Reduction corporoplasty for idiopathic acquired aneurysmal dilatation of the corpora cavernosa: surgical management of the ‘Bullfrog syndrome’. Case report.

Reduction corporoplasty for idiopathic acquired aneurysmal dilatation of the corpora cavernosa: surgical management of the ‘Bullfrog syndrome’. Case report. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Reduction corporoplasty for idiopathic acquired aneurysmal dilatation of the corpora cavernosa: surgical management of the ‘Bullfrog syndrome’. Case report. Maxime Sempels, Robert Andrianne, David Waltregny, François Triffaux This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5342233/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Penile deformities are heterogeneous and due to various causes. Among these deformities, acquired enlargement of the penis is a rare condition and can be disastrous for sexual life. Only scattered cases of acquired penile girth increase have been published with different names, and the surgical management of this condition remains not clear. Case presentation: We report a case of idiopathic acquired aneurysmal dilatation of the corpora cavernosa, which we called ‘bullfrog syndrome’. Evaluation included a penile doppler ultrasound and a magnetic resonance imaging, which revealed true aneurysmal dilatation of the corpora in their middle and distal portions, occurring only during erection. Conclusion: We describe an innovative surgical technique of corporoplasty to treat this penile disfiguration. Our technique included a corpora cavernosa plication and a polypropylene mesh support. The patient was satisfied and reported a normally shaped penis, an intact erectile function and no recurrence. Penis enlargement Idiopathic penile deformities Corpora cavernosa aneurysm reduction corporoplasty case report. Figures Figure 1 Figure 2 Figure 3 Introduction Penile deformities can be congenital, due to Peyronie’s disease, secondary to recurrent low flow priapism, or due to a penile traumatism. These deformities often include deviations, shortenings or hour-glass deformations, and sometimes require a surgical treatment. Surgical reconstructive techniques are well described in these conditions, and include plication techniques, incision or excision of tunica albuginea with sealing or grafting techniques, and lengthening procedures. 1 , 2 , 3 However, you will rarely encounter a situation where a penis is too bulky. Surgical procedures in this condition, such as reduction corporoplasty, are poorly documented in the literature. In the following case, we report a rare presentation of a male with an acquired aneurysmal dilatation of his corpora cavernosa, and we describe the surgical correction of this problem. Case presentation A 40-years old man presented for a severe acquired deformation of his penis during erection. He had no morbidity, history of penile trauma nor any vascular disease. He developed in a few months, progressively, a significant enlargement of his penile shaft, which occurred only during erection and make intercourse impossible (Fig. 1 ). Indeed, he wished to be sexually active and had several situations where intercourse with vaginal penetration was not possible because of the girth of his phallus, causing pain and discomfort to his partner. He reported normal erectile function, and orgasm and ejaculation where possible with masturbation. He denied any penile pain or deviation. Clinical examination was quite normal in a flaccid state. The penile doppler ultrasound, performed after an intra-cavernous injection of prostaglandins E1, confirmed a severe enlargement of the corpora cavernosa, with a normal cavernosal tissue aspect and a very thin tunica albuginea. The vascular aspects, including arterial velocity and resistivity index, were completely normal. An MRI, also performed after a cavernosal injection of prostaglandins, demonstrated a large, bilateral and symmetric dilatation of the two corpora cavernosa, from the cavernosal crux until the distal part of the corpora. It looked like a cavernosal aneurysm. We then proposed a surgical correction such as a reduction cavernoplasty (Fig. 2 ). We performed this intervention under general anesthesia by a single peno-scrotal longitudinal incision. This peno-scrotal approach allowed us to deglove the penis and expose both the distal and the proximal part of the corpora cavernosa. An intra-operative erection was then induced by intra-cavernous injection of saline and allowed us to perfectly delimit the pathological area. A longitudinal plication was made bilaterally, 10 centimeters long on the para-urethral area, in order to avoid any neurovascular injury. We used monofilament non-absorbable running sutures, without any incision or excision of the tunica albuginea. In order to support this repair, we tailored a polypropylene mesh and applied it around the penile shaft, without covering the urethra. Sutures