An unusual delayed complication of paraffin self-injection for penile girth augmentation
© De Siati et al.; licensee BioMed Central Ltd. 2013
Received: 26 August 2013
Accepted: 26 November 2013
Published: 1 December 2013
Penile self-injection of various oils is still carried out among Eastern Europe people for penile girth augmentation despite the potential destructive complications of this practice are well known. Penile reactions to such foreign bodies include scarring, abscess formation, ulceration, and even Fournier’s gangrene; voiding problems due to mineral oil self-injection have been reported only once. To our knowledge, we describe the first case of paraffin self-injection for penile girth augmentation presenting with acute urinary retention.
A 27-year-old Romanian man presented with severe penile pain and acute urinary retention five years after having practiced repeated penile self-injections of paraffin for penile girth augmentation. The penile shaft was massively enlarged, fibrotic and phymotic; urethral catheterization failed due to severe stricture of the proximal pendulum urethra. The patients refused placement of a suprapubic catheter and underwent immediate penile surgical exploration. The scarred tissue between dartos and Buck’s fascia and a fibrotic ring occluding the urethra were removed and the penile skin reconstructed. Pathology confirmed the diagnosis of paraffinoma. The patient resumed normal voiding immediately after catheter removal on second postoperative day; he was very pleased with cosmetic, sexual and voiding results at six weeks, six months and 1 year follow-up.
The present report describes a novel complication of penile self-injection for penile girth augmentation. Because of the increasing number of patients seeking penile augmentation, physicians dealing with sexual medicine should pay more attention to such request to prevent the use of non medical treatments that can turn into medical disasters.
KeywordsLipogranuloma Penis Male genitalia Mineral oils
Penile girth augmentation (PGA) by means of subcutaneous injection of various oils is still carried out among people from the Eastern Europe despite the potential destructive complications of this practice are well known since the early 1900s . As a matter of fact, several kinds of foreign body reactions, including penile scarring and deformity, abscess formation, ulceration, erectile dysfunction and even Fournier’s gangrene, have been reported following injection of these oils [1–12]. Reactions to cod fish oil tend to occur shortly (1–2 weeks) after injection , whereas reactions to paraffin or mineral oil tend to occur 1 to 2 years after injection ; both usually cause skin scarring leading to paraphimosis and penile deformity, or skin infection leading to purulent discharge, ulceration and even necrosis. Voiding problems have previously been reported only once, in a 64-year-old man with a 9-cm firm irregular penile mass after repeated self-injections on mineral oil . Herein we report the first case, to our knowledge, of penile paraffinoma presenting with acute urinary retention five years after repeated penile self-injection of paraffin for PGA.
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  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 , vaseline , mineral oil , cod liver oil , metallic mercury , and petroleum jelly ; 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  and one case of urethral involvement  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 , 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.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Penile girth augmentation.
- Lee T, Choi HR, Lee YT, Lee YH: Paraffinoma of the penis. Yonsei Med J. 1994, 35: 344-348.PubMedView Article
- Cohen JL, Keoleian CM, Krull EA: Penile paraffinoma: self-injection with mineral oil. J Am Acad Dermatol. 2001, 45: S222-S224. 10.1067/mjd.2001.103995.PubMedView Article
- Oh KJ, Park K, Kang TW, Kwon DD, Ryu SB: Subcutaneous metallic mercury injection for penile augmentation. Urology. 2007, 69: e3-e4.PubMedView Article
- Arthaud JB: Silicone-induced penile sclerosing lipogranuloma. J Urol. 1973, 110 (2): 210-PubMed
- Prather CL, Jones DH: Liquid injectable silicon for soft tissue augmentation. Dermatol Ther. 2006, 19: 59-68.View Article
- Wassermann RJ, Greenwald DP: Debilitating silicon granuloma of the penis and scrotum. Ann Plast Surg. 1995, 35: 505-509. 10.1097/00000637-199511000-00010.PubMedView Article
- Christ JE, Askew JB: Silicone granuloma of the penis. Plast Reconstr Surg. 1982, 69: 337-339. 10.1097/00006534-198202000-00028.PubMedView Article
- Santucci RA, Zehring RD, McLure D: Petroleum jelly lipogranuloma of the penis treated with excision and native skin coverage. Urology. 2000, 56 (2): 331-PubMedView Article
- Gurdal M, Karaman MI: An unusual case of penile augmentation: subcutaneous stone implantation. Urology. 2002, 59: 445-PubMedView Article
- Nyirády P, Kelemen Z, Kiss A, Bánfi G, Borka K, Romics I: Treatment and outcome of vaseline-induced sclerosing lipogranuloma of the penis. Urology. 2008, 71: 1132-1137. 10.1016/j.urology.2007.12.081.PubMedView Article
- Alter GJ: Reconstruction of deformities resulting from penile enlargement surgery. J Urol. 1997, 158: 2153-2157. 10.1016/S0022-5347(01)68185-0.PubMedView Article
- Zimmermann US, Clerici TJ: The histological aspects of fillers complications. Semin Cutan Med Surg. 2004, 23: 241-250. 10.1016/j.sder.2004.09.004.PubMedView Article
- Al-Ansari AA, Shamsodini A, Talib RA, Gul T, Shokeir AA: Subcutaneous cod liver oil injection for penile augmentation: review of literature and report of eight cases. Urology. 2010, 75 (5): 1181-1184. 10.1016/j.urology.2009.11.023.PubMedView Article
- Son H, Lee H, Huh JS, Kim SW, Paick JS: Studies on self-esteem of penile size in young Korean military men. Asian J Androl. 2003, 5 (3): 185-189.PubMed
- Campbell JS, Henderson IW: Efffects of instillation of paraffins in tissues. Lancet. 1973, 1 (7806): 775-776.PubMedView Article
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2490/13/66/prepub
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.