Phalloplasty procedures for most men requiring penile augmentation surgery are cos-metic procedures; generally the patients have a normal-sized and fully functional penis but they think that their penis is too small. There are not well defined indications for penile enhancement surgery and, except for the treatment of “micropenis”, there are not established guidelines and the outcome measures for success are still unclear. All penile enhancement techniques often do not reach the expected result and the grade of pa-tient’s satisfaction is frequently poor. Phalloplasty procedures for psychological dys-morfism are not approved by any scientific society and the majority of these procedures are performed in private settings. The ethical and medicolegal problems resulting from a penis enhancement can be various and numerous, but few of them are reported in litera-ture. After phalloplasty an attribution of professional responsibility and request of reim-bursement is not rare. In this contribution the authors summarize a panorama of several urological and medico-legal aspects related to phalloplasty procedures.