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Daniswara N, Pandoyo PAS, Nugroho EA, Santosa A, Soedarso MA, Addin SR, Wibisono DS, Wicaksono F. Smile Incision-Modified Technique for Better Scrotal Outcome in Surgical Management of Penile Paraffinoma. Urol Int 2023; 107:935-942. [PMID: 37903462 DOI: 10.1159/000534348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Penile augmentation with foreign material injection is used to increase penile length, girth, or both. Most of these individuals develop complications due to an abnormal mass formation known as penile paraffinoma. Multiple surgical techniques for restoring penile function and correcting near-normal penile shape have been developed, but prior techniques have some post-operative complications. METHODS We explained the smile incision-modified technique for penile paraffinoma reconstruction using illustrations to describe step-by-step procedures. This study aimed to describe our modified surgical technique for reconstruction to correct complications due to disastrous consequences of failed penile augmentation. RESULTS A total of 16 patients aged 28-66 years (mean: 44.25 ± 2.63) were operated with a smile incision-modified technique from January 2017 until December 2020 in Semarang Dr. Kariadi tertiary hospital. There were no intraoperative complications observed. We found hematoma in 3 patients in a 1-week follow-up. After 2 weeks of post-operative surgery, all patients had no skin dehiscence or necrosis. Cosmetic appearance and functional improvement after reconstruction were acceptable by all patients. CONCLUSION Penile paraffinoma reconstruction using the smile incision-modified technique was a feasible and effective technique to manage penile paraffinoma patients with good esthetic results and minor complications.
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Affiliation(s)
- Nanda Daniswara
- Urology Division, Departement of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | | | - Eriawan Agung Nugroho
- Urology Division, Departement of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | - Ardy Santosa
- Urology Division, Departement of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | - Mohamad Adi Soedarso
- Urology Division, Departement of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | - Sofyan Rais Addin
- Urology Division, Departement of Surgery, Dr Kariadi General Hospital, Semarang, Indonesia
| | - Dimas Sindhu Wibisono
- Urology Division, Departement of Surgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Fandy Wicaksono
- Urology Division, Departement of Surgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Napolitano L, Marino C, Di Giovanni A, Zimarra A, Giordano A, D'Alterio C, Califano G, Creta M, Celentano G, La Rocca R, Mirone C, Spena G, Palmieri A, Longo N, Imbimbo C, Capece M. Two-Stage Penile Reconstruction after Paraffin Injection: A Case Report and a Systematic Review of the Literature. J Clin Med 2023; 12:jcm12072604. [PMID: 37048687 PMCID: PMC10095333 DOI: 10.3390/jcm12072604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size. METHODS A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique. RESULTS A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out. CONCLUSION In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Claudio Marino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Angelo Di Giovanni
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Assunta Zimarra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Alessandro Giordano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Carlo D'Alterio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Claudia Mirone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Naples, Italy
| | - Gianluca Spena
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80100 Naples, Italy
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Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single-centre experience and systematic review. Int J Impot Res 2023:10.1038/s41443-023-00675-8. [PMID: 36859681 DOI: 10.1038/s41443-023-00675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/03/2023]
Abstract
Injection of exogenous material into the penis and scrotum has been performed for augmentation purposes. Complications include cosmetic dissatisfaction, penile necrosis and lymphoedema. We report the complications and outcomes from a single centre with an updated systematic review of the literature. A retrospective review of all cases presenting with foreign substance injection into the genitalia, over a 10-year period was performed. Thirty-five patients with a mean (standard deviation (SD); range) age of 36.9 (±9.1; 22-61) years at presentation were included. The mean (SD; range) time between injection and presentation was 7.8 (±5.8; 1 day-20 years) years. The most common injected substance was silicone (n = 16, 45.7%) and liquid paraffin (n = 8, 22.9%). The penile shaft (94.3%) was the most injected site. The most common presentations were cosmetic dissatisfaction (57.1%) and pain and/or swelling (45.7%). Surgery was required in 32 (91.4%) cases. Primary procedures included local excision and primary closure (n = 19, 59.4%), circumcision (n = 5, 15.6%), excision with a split skin graft or a scrotal flap reconstruction (n = 5, 15.6%). Three (8.6%) patients presented with necrosis and required acute debridement. Overall, 18 patients had more than 1 procedure, and 8 patients required 3 or more procedures. A systematic search of the literature identified 887 articles of which 68 studies were included for analysis. The most common substance injected was paraffin (47.7%), followed by silicone (15.8%). The majority of patients (77.9%) presented with pain, swelling or penile deformity. 78.8% of the patients underwent surgical treatment, which included excision and primary closure with or without the use of skin grafts (85.1% of all procedures), the use of flaps (12.3%) and penile amputation (n = 2). Complications of foreign body injection into the male genitalia can be serious resulting in necrosis and autoamputation. Surgical intervention is often required to excise abnormal tissue to manage pain and improve cosmesis.