were done on the para-urethral area, again to avoid dorsal nerves and vessels injury, and the mesh was applied in one piece, under Dartos fascia. Skin was closed and a compressive dressing was applied. Patient was doing well after the surgery, without complications. He described some pain in the penile shaft and dysesthesia on the glans, which resolved after 6 weeks. He was then perfectly satisfied. His erectile function was conserved, with a normally shaped penis (Fig. 3 ). After 1 year of follow-up, there is no recurrence of deformation, sexual intercourse is possible, and he is still satisfied. Discussion Enlargement of the penis is a rare condition that can cause a patient daily grief, a discomfort for the partner and even make sexual intercourse impossible. This could negatively impact on sexual identity and quality of life. Only scattered cases were published in the last 40 years and have been reported with different names (megalophallus, aneurysmal dilatation of corpora cavernosa, spontaneous corporal herniation, megalopenis). In most cases an underlying sickle cell disease, which determine priapismic events, has been causally linked to the development of penile girth increase. After recurrent low flow priapism, the problem is a hyperplastic reaction with fibrosis and thickening of the albuginea, resulting in a penile girth increase both in flaccidity and erection. 4 , 5 Other cases, including our, are idiopathic and due to a real aneurysmal dilatation of the corpora cavernosa. The albuginea is in these situations very thin and the deformation occur only during erection. We decided to call this idiopathic aneurysm ‘the bullfrog syndrome’, in comparison with the dynamic and elastic enlargement of the vocal sac of american bullfrogs. The literature is currently poor in providing a protocol for managing patients with corporal enlargement. Daniel L. Watson and Abraham Morgentaler described in 1995 the first case in our knowledge of a real aneurysmal dilatation of the corpora cavernosa. They performed a reduction corporoplasty by a subcoronal incision, degloving and albuginea excision. A satisfactory result was achieved after their surgical repair and the patient did not present any recurrence. 6 Martinez et al described a reduction corporoplasty for a young patient with an enlarged penis after recurrent priapism. The surgical repair was also performed by a subcoronal approach with a degloving. They used an elliptical longitudinal excision of the pathologic albuginea with a direct closure. Results were also satisfactory in this case report, with good erectile function, and without any pain or recurrence. 7 Pescatori et al proposed another idiopathic case and they reviewed other cases in the literature. They called the acquired penile girth increase syndrome the ‘circumferencial acquired macropenis’, which include post-priapic and idiopathic cases. 8 Their surgical technique involves a geometrically-based reduction corporoplasty (with elliptical excision of albuginea), and a repair reinforcement with a bovine pericardium patch. At 19 months follow-up their patient was maintaining a normalized penile shape and was fully satisfied. In our case, we were also afraid about the possibility of albuginea herniation recurrence, and then we sought to set up an innovative technique of corporoplasty. Firstly, we avoided to open and to excise the albuginea, in order to decrease the cavernosal tissue injury and to keep intact the veno-occlusive function. So, we only plicate the albuginea. Secondly, we decided to apply a polypropylene mesh to support our reconstruction and avoid any recurrence. Sutures have been done in the para-urethral area to avoid any neurovascular injury. Furthermore, urethra was not covered by the mesh, to avoid of course any post-operative urethral complications such as stenosis or fistula. Thirdly, about the incision, we think it is better to deglove the penis by a penoscrotal longitudinal approach. This approach offers a nice exposition of the corpora cavernosa, even in their proximal part. Moreover, when using a mesh, the risk of infection and/or erosion of this synthetic material could be lower with a penoscrotal approach than with a subcoronal incision. In conclusion, this reduction corporoplasty by a plication technique and with a polypropylene mesh support seems to be a feasible, safe and effective procedure to treat aneurysmal dilatation of the corpora cavernosa. Declarations Ethics approval and consent to participate: For this case report, the ethics committee of the University Hospital of Liège and Faculty of Medicine of Liège did not consider necessary an ethics approval. However, you can find in another file the official letter from our ethics committee, and its name and reference number. We confirm that this work was made in accordance with the ethical principles presented in the latest version of the declaration of Helsinki. Patient data confidentiality was absolutely respected. Written informed consent was obtained from the patient for the treatment he received. