How is circumferential acquired macropenis evaluated and surgically managed in modern urologic practice?
Executive summary
Circumferential acquired macropenis is a rare, recently codified syndrome of symptomatic, symmetric penile girth increase that can impair penetration and sexual function; most reported cases follow priapistic episodes but a minority are idiopathic, and surgical reduction via a geometrically-based reduction corporoplasty has been described with favorable short‑ to mid‑term results [1] [2]. Contemporary urologic practice evaluates these patients with focused history, targeted imaging and intracavernous studies to define etiology and guide a tailored corporoplasty that restores “target” circumferences while protecting neurovascular structures [1] [3].
1. Defining the entity and who gets it
The term “circumferential acquired macropenis” unifies an unusual syndrome of acquired penile girth increase reported in a very small case series and literature review that identified seven cases overall; five were attributed to priapism and the remainder lacked a clear cause, prompting the authors to distinguish post‑priapistic and idiopathic subtypes [1] [4]. Clinically the condition presents when girth increase becomes functionally obstructive — most notably dyspareunia and inability to achieve full penetration — rather than as a purely cosmetic concern [1] [5].
2. Clinical evaluation — history and physical exam
Evaluation begins with a detailed sexual and vascular history emphasizing prior priapism, episodes of prolonged erection, changes in flaccid versus erect girth, partner symptoms such as dyspareunia, and time course; physical exam documents symmetric versus focal enlargement and assesses skin, glans, and urethral position [1] [4]. The distinction between girth enlargement present in both flaccid and erect states (post‑priapistic) versus erection‑only enlargements (idiopathic) is emphasized by the literature because it correlates with intraoperative tissue findings [1].
3. Imaging and functional testing to define anatomy
Advanced imaging—dynamic cavernosography and contrast‑enhanced or dynamic MRI—has been used to visualize corporal anatomy, herniation, and areas of albugineal thinning and can complement clinical assessment when planning correction [6] [1]. The articles report use of dynamic cavernosography and MRI to confirm bilateral corporal herniation or thinning of the tunica albuginea in idiopathic cases, guiding the surgeon to the affected segments [6] [3].
4. Intraoperative findings that shape management
At surgery the key findings are symmetric dilation of the corpora and, in idiopathic cases, a thinned or attenuated tunica albuginea over the affected segment consistent with a localized aneurysmal‑type dilatation or herniation; neurovascular bundle elevation is an essential early step to permit safe tunical work [1] [3]. The literature frames circumferential acquired macropenis as essentially a structural corporopathy—bilateral corporal herniation—rather than a skin or subcutaneous problem, which is why corporoplasty (tunical remodeling) is the preferred corrective approach [1] [4].
5. Geometrically‑based reduction corporoplasty — technique and principles
The proposed operation measures proximal and distal “target” circumferences where tunica appears normal, marks bilateral paraurethral reference intervals along the dilated tunica, and then designs ellipses of tunical excision and plication to restore the desired circumference while preserving urethral and neurovascular integrity; the neurovascular bundle is elevated early and circumferential tunical measurements guide symmetric reduction [3] [7]. The single published surgical series describing this geometric method reported normalization of shape, resolution of dyspareunia and maintained sexual function at 20 months follow‑up in their index patient and cites earlier reports of reduction corporoplasties for similar corpora dilations [8] [5].
6. Outcomes, limitations and alternative considerations
Reported outcomes in the literature are promising but limited: the defining review and case report series encompass very few patients, the geometric technique has robust follow‑up in a single reported case (20 months), and authors explicitly acknowledge small sample size and the need for more cases to validate indications, durability and complication profiles [1] [2]. Alternative strategies are not extensively detailed in the current literature beyond tunical reduction corporoplasties used for focal dilatation; clinicians should balance reconstructive benefit with risks to erectile function and urethral integrity and recognize that published data are preliminary [9] [4].
7. Bottom line
Modern urologic management of circumferential acquired macropenis integrates careful etiologic delineation (post‑priapistic versus idiopathic), targeted imaging and intraoperative mapping, and a tunical‑preserving, geometrically planned reduction corporoplasty that restores target circumferences and preserves neurovascular structures; evidence to date is limited to a handful of cases but shows symptomatic improvement in reported patients [1] [3] [8].