering with biodegradable PLGA scaffolds phalloplasty which Dr. Perovic performs? Is the penis circumference increased in both flaccid and erect state?

Transsexual Surgery & Other Surgery Abroad Questions

One Perovic Total Phalloplasty Stage 3 patient I know suffered implant protrusion and returned to Belgrade for Dr Perovic to correct the problem. Why did that happen? What percentage of Total Phalloplasty Stage 3 patients experience implant protrusion?

When I go to Belgrade can I bring Dr Sava Perovic's surgical fee as traveler's checks? Or is only cash accepted?

What is the deepest neovagina Dr Perovic could give an MtF transsexual who has a husband with an 11-inch penis? Would the neovagina be destroyed from penetrative intercourse? Is there any hope?

What is a vascular graft? Can you explain it's relationship to the penile implant I'm going to get?

My psychiatrist is unwilling to forward a copy of my psychiatric approval letters as explained in the Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders (World Professional Association for Transgender Health) but I'm ready for my SRS. I have done very well without outside help. I have been doing fine without the help of doctors for psychiatric approval. This is not a rash decision. I have heard good things about your facility and I was hoping you would do my SRS because I am having it done and I do not want to go somewhere less qualified. Will you perform my sex change surgery?

If I get a mastectomy one month before getting Perovic Total Phalloplasty using the musculocutaneous latissimus dorsi flap (MLD flap), when should I start having the MLD donor site massaged?

How long after Perovic Metoidioplasty 2008 will I be able to drive a car, do sports, have sex and return to work?

If the orgasmic sensation is located at the base of the neophallus resulting from Total Phalloplasty, what kind of sensation does the head and shaft have?

If the entire vagina is removed during a vaginectomy, how is the bladder kept in place to avoid risk of prolapse and incontinence?

Have any patients experienced any urinary problems as a result of a vaginectomy?

What complications can possibly occur as a result of a vaginectomy?

What are the advantages and disadvantages of using general anesthesia vs. local anesthesia or an epidural during metoidioplasty?

Can Professor Perovic write a letter for me stating that I've already had my sex reassignment surgery since I'm going to have it soon?

What are the advantages of getting surgery from Dr Perovic in Belgrade?

Is Serbia a third-world country? Is Belgrade a dangerous place to visit?

What is the average penis size? Is average penis length the same around the world?

Can I get Perovic Total Phalloplasty & still keep my vaginal canal with the ability to be penetrated?

Dear Professor Perovic, what is the average length and width of the penis after your metoidioplasty (metaoidioplasty)?

Is Dr. Perovic board certified to practice in the United States?

Is it possible for Dr. Perovic to bill the cost of my surgery directly to my insurance provider?

What types and brands of penile prosthesis devices can Dr Perovic implant?

Does Dr Perovic use InteXen LP (lyophilized porcine), the dermal matrix graft material of American Medical Systems Holdings Inc of Minnesota?

I have a hormone condition. Can I get male breast reduction (gynecomastia) and nipple reduction at the same time I get penis enlargement surgery by Sava Perovic?

Would I be better off contacting Dr Perovic directly? And what is the schedule and number of examinations with the doctor before and after the penis enlargement surgery?

Does Professor Perovic put in writing his assurances that he'll sort out any complications arising later from the surgery?

What happens to old fat injections when you do penis enlargement using PLGA scaffolds?

Do the Thai plastic surgeons who have studied your "Tissue Engineering with Biodegradable Scaffolds" procedure perform it in Bangkok?

Are there any Thai doctors who perform Dr Sava Perovic's FtM sex change surgery in Bangkok?

How does Dr. Perovic incorporate the clitoral nerves to the neophallus during his Total Phalloplasty?

Is a scrotoplasty also included in the third stage of Perovic Total Phalloplasty surgery?

Is it necessary to have a vaginectomy before getting Perovic Total Phalloplasty?

How long must a Perovic Total Phalloplasty patient stay in hospital?

Is it OK to bring friends, relatives and/or other people interested in becoming patients of Dr Perovic to Belgrade when I get my surgery from the professor?

