DART-VAG: initial clinical experience with a novel autologous technique for penile girth augmentation

PURPOSE: Dissatisfaction with penile girth is an increasingly recognized concern among men and can cause psychosocial distress despite normal anatomy. Existing augmentation techniques are often associated with limited durability or procedure-related morbidity. This study presents the initial clinical experience with a novel autologous penile girth augmentation technique that combines dartos fascia and tunica vaginalis flap (DART-VAG). METHODS: This was a prospective, non-randomized interventional study evaluating the DART-VAG technique. Penile length and circumference were measured preoperatively and at a 6-month follow-up. Psychosexual outcomes were assessed in a subset of patients using the Degree of Distress due to size concerns (DDC) questionnaire and the Male Genital Self-Image Scale (MGSIS). Postoperative complications and patient satisfaction were prospectively recorded. RESULTS: Thirty-two adult men underwent penile girth augmentation with DART-VAG between November 2021 and August 2025. No intraoperative complications occurred. Mean penile length increased from 6.2 ± 1.67 cm to 8.7 ± 1.46 cm (p < 0.001), and mean circumference increased from 9.4 ± 1.08 cm to 11.2 ± 1.15 cm (p < 0.001). No patient reported loss of achieved dimensions, and all patients (100%) reported satisfaction at 6 months. Wound dehiscence occurred in four patients (12.5%), most of whom were managed conservatively; one patient (3.1%) required surgical drainage of a scrotal hematoma. Total DDC scores decreased significantly after surgery, and MGSIS improved in specific domains. CONCLUSIONS: DART-VAG is a feasible technique for penile girth augmentation, providing significant gains, acceptable complications, and favorable psychosexual outcomes. Larger studies with longer follow-up are needed to confirm our findings.