Augmentation Phalloplasty Patient Selection and Satisfaction Inventory: a novel questionnaire to evaluate patients considered for augmentation phalloplasty surgery because of penile dysmorphophobia.

Objectives: To introduce a novel questionnaire by which we attempted to identify the most suitable candidates for augmentation phalloplasty surgery for penile dysmorphophobia and to objectively estimate the outcome.

Methods: A total of 45 physically normal young adult men who presented with complaints of a "small penis" and were seeking surgical correction were included in the study. In addition to the ordinary evaluation, all completed the questionnaire devised by our department, the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI). The APPSSI aims to quantitatively assess the severity of the condition and the degree of the patient's willingness to undergo penile augmentation and to numerically measure the postoperative result. The APPSSI consists of four questions, with each having five possible answers (scale 0 to 4). Questions 1 through 3 were asked preoperatively (suitability assessment) and questions 1, 2, and 4 postoperatively (outcome evaluation). The eligibility threshold for surgery was a preoperative score of 6 or less. The preoperative scores ranged from 0 (surgery justified) to 12 (surgery not justified), and the postoperative scores ranged from 0 (disappointed) to 12 (excited). The Student t test was used for statistical analysis, and P <0.05 was considered to indicate statistical significance.

Results: Of the 45 patients, 13 (28.8%) with an APPSSI score of 6 or less (mean 3.18) underwent penile lengthening (n = 7), lengthening-enlargement (n = 4), or celioplasty-penile lengthening (n = 2). Postoperatively, the score increased by 4.36 (mean 7.54, P <0.001), and the condition improved by 25% to 50% in 11 patients, 66.6% in 1, and remained unchanged (0%) in 1 patient.

Conclusions: The APPSSI questionnaire properly identified patients who significantly benefited from augmentation phalloplasty. Nevertheless, because of the small sample size and nonrandomized study, the questionnaire's validation requires a larger number of patients tested in a randomized manner by more researchers to become a valuable clinical instrument and patient eligibility criterion for this type of surgery.