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and accompanying images. Funding Not applicable. Author Contribution MS was the referent urologist of the patient, the main surgeon for the surgery, and ensure the patient's follow-up. MS is the main author, who reviewed the literature and wrote this article.FT did the ultrasound study, and corrected this article.RA participated in the surgery, and corrected this article.DW was a major contributor in writing this manuscript.All authors read and approved the final manuscript. References Segal RL, Burnett AL. Surgical management for Peyronie’s disease. World J Mens Health 2013; 31: 1–11. Kalsi J, Minhas S, Christopher N, Ralph D. The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie’s disease. BJU Int 2005;95: 1029–33. Perovic SV, Djordjevic ML. The penile disassembly technique in the surgical treatment of Peyronie’s disease. BJU Int 2001; 88: 731–8. Datta NS. Megalophallus in sickle cell disease. J Urol 1977;117:672–673. Kassim AA, Umans H, Nagel RL, et al. Megalophallus as a sequela of priapism in sickle cell anemia: use of blood oxygen level-dependent magnetic resonance imaging. Urology 2000; 56: 509. Watson DL, Morgentaler A. Spontaneous corporeal herniation of the penis: a new abnormality of the tunica albuginea? J Urol 1995;153:737–740. Martinez DR, Manimala NJ, Rafiei A, et al. The reduction corporoplasty: The answer to the improbable urologic question “Can you make my penis smaller?”. J Sex Med 2015; 12: 835–839. Edoardo Stefano Pescatori, Barbara Drei, and Salvatore Rabito. Circumferential Acquired Macropenis: Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. J Sex Med 2022; 10: 100460. Additional Declarations No competing interests reported. Supplementary Files Bullfrogsyndromefigures.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5342233","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":375050586,"identity":"13f9aa51-e3bc-4ec8-a566-4909601c2e41","order_by":0,"name":"Maxime Sempels","email":"data:image/png;base64,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","orcid":"","institution":"University hospital of Liège","correspondingAuthor":true,"prefix":"","firstName":"Maxime","middleName":"","lastName":"Sempels","suffix":""},{"id":375050589,"identity":"270c8ca4-0092-43e4-bf5b-41f9a7bdde20","order_by":1,"name":"Robert Andrianne","email":"","orcid":"","institution":"University hospital of Liège","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Andrianne","suffix":""},{"id":375050591,"identity":"7c427be1-1421-4608-9297-f046b5aa3996","order_by":2,"name":"David Waltregny","email":"","orcid":"","institution":"University hospital of Liège","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Waltregny","suffix":""},{"id":375050592,"identity":"486e36ea-18f1-4877-ab70-fc55012b6ee3","order_by":3,"name":"François Triffaux","email":"","orcid":"","institution":"University hospital of Liège","correspondingAuthor":false,"prefix":"","firstName":"François","middleName":"","lastName":"Triffaux","suffix":""}],"badges":[],"createdAt":"2024-10-27 16:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5342233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5342233/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70961264,"identity":"3f785280-c95b-4278-bc6c-c3dd06e4598d","added_by":"auto","created_at":"2024-12-09 15:27:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":308061,"visible":true,"origin":"","legend":"\u003cp\u003ePre-operative pictures. (A) Normal aspect on flaccid state. (B) Large deformation on erection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5342233/v1/9c99f165c17951465dcca659.png"},{"id":70960687,"identity":"5aa2eab9-c2fb-4264-9a8a-1a2a7adbde2b","added_by":"auto","created_at":"2024-12-09 15:19:18","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":315848,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-operative pictures\u003c/p\u003e\n\u003cp\u003e(A) \u0026nbsp;Longitudinal penoscrotal incision. (B) Exposition of corpora cavernosa. (C) Complete degloving by this peno-scrotal approach, without sub-coronal incision. (D) Artificial erection by transglandular intracavernosal saline instillation. (E) Highlighting the large aneurysmal dilatation, and demarcation of the future area of plication. (F) Reduction corporoplasty by a plication technique with a para-urethral longitudinal running suture, without albuginea excision or incision; right side view. Neurovascular structures on the dorsal aspect of the corpora are respected. (G) Ventral view of the bilateral para-urethral reduction corporoplasty. (H) Placement and suture of the polypropylene sub-circumferential mesh (between Dartos and Buck’s fascia); left side vue. (I) Placement and suture of the polypropylene sub-circumferential mesh; right side vue. (J) Closure of Dartos fascia. (K) Final aspect after cutaneous closure.