PENIS AUGMENTATION BY APPLICATION OF SILICONE MATERIAL: COMPLICATIONS AND SURGICAL TREATMENT

INTRODUCTION

A 36-year-old patient underwent penis enlargement with injections of an unknown silicone material. Three months after application he developed severe inflammatory changes, ulcerations and deformities caused by scarring (Fig. 1).

MATERIALS AND METHODS

Local therapy combined with intravenous antibiotics at the Urology department did not lead to improvement. Because of deterioration, development of new ulcers and severe pain, the patient was indicated for surgery under general anesthesia. During surgery it was necessary to completely remove the skin and infiltrated subcutaneous tissue of the penis from the corona glandis down to the scrotum (Fig. 2). Corpus cavernosum and corpus spongiosum were not affected by the application of this foreign material.

Tunneling was performed just under the skin of the scrotum in the area of scrotal raphe. At the lowest point of the scrotum a hole was created through which the glans penis was passed (Fig. 3). In the corona glandis and skin of the scrotum was used absorbable suture material. The resulting defect between the scrotum and mons pubis after implantation of the penis under the scrotal skin was closed with absorbable interrupted sutures (Fig. 4). There was no need for an epicystostoma; only a urinary catheter was introduced for one day.

RESULTS

The postoperative course was entirely without complications. Pain that was present prior to the surgery due to chronic inflammation and defects subsided immediately. The patient had no problems with voiding after surgery. The total duration of hospitalization was five days; sutures were removed after 14 days. After three months (Fig. 5, 6) the patient began to live normal sexual life. After 15 months post-operatively he became a happy father of a baby girl. Histopathological finding showed silicone material of unknown origin.

One year after surgery the patient was offered a small correction of abundant scrotal skin, including subsequent laser hair removal. The patient was so happy with the outcome and function that he did not use the offered procedures.

DISCUSSION

Penis enlargement is one of the controversial treatments with little standardization of surgical technique, although the size of the penis is similar for most adults (14, 24).

Cosmetic surgery on the male genitalia is not as common as other aesthetic procedures in other areas, however, it has a higher incidence of complications.

The most serious complications after application of silicone, mineral oils, etc. include: swelling (20), ulceration (6), necrosis, disappearance of fat, penile lumps, nodules (23), shaft deformities, hematoma, paraffinoma, foreign-body granuloma (1, 7, 8, 22), paradoxical penile shortening. Subsequent complications negatively affect the psychological well - being and sexual life of the patient (15, 18).

There are various reasons why men request penis enlargement surgery. Most often it is experimentation, attempt to improve sexual experiences and stimulation including various degrees of penile dysmorphophobia (21).

Many methods of penis enlargement have been described. At the time of adolescence it is often topical testosterone cream or parenteral testosterone (5, 10). Non-surgical procedures include penis lengthening pills, stretching apparatus, vacuum pumps (16). The most common invasive procedures include release (division) of the fundiform ligament and the suspensory ligament (3), infrapubic lipectomy, autologous fat injections, application of hyaluronic acid gel (12), enlargement of the tunica albuginea with a saphenous graft (4), wrapping and dermal-fat graft around the penile circumference (3), silicone injections, polyacrylamide gel (17), injection of hydrogel (19). Rare is the application of unknown substances such as self-injection of mineral oil (vaseline), paraffin (13), and even a subcutaneous implantation of a stone has been described (9).

Treatment of complications: Minor defects and inflammation can be treated with local dressings or intravenous antibiotic therapy. In severe cases with infiltration of subcutaneous tissue and defects, radical surgical excision is required. Split thickness skin grafts are most commonly used for the closure of defects. The advantage of this method is speed and availability. Disadvantages include firm scars and recurrent trauma of the grafts, which are rigid and lack elasticity. Smaller defects may be managed with local tissue advancement flaps such as V-Y flap (2). For larger defects, bilateral scrotal flaps can be used, which provide good quality skin cover.

CONCLUSION

Implantation of the penis under the skin of the scrotum is a fast, safe and effective method that can be used for management of virtually any circular skin defects of the penis with minimal complications. Scrotal skin is thin, soft, elastic and abundant and provides a quality, adequate, sliding cover around the penis. This method does not restrict the patient in any activity and it enables normal sexual life within a few months. It may or may not be accompanied by laser depilation.

The authors declare that they have no conflict of interest to disclose.

Address for correspondence:

Andrej Sukop, M.D., PhD.

Department of Plastic Surgery, 3^rd Faculty of Medicine, Charles University in Prague

Ruska 87

100 34 Prague 10

Czech Republic

E-mail: andrej@sukop.cz