Abstract
Objective: To critically appraise the safety and efficacy of male genital augmentation and enhancement procedures, and to formulate consensus recommendations for urologists and medical professionals. Methods: A systematic search of the literature published between 2000 and 2025 was conducted. Outcomes of interest focused on penile length and girth changes, complications, and validated patient-reported outcomes. Risk of bias was assessed using Cochrane RoB-2 for randomised controlled trials (RCTs) and the Newcastle–Ottawa Scale (NOS) for non-randomised studies. Evidence was synthesised qualitatively by intervention type. Consensus recommendations were generated through structured group appraisal by the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery (AGUS), integrating the evidence base with expert opinion, quality assessments, and patient safety considerations. Results: Thirty-six studies ( n = 3748) were included: 12 injectable fillers and 24 surgical. Injectable fillers produced short-term girth gains with mild, transient complications. Surgical procedures demonstrated modest increases in length and girth, though complicated by infection, fibrosis, and/or device removal. Across the eligible evidence, the risk of bias was high, the quality of evidence was low, and expert opinion was consistently low. Conclusion: Evidence quality remains poor, heterogeneous, and methodologically limited. As such, five key recommendations were generated by the BAUS AGUS committee on genital augmentation and enhancement with either injectable fillers or surgical procedures. Level of evidence: 2
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