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5342233/v1/72f4983f4b1551c608e9e664.jpg"},{"id":70960690,"identity":"ef5c7f77-fae2-4938-ba68-c4cd36d6150a","added_by":"auto","created_at":"2024-12-09 15:19:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":300159,"visible":true,"origin":"","legend":"\u003cp\u003ePost-operative pictures\u003c/p\u003e\n\u003cp\u003e(A) Flaccid state after 48h. (B) Erection at 6 months.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5342233/v1/81b056ab9ecd51699abd0c59.png"},{"id":87447069,"identity":"5da14627-80b6-49cc-b9c4-c76c49fe9cb7","added_by":"auto","created_at":"2025-07-24 01:08:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1530270,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5342233/v1/a6cc3378-e3c2-45a5-b4b1-287108de61e3.pdf"},{"id":70960691,"identity":"e1bc03d1-56ce-4e16-93c8-074402fa5908","added_by":"auto","created_at":"2024-12-09 15:19:20","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":46375698,"visible":true,"origin":"","legend":"","description":"","filename":"Bullfrogsyndromefigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-5342233/v1/93038f49e2dc1d8f2824781d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eReduction corporoplasty for idiopathic acquired aneurysmal dilatation of the corpora cavernosa: surgical management of the ‘Bullfrog syndrome’. Case report.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePenile deformities can be congenital, due to Peyronie\u0026rsquo;s disease, secondary to recurrent low flow priapism, or due to a penile traumatism.\u003c/p\u003e \u003cp\u003eThese deformities often include deviations, shortenings or hour-glass deformations, and sometimes require a surgical treatment. Surgical reconstructive techniques are well described in these conditions, and include plication techniques, incision or excision of tunica albuginea with sealing or grafting techniques, and lengthening procedures.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, you will rarely encounter a situation where a penis is too bulky.\u003c/p\u003e \u003cp\u003eSurgical procedures in this condition, such as reduction corporoplasty, are poorly documented in the literature.\u003c/p\u003e \u003cp\u003eIn the following case, we report a rare presentation of a male with an acquired aneurysmal dilatation of his corpora cavernosa, and we describe the surgical correction of this problem.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 40-years old man presented for a severe acquired deformation of his penis during erection. He had no morbidity, history of penile trauma nor any vascular disease. He developed in a few months, progressively, a significant enlargement of his penile shaft, which occurred only during erection and make intercourse impossible (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Indeed, he wished to be sexually active and had several situations where intercourse with vaginal penetration was not possible because of the girth of his phallus, causing pain and discomfort to his partner.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHe reported normal erectile function, and orgasm and ejaculation where possible with masturbation. He denied any penile pain or deviation.\u003c/p\u003e \u003cp\u003eClinical examination was quite normal in a flaccid state.\u003c/p\u003e \u003cp\u003eThe penile doppler ultrasound, performed after an intra-cavernous injection of prostaglandins E1, confirmed a severe enlargement of the corpora cavernosa, with a normal cavernosal tissue aspect and a very thin tunica albuginea. The vascular aspects, including arterial velocity and resistivity index, were completely normal. An MRI, also performed after a cavernosal injection of prostaglandins, demonstrated a large, bilateral and symmetric dilatation of the two corpora cavernosa, from the cavernosal crux until the distal part of the corpora. It looked like a cavernosal aneurysm.\u003c/p\u003e \u003cp\u003eWe then proposed a surgical correction such as a reduction cavernoplasty (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We performed this intervention under general anesthesia by a single peno-scrotal longitudinal incision. This peno-scrotal approach allowed us to deglove the penis and expose both the distal and the proximal part of the corpora cavernosa. An intra-operative erection was then induced by intra-cavernous injection of saline and allowed us to perfectly delimit the pathological area. A longitudinal plication was made bilaterally, 10 centimeters long on the para-urethral area, in order to avoid any neurovascular injury. We used monofilament non-absorbable running sutures, without any incision or excision of the tunica albuginea. In order to support this repair, we tailored a polypropylene mesh and applied it around the penile shaft, without covering the urethra. Sutures were done on the para-urethral area, again to avoid dorsal nerves and vessels injury, and the mesh was applied in one piece, under Dartos fascia. Skin was closed and a compressive dressing was applied.