Self-injection for penile enlargement Guidelines for residents to avoid serious complications

Dr. Stefan Tiganu Medlife Genesys Dept. of Urology Oradea (RO)

tiganustefan@

gmail.com

Dr. Madalina Sava Medlife Genesys Dept. of Dermatology Oradea (RO)

madalina.sava0508@

gmail.com

From ancient times, the size of the male genitals had a separate place in the definition of masculinity. Among the ancient Greeks, the small size of the genitals was considered a sign of beauty and intelligence, whilst a large penis was considered hideous and unattractive. [1] Other cultures like Arabic, Chinese, Japanese and Norsemen in their early times depicted men having larger penises than normal and this was considered a sign of masculinity. [2] slit that was performed 2 months prior presentation due to acute urinary retention. At this time he accepted removal only of the bulge that on ultrasound appeared to be an abscess. The mass was removed and the skin defect closed without grafting. Intense fibrous process under the skin was revealed.

Contemporary men under the influence of culture, society and the media tend to underestimate their size, therefore, they want to increase it. Unfortunately for various reasons they end up resorting to dubious self-treatments and injections with allogeneic substances such as petroleum jelly, kanamycin and other mineral oils.

The practice of self-induced penile enlargement with allogeneic non-resorbable substances involves injecting foreign substances between the corpora cavernosa and penile skin to increase its girth and length. The idea behind this practice is that the injected substance will cause the penis to expand and create a larger size. However, this practice is extremely dangerous.

Injecting non-resorbable substances into the penis can cause serious complications, such as infection with subsequent sepsis, scarring, phimosis, deformities, acute urinary retention, substance migration, trophic ulcers [3] and even death.

Moreover, the injected substances may also cause allergies, inflammation, and irreversible tissue damage, leading to pain, discomfort and erectile dysfunction.

Self-induced penile enlargement with non-resorbable allogeneic substances is not only physically harmful but also mentally distressing. Men who engage in this practice may experience feelings of shame, guilt and anxiety due to insecurity about their size. However, it is important to note that penis size does not determine a man's sexual ability or satisfaction.

Fig. 1: Preoperative aspect after dorsal slit

Fig. 2: Immediate postoperative aspect

Fig. 3: Healing process 10 days after surgery

Case number II

• Local examination can find either a palpable mobile mass or a thickening of the skin with atrophic or ulcerated lesion on it, a penile deformity, oedema or a phimosis, sometimes urinary retention is the cause of ED presentation.

• If there is doubt in diagnosis, an ultrasound and an MRI may be of help. [4]

• If there is any sign of infection, a broad spectrum antibiotic should be initiated. If the patient has a fever, admission to a ward should be discussed, or if he is unstable, intensive care would be needed.

• All patients should be informed of further complications and the necessity of surgical intervention in the future.

Conclusion Self-induced penile enlargement with permanent fillers is dangerous, with possible severe complications in the long term- migration, granulation and infection. This potentially harmful practice should be avoided at all costs.

These male patients usually come to the emergency department (ED) with complications such as urinary infection and infected ulcers, urinary retention or considerable oedema. In most of the cases the patients can be managed conservatively but unfortunately they may need surgical therapy later in life to remove affected skin and in some cases a graft will be used. Even if the procedure goes perfectly, the cosmetic outcome may be unsatisfying. [3]

Below are two patient cases that presented at our outpatient clinic, and after further management, needed surgery.

Case number I

A 35-year-old male patient had his first presentation in our outpatient clinic with a narrow phimosis, a big bulge in his front foreskin and complaining of erectile disfunction, all after penile injection of petroleum jelly 10 years ago. His second visit was 6 months later, when he came with the same bulge but with a dorsal

A 28-year-old male had injected Kanamycin 2 years before presentation. All the injected mass migrated in the front part of his foreskin, inducing a very tight phimosis, with an inability to achieve orgasm. After counselling the patient and explaining possible complications, he agreed to have a circumcision performed.

Fig. 4: Preoperative image

Fig. 5: Immediate postoperative image

Follow-up results for both patients included a quality of life (QoL) evaluation, and surgery satisfaction was further assessed at control examination. For a young urologist managing such cases, it can be very challenging because of the lack of information and the rarity of cases, so we have provided some guidelines to follow.

Some guidelines

• History is of utmost importance, usually patients know the type of fillers, when it was done and the order of symptoms onset.