An Unusual Delayed Complication of Paraffin Self-injection for Penile Girth Augmentation

Mario De Siati; Oscar Selvaggio; Giuseppe Di Fino; Giuseppe Liuzzi; Paolo Massenio; Francesca Sanguedolce; Giuseppe Carrieri; Luigi Cormio

Disclosures

BMC Urol. 2013;13(66) 

In This Article

Conclusions

The number of patients seeking penile augmentation is continuously increasing. The vast majority of them has a normally sized and normally functioning penis but is dissatisfied by the girth. A recent study on healthy young Korean military men[14] pointed out that 24% of them underestimated their penile size. It is therefore intuitive that some of them could look for PGA.

PGA can be achieved by longitudinally grafting the tunica albuginea or by subcutaneous injection of filling substances. While grafting requires surgery, subcutaneous injection is easily carried out by medical and even non-medical personnel, thus making such procedure particularly attractive.

Filling substances used in the non-medical setting include paraffin,[1] vaseline,[10] mineral oil,[2] cod liver oil,[13] metallic mercury,[3] and petroleum jelly;[8] they all could cause a foreign body reaction leading to penile scarring and deformity, abscess formation, ulceration, erectile dysfunction and even Fournier's gangrene.[1–12] The foreign body reaction usually involves the penile skin and the dartoic fascia; conversely, involvement of tissues under Buck's fascia is extremely rare. Reviewing the literature we found only one case of corpus cavernosum involvement[15] and one case of urethral involvement[2] leading to voiding difficulties but not urinary retention. Therefore, the present is, to our knowledge, the first reported case of urinary retention following repeated paraffin self-injections for PGA.

There are two interesting features of the reported case. The first is the delayed occurrence of the voiding problems. As mentioned above, delayed reactions tend to occur between first and second year after penile paraffin injection,[1] whereas in our patient the delayed reaction occurred after approximately five years. This finding suggests that the chronic inflammatory reaction to such foreign body could theoretically reactivate at later stages and that such delayed inflammatory process is more likely to move towards the underlying tissues rather than the stabilized overlying penile skin. The second is the sudden resolution of the voiding problems after surgery. As a matter of fact, complete removal of the sclerosing lipogranuloma compressing the corpus spongiosum up to occluding the urethral lumen resulted in prompt resumal of spontaneous micturition with a normal flow rate and absence of post-void residual urine volume.

In conclusion, urologists tend to be quite indifferent to their patients' complaints about penile girth, often proposing psychiatric consultations rather than surgical solutions. Such indifference, together with the availability of non medical treatments administered by non-medical personnel and popularized on the web, is likely responsible for patients continuing to adopt non-medical solutions in spite of their well-known risks. Physicians dealing with sexual medicine should provide more attention to these patients and search for simple surgical solutions, thus avoiding non-medical solutions that can turn into medical disasters.

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