How common are cases of acquired penile girth increase in urology literature and what etiologies are reported?
Executive summary
Acquired penile girth increase is distinctly rare in the urology literature: a focused review identified only seven well-documented cases of symmetrical, circumferential girth enlargement (termed “circumferential acquired macropenis”) in the published record, prompting a surgical case series and technique proposal [1] [2]. Reported etiologies cluster into post‑priapistic changes in a majority of cases and idiopathic thinning/herniation of the tunica albuginea in the remainder, while separate literature documents iatrogenic and self‑inflicted girth enlargement procedures that produce different patterns of deformity and complications [1] [2] [3] [4].
1. The evidence base is tiny — only scattered case reports and one small series
A systematic search that underpins the “circumferential acquired macropenis” concept identified seven cases in total and used a single operative case to develop a geometrically based reduction corporoplasty technique, illustrating how rare and piecemeal the evidence is [1] [2]. The scarcity of cases means prevalence estimates do not exist in population terms; the condition appears in the literature chiefly as isolated reports of mechanical sexual dysfunction rather than as a common clinical presentation [2] [1].
2. Two dominant clinical patterns — post‑priapism and idiopathic albuginea thinning
Authors classify the syndrome into two phenotypes: post‑priapistic cases, where girth increases are present in both flaccidity and erection and are linked to prior prolonged erections, and idiopathic cases, where girth increase is observed with erection only and surgery reveals a thinned or herniated tunica albuginea over the involved corpora [5] [6]. In the reviewed series five of seven cases were attributed to priapism as the likely causal event, while the remaining cases including the authors’ index patient had no clear precipitant [1] [2].
3. A different problem: augmentation procedures and injectable materials
A separate and larger literature documents intentional girth augmentation—surgical grafts, fillers, autologous fat, and illicit injections—with complications ranging from dermatitis and granulomas to severe infections, scarring and permanent deformity that may mimic or create acquired enlargement or asymmetry; these reports form a distinct etiology class from the bilateral corpora dilatation described as circumferential macropenis [3] [7] [4]. Many injectable agents are used off‑label or illicitly, and complications are likely under‑reported, complicating efforts to quantify incidence [3] [4] [7].
4. Clinical consequences, management and guideline context
Clinically, the published circumferential macropenis cases produced mechanically hampered penetration and partner dyspareunia leading to corrective corporoplasty in the index reports, with reported functional improvement after surgery [2] [6]. European guidelines emphasize careful categorization of penile abnormalities into congenital, acquired, and dysmorphophobic etiologies and call for multidisciplinary assessment before cosmetic procedures, reflecting limited evidence and potential psychosocial drivers surrounding size concerns [8] [9].
5. Why rarity may be underestimated — reporting bias and overlapping entities
Rarity in the formal literature does not exclude more frequent, under‑recognized presentations: complications from girth‑enhancement injections are probably under‑reported and self‑injection practices persist in some regions, and other acquired abnormalities (e.g., Peyronie‑related deformity, buried penis, traumatic scars) can cause apparent girth change that is categorized differently by authors [4] [7] [10]. The small case count for circumferential macropenis may reflect narrow diagnostic framing, publication bias toward novel surgical repairs, and fragmented reporting across specialties [1] [11].
6. Bottom line for clinicians and researchers
The urologic literature treats acquired, symmetric penile girth increase as an uncommon, mostly case‑report phenomenon with two principal mechanistic categories—post‑priapism and idiopathic albuginea thinning—while a broader body of work documents iatrogenic and illicit augmentation‑related deformities with different pathophysiology and higher complication reports [1] [2] [3] [4]. High‑quality epidemiology, clearer nosology, and standardized reporting are missing; current guidance therefore stresses cautious evaluation, multidisciplinary assessment, and restraint regarding elective augmentation in patients with normal anatomy [8] [12].