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

Abstract 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.