Where do you usually perform Perovic Total Phalloplasty in Belgrade?

What's a fistula?

If i went to Belgrade to have FtM metoidioplasty surgery performed by Dr Perovic himself, where and at which hospital will the Perovic metoidioplasty be performed?

Who exactly IS on Professor Perovic's Team?

Does Dr Perovic's Metoidioplasty surgical fee include full hysterectomy and vaginectomy?

If I choose to have my Perovic Metoidioplasty 2008 done personally by the professor in Belgrade, will someone organize accommodations and transport during my stay there?

Will Dr Perovic supply me with Andractim gel to put on my clitoris to make it bigger?

Do you use good medical facilities? Can your patients who go there expect to have peace, quiet and privacy, unlike what some persons have experienced with other doctors?

Can Dr SV Perovic do "glans sculpting" so the glans looks more natural and conspicuous? Can anything be done in that regard in addition to the de-epithelialized skin strip at the tip of the neophallus created during Total Phalloplasty?

What is the actual complication rate for Perovic Metoidioplasty 2008 with the urethral lengthening procedure?

In what way is Perovic Metoidioplasty 2008 more advanced than in the past and better than what is offered by other doctors?

If my friend, family member, companion, wife or signficant other wants to come along with me to Belgrade to provide support and will stay with me at my hotel or apartment arranged by your team, will they need to pay extra for their accommodation?

How much does it cost to stay at a medical facility in Belgrade longer than the stipulated number of days in the surgery package price?

Can Sava Perovic's Tissue Engineering with Biodegradable Scaffolds be used for the clitoris during metoidioplasty to gain more girth and possibly length?

If buccal mucosa is used for urethroplasty, will it cause problems when I eat?

How soon after Total Phalloplasty Stage One will I be able to walk, work, drive and play sports?

Questions and answers about aesthetic genital surgery from the RTS-a TV interview with Dr Perovic on Saturday, 24 November 2007: Prof. dr Savom Perovićem o polnim organima - Dr Perovic The Carnal Organ Player!

Q: Bliskost tela u tangu uvek kreće romantično i onda dolazi do konkretnog, a vi ste lekar za konkretne situacije, kada dolazi do spajanja muškarca i žene. Vi ste hirurg, urolog, prof. dr Sava Perović, dosad ste pokazali svoju veštinu svuda u svetu. Gde ste sve bili?

A: Mogu reći da je cela ova godina bila vezana za putovanja po celom svetu. Od dvanaest meseci sigurno sam osam bio van Beograda.

Q: Član ste velikog broja svetskih udruženja gde pokazujete svoje umeće. Šta je ono što vi radite, a što drugi u svetu ne rade tako dobro kao vi?

A: Ono što me je proslavilo u svetu jeste veština da polni organ rastavim u delove, u najsitnije njegove anatomske delove, popravim urođeno ili stečeno oboljenje i potom taj organ sastavim, a da se to nimalo ne primeti i da pri tom zadovoljim estetiku, jer ona u meni, baš kao i agrentinski tango, budi posebna osećanja, ne mogu to da opišem.

Q: Da li vam se ljudi uvek obraćaju s razlogom, jer kod nas postoji jedno uverenje, kao verovatno i u svetu, da veličina muškog polnog organa ima veze s njegovom dužinom, debljinom i uspehom u seksualnom činu? Da li je to uvek tako?

A: Nažalost, moram da kažem da 80% muškaraca koji dolaze kod mene imaju potpuno normalan polni organ, čak mogu da se svrstaju u tzv. mačomene. Razlog za operaciju uopšte ne postoji. Ja te pacijente šaljem kod psihijatra na jednu strogu psihijatrijsku kontrolu, jedno ispitivanje. I pored toga, čak i ako dobijem preporuku psihijatra, ja još uvek razmišljam da li da kod tih pacijenata izvedem hiruršku intervenciju, jer ona jednostavno nije medicinski opravdana.

Q: Kako izgleda njihovo obraćanje vama? Oni dođu kod vas i šta vam kažu?