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatient was doing well after the surgery, without complications. He described some pain in the penile shaft and dysesthesia on the glans, which resolved after 6 weeks. He was then perfectly satisfied. His erectile function was conserved, with a normally shaped penis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After 1 year of follow-up, there is no recurrence of deformation, sexual intercourse is possible, and he is still satisfied.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEnlargement of the penis is a rare condition that can cause a patient daily grief, a discomfort for the partner and even make sexual intercourse impossible. This could negatively impact on sexual identity and quality of life.\u003c/p\u003e \u003cp\u003eOnly scattered cases were published in the last 40 years and have been reported with different names (megalophallus, aneurysmal dilatation of corpora cavernosa, spontaneous corporal herniation, megalopenis).\u003c/p\u003e \u003cp\u003eIn most cases an underlying sickle cell disease, which determine priapismic events, has been causally linked to the development of penile girth increase. After recurrent low flow priapism, the problem is a hyperplastic reaction with fibrosis and thickening of the albuginea, resulting in a penile girth increase both in flaccidity and erection.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOther cases, including our, are idiopathic and due to a real aneurysmal dilatation of the corpora cavernosa. The albuginea is in these situations very thin and the deformation occur only during erection.\u003c/p\u003e \u003cp\u003eWe decided to call this idiopathic aneurysm \u0026lsquo;the bullfrog syndrome\u0026rsquo;, in comparison with the dynamic and elastic enlargement of the vocal sac of american bullfrogs.\u003c/p\u003e \u003cp\u003eThe literature is currently poor in providing a protocol for managing patients with corporal enlargement.\u003c/p\u003e \u003cp\u003eDaniel L. Watson and Abraham Morgentaler described in 1995 the first case in our knowledge of a real aneurysmal dilatation of the corpora cavernosa. They performed a reduction corporoplasty by a subcoronal incision, degloving and albuginea excision. A satisfactory result was achieved after their surgical repair and the patient did not present any recurrence.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMartinez et al described a reduction corporoplasty for a young patient with an enlarged penis after recurrent priapism. The surgical repair was also performed by a subcoronal approach with a degloving. They used an elliptical longitudinal excision of the pathologic albuginea with a direct closure. Results were also satisfactory in this case report, with good erectile function, and without any pain or recurrence.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePescatori et al proposed another idiopathic case and they reviewed other cases in the literature. They called the acquired penile girth increase syndrome the \u0026lsquo;circumferencial acquired macropenis\u0026rsquo;, which include post-priapic and idiopathic cases.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTheir surgical technique involves a geometrically-based reduction corporoplasty (with elliptical excision of albuginea), and a repair reinforcement with a bovine pericardium patch.\u003c/p\u003e \u003cp\u003eAt 19 months follow-up their patient was maintaining a normalized penile shape and was fully satisfied.\u003c/p\u003e \u003cp\u003eIn our case, we were also afraid about the possibility of albuginea herniation recurrence, and then we sought to set up an innovative technique of corporoplasty.\u003c/p\u003e \u003cp\u003eFirstly, we avoided to open and to excise the albuginea, in order to decrease the cavernosal tissue injury and to keep intact the veno-occlusive function. So, we only plicate the albuginea.\u003c/p\u003e \u003cp\u003eSecondly, we decided to apply a polypropylene mesh to support our reconstruction and avoid any recurrence. Sutures have been done in the para-urethral area to avoid any neurovascular injury. Furthermore, urethra was not covered by the mesh, to avoid of course any post-operative urethral complications such as stenosis or fistula.\u003c/p\u003e \u003cp\u003eThirdly, about the incision, we think it is better to deglove the penis by a penoscrotal longitudinal approach. This approach offers a nice exposition of the corpora cavernosa, even in their proximal part. Moreover, when using a mesh, the risk of infection and/or erosion of this synthetic material could be lower with a penoscrotal approach than with a subcoronal incision.