Abstract
<jats:p>Introduction. Surgical correction of perceived or true penile shortening remains a challenging task in reconstructive urology-andrology. A significant proportion of patients seeking penile lengthening present with normal anatomical parameters but suffer from psychological distress related to size perception, while a smaller cohort has objective shortening due to congenital anomalies (hypospadias, epispadias) or acquired conditions (Peyronie's disease, fibrosis post-radical prostatectomy). Main content. This review is dedicated to analyzing modern minimally invasive surgical strategies for penile length correction. Data on percutaneous ligamentolysis (PL) and penile lengthening procedures with penile prosthesis (PLP-PP) techniques are presented. It is shown that PL provides a visible length gain averaging 1.5-2.5 cm but is associated with a risk of retraction (up to 30% at 2-3 years) and dynamic instability (15-20%). The mechanisms of intervention efficacy are discussed, including suspensory ligament release, tunical expansion, and sliding techniques. Special attention is paid to patient selection criteria: baseline stretched penile length (SPL) <7 cm, BMI<30 kg/m², preserved erectile function, as well as mandatory psychosexual assessment to identify dysmorphophobia, which is associated with a high risk of dissatisfaction (>70%) even after technically successful surgery. Conclusion. Minimally invasive strategies (PL, PLP-PP) are valuable tools for penile length correction but require strict differentiation of indications. PL is indicated for relative shortening, while PLP-PP is indicated for true shortening with erectile dysfunction. Efficacy and safety are directly dependent on meticulous multidisciplinary patient selection, realistic expectations, and preoperative preparation.</jats:p>