A: Oni jednostavno koriste ono što se dešava godinama i decenijama u estetskoj hirurgiji kod žena. Žena želi da uveća grudi, ulepša nos itd, pa i oni kažu: i mi želimo da uvećamo naše genitalije. Jednostavno je počela da se razvija tzv. estetska genitalna hirurgija, koja potiče iz bogate Kalifornije i mogu da kažem da sam jedan od pionira, zajedno sa njima, upravo ja. Ali indikacije su ovde u Srbiji u mom slučaju veoma stroge.

Q: Kada vam se jave takvi pacijenti i obrate s molbom da im uvećate penis, da li ih često odbijate?

A: Vrlo često ih odbijam. Prvo im kažem da pripadaju muškarcima koji nisu čak ni na donjoj granici, ni u sredini, nego su pri vrhu. Znači, ne postoji medicinski razlog da se uveća polni organ, a takođe ne postoji ni razlog za estetsku korekciju, jer im polni organ izgleda normalno, ne postoje nikakvi deformiteti, pa nema šta da se estetski popravi. Kažem im da se samo izlažu jednom riziku, jer hirurgija nije matematika i čovek ne može da garantuje uspeh.

Q: Recite mi nešto o rizicima hirurške intervencije? Hirurzi retko govore o tome. Retko ćete od hirurga čuti da je svaka hirurška intervencija rizik – da je i najmanja hirurška intervencija rizik?

A: Ne postoji mala hirurška intervencija! Svaka je veoma ozbiljna i velika i svaka ima svoj rizik!

Q: Englezi imaju uzrečicu: kažu da je mala intervencija uvek ona koja se obavi na nekom drugom?

A: Kod tih tzv. malih hirurških intervencija najčešće i dolazi do komplikacija. Puno radim u hirurgiji, i to s takvim entuzijazmom i tolikom ljubavlju da mi se čini da u hirurgiji uživam kao u nekoj vrsti umetnosti. Jer, hirurgija koju ja radim tačno se prepliće s umetnošću. Težim da i tu drugu komponentu, umetnost, unesem u svoje hirurške intervencije. Kad vršim npr. skulpturiranje polnog uda.

Q: Imate jako veliki broj sledbenika u svetu. Ljudi znaju da vi imate neke svoje metode. Imate jako puno učenika. Svojevremeno su dolazili na dečju kliniku u Tiršovoj ulici da bi posmatrali vaše operacije, a vi ste im davali licence za određene vrste intervencija, jer jedno je hirurgija, ali treba povezati i nerve i zadržati kompletnu funkciju tog osetljivog polnog organa - penisa. Mislite li da muškarci imaju mnogo kompleksniji polni organ nego žene? Veća je prokrvljenost, veći rizici? Kod žena je taj reproduktivni aparat vrlo jednostavan?

A: Nažalost, za razliku od žena, taj mehanizam, ta funkcija muškog polnog organa toliko je kompleksna i povezana s masom problema da bi se ostvarila uspešna erekcija i uspešan seksualni odnos da bi se o tome mogla napisati knjiga od 2.000 strana. I još uvek smo u fazi istraživanja i ispitivanja - i još uvek nema konačnog odgovora. Ali, moram da napomenem, sada više nije samo u trendu tzv. muška polna nemoć, impotencija, već i polna nemoć žena. Evo, baš sad idem u Lisabon, gde će veliki deo kongresa biti posvećen ženskoj seksualnoj disfunkciji, nemoći žena u seksualnom odnosu.

Q: Da li se vi slažete s tim da jedan uspešan seksualni odnos može postojati samo ako ima ljubavi? Ima li to veze? Slažete li se s tim da je za jedan uspešan seksualni odnos bitnija ljubav nego to kako izgledaju polni organi i koje su veličine? Da li vi to kažete svojim pacijentima?

A: Apsolutno. Imao sam prilike da vidim veliku ljubav između partnera, a kad sam pogledao njihove genitalije, rekao sam – pa ovo je nemoguće. Odlučio je ipak njihov mozak. Sve je u glavi!

Q: Je l’ da je zdravlje najvažnije?

A: Jeste.