{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:15:40Z","timestamp":1789456540716,"version":"build-2803163510"},"reference-count":28,"publisher":"CSIRO Publishing","issue":"4","license":[{"start":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T00:00:00Z","timestamp":1780704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Penile augmentation is among the fastest-growing male aesthetic procedures worldwide, yet comparative safety data in all major modalities remain fragmented, impeding evidence-based patient counselling and shared decision-making in sexual health practice. This systematic review and meta-analysis was undertaken to consolidate and critically appraise the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic searches were made from seven databases from inception through December 2024. Complications with penile augmentation procedures were classified using the Clavien-Dindo system. Risk of bias was assessed with RoB ver. 2.0, ROBINS-I, and the Newcastle-Ottawa Scale. Random-effects meta-analyses used the Freeman\u2013Tukey transformation; between-subgroup heterogeneity was tested with the Q-between statistic. Four pre-specified sensitivity analyses and GRADE certainty ratings were conducted using PRISMA 2020; registered in PROSPERO (CRD420261374814).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 23 primary studies (9 randomised control trials, 14 observational; N\u00a0=\u00a02620; 8 countries) were included. The pooled complication rate was 14.9% (95% CI: 11.5\u201318.6%; I2\u00a0=\u00a035.1%; prediction interval: 5.9\u201327.0%). Between-subgroup heterogeneity was statistically significant (Q-between\u00a0=\u00a018.42, d.f.\u00a0=\u00a05, P\u00a0=\u00a00.002). All cross-material comparisons are indirect (no head-to-head RCTs exist). Hyaluronic acid (HA) appeared numerically lowest (9.0%; 95% CI: 5.1\u201313.9%; GRADE: moderate). Girth gains from modalities ranged from 1.23\u20131.50\u00a0cm (dermal-fat grafts) to 2.50\u20133.50\u00a0cm (silicone implants). GRADE certainty was moderate for HA\u00a0and very low for permanent materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on current indirect evidence, HA injection may be considered among the available minimally invasive options, with a complication profile that appeared more favourable than that of permanent materials, and with the added safety advantage of enzymatic reversibility. This finding is relevant to sexual health counselling practice. Head-to-head trials and validated patient-reported outcome measures are urgently needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh26112","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:53:19Z","timestamp":1783299199000},"source":"Crossref","is-referenced-by-count":1,"title":["Penile augmentation procedures: a systematic review and meta-analysis of techniques, materials, and safety outcomes"],"prefix":"10.1071","volume":"23","author":[{"given":"Thais Daniele Flores","family":"Fonseca","sequence":"first","affiliation":[{"name":"ACentro Universit\u00e1rio Una Itabira, Itabira, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-0328","authenticated-orcid":true,"given":"Samyr Machado","family":"Querobino","sequence":"additional","affiliation":[{"name":"ACentro Universit\u00e1rio Una Itabira, Itabira, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"2026070520514449700_R1","doi-asserted-by":"publisher","first-page":"299","DOI":"10.5534\/wjmh.210007","article-title":"Efficacy and safety of penile girth enhancement using hyaluronic acid filler and the clinical impact on ejaculation: a multi-center, patient\/evaluator-blinded, randomized active-controlled trial.","volume":"40","author":"Ahn","year":"2022","journal-title":"World J Mens Health"},{"issue":"7","key":"2026070520514449700_R2","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1111\/j.1743-6109.2012.02744.x","article-title":"Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series.","volume":"9","author":"Alei","year":"2012","journal-title":"J Sex Med"},{"key":"2026070520514449700_R3"},{"issue":"2","key":"2026070520514449700_R4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/s0302-2838(02)00264-6","article-title":"A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts--three years of experience.","volume":"48","author":"Austoni","year":"2005","journal-title":"Eur Urol"},{"issue":"6","key":"2026070520514449700_R5","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1111\/bju.13010","article-title":"Am I normal? 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