\u003c/p\u003e \u003cp\u003eIn conclusion, this reduction corporoplasty by a plication technique and with a polypropylene mesh support seems to be a feasible, safe and effective procedure to treat aneurysmal dilatation of the corpora cavernosa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthics approval and consent to participate:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor this case report, the ethics committee of the University Hospital of Liège and Faculty of Medicine of Liège did not consider necessary an ethics approval.\u003c/p\u003e\n\u003cp\u003eHowever, you can find in another file the official letter from our ethics committee, and its name and reference number.\u003c/p\u003e\n\u003cp\u003eWe confirm that this work was made in accordance with the ethical principles presented in the latest version of the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003ePatient data confidentiality was absolutely respected.\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the treatment he received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConsent for publication:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying images.\u003c/p\u003e\n\u003ch4\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/h4\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMS was the referent urologist of the patient, the main surgeon for the surgery, and ensure the patient's follow-up. MS is the main author, who reviewed the literature and wrote this article.FT did the ultrasound study, and corrected this article.RA participated in the surgery, and corrected this article.DW was a major contributor in writing this manuscript.All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSegal RL, Burnett AL. Surgical management for Peyronie\u0026rsquo;s disease. World J Mens Health 2013; 31: 1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalsi J, Minhas S, Christopher N, Ralph D. The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie\u0026rsquo;s disease. BJU Int 2005;95: 1029\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerovic SV, Djordjevic ML. The penile disassembly technique in the surgical treatment of Peyronie\u0026rsquo;s disease. BJU Int 2001; 88: 731\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDatta NS. Megalophallus in sickle cell disease. J Urol 1977;117:672\u0026ndash;673.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassim AA, Umans H, Nagel RL, et al. Megalophallus as a sequela of priapism in sickle cell anemia: use of blood oxygen level-dependent magnetic resonance imaging. Urology 2000; 56: 509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson DL, Morgentaler A. Spontaneous corporeal herniation of the penis: a new abnormality of the tunica albuginea? J Urol 1995;153:737\u0026ndash;740.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinez DR, Manimala NJ, Rafiei A, et al. The reduction corporoplasty: The answer to the improbable urologic question \u0026ldquo;Can you make my penis smaller?\u0026rdquo;. J Sex Med 2015; 12: 835\u0026ndash;839.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdoardo Stefano Pescatori, Barbara Drei, and Salvatore Rabito. Circumferential Acquired Macropenis: Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. J Sex Med 2022; 10: 100460.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Penis enlargement, Idiopathic penile deformities, Corpora cavernosa aneurysm, reduction corporoplasty, case report.","lastPublishedDoi":"10.21203/rs.3.rs-5342233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5342233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e Penile deformities are heterogeneous and due to various causes.\u003c/p\u003e\n\u003cp\u003eAmong these deformities, acquired enlargement of the penis is a rare condition and can be disastrous for sexual life. Only scattered cases of acquired penile girth increase have been published with different names, and the surgical management of this condition remains not clear.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eWe report a case of idiopathic acquired aneurysmal dilatation of the corpora cavernosa, which we called ‘bullfrog syndrome’. Evaluation included a penile doppler ultrasound and a magnetic resonance imaging, which revealed true aneurysmal dilatation of the corpora in their middle and distal portions, occurring only during erection. \u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e We describe an innovative surgical technique of corporoplasty to treat this penile disfiguration. Our technique included a corpora cavernosa plication and a polypropylene mesh support. The patient was satisfied and reported a normally shaped penis, an intact erectile function and no recurrence.\u003c/p\u003e","manuscriptTitle":"Reduction corporoplasty for idiopathic acquired aneurysmal dilatation of the corpora cavernosa: surgical management of the ‘Bullfrog syndrome’. 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