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Aesthetic and Functional Results after Single- and Two-Stage Resection and Reconstruction of Penile Paraffinomas - Experience from Two Tertiary Centers and a Surgical Management Algorithm. Urology 2023; 171:227-235. [PMID: 36243144 DOI: 10.1016/j.urology.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
Abstract
The treatment of choice of penile paraffinoma (PP) is surgical resection. Penile soft tissue coverage in a combined Urology/Plastic Surgery procedure, is often needed. OBJECTIVE To describe the surgical techniques, aesthetics and functional outcomes, and to provide a practical algorithm for the surgical management of symptomatic PP. METHODS We retrospectively recruited PP patients treated with surgical resection, from 2004 to 2020, in the Reina Sofia Hospital of Murcia (Spain) and Sourasky Medical Center (Israel). Procedural and postoperative erectile function, according to the short version of the International Index of Erectile Function (IIEF-5) data were collected. RESULTS Eight patients underwent surgery. The mean age was 30 years. The mean time between substance injection and surgery was 6 years. The most frequently injected material was liquid paraffin (50%), followed by Vaseline. Extensive skin involvement was present in all patients with liquid paraffin, requiring 2-stage surgery or skin graft. PP surgical treatment was successfully achieved in an Urology/Plastic Surgery joined effort. Postoperative erectile function was preserved in all cases. CONCLUSION PP can pose a surgical challenge. A combined surgical approach with urology and plastics allows for functional and aesthetic preservation. The extent of PP and the viability of shaft skin preservation should guide surgical approach.
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One-stage Reconstruction of Penile Paraffinoma Using Spiral Stitches FTSG and Evaluation of Sexual Function. Plast Reconstr Surg Glob Open 2022; 10:e4048. [PMID: 35070600 PMCID: PMC8769144 DOI: 10.1097/gox.0000000000004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
Paraffinoma of the penis is rare and caused by paraffin liquid injection. This condition can cause significant penile deformity, ulceration, pain, and sexual dysfunction. However, it can be managed with surgical procedures to obtain normal aesthetic and functional results. Herein, we reported a 42-year-old male with penile paraffinoma who underwent excessive surgical excision of the fibrotic tissue and one-stage reconstruction using a spiral stitch full-thickness skin graft. At one year of follow-up it showed a good aesthetic outcome with no hypertrophic scars, skin contractures, penile curvature, or penile shortening. The sexual evaluation using the International Index of Erectile Function instrument also showed a good result with normal erectile function and satisfaction with sexual sensation. This case is interesting because we used the spiral stitch full-thickness skin graft technique to cover the degloving area and long-term follow-up to evaluate the aesthetic and functional results.
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Ahn ST, Shim JS, Bae WJ, Kim SW, Kim JJ, Moon DG. Efficacy and Safety of Penile Girth Enhancement Using Hyaluronic Acid Filler and the Clinical Impact on Ejaculation: A Multi-Center, Patient/Evaluator-Blinded, Randomized Active-Controlled Trial. World J Mens Health 2021; 40:299-307. [PMID: 33988002 PMCID: PMC8987147 DOI: 10.5534/wjmh.210007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Additionally, we evaluated the clinical impact on ejaculation after PGE. Materials and Methods This was a prospective, patient/evaluator-blinded, randomized, active-controlled, multicenter trial. Patients recruited between December 2017 and March 2018 were randomly assigned to the HA filler or control group (polylactic acid [PLA] filler). Penile girth, satisfaction level, Premature Ejaculation Profile (PEP), and self-estimated intravaginal ejaculation latency time (IELT) were assessed at baseline and at 24 weeks post-injection. Results Sixty-four subjects (32 in each group) completed the trial. The mean increase in girth was 22.74±12.60 mm and 20.23±8.73 mm in the HA and control groups, respectively. Satisfaction level regarding penile appearance and sexual life significantly increased in both groups. There was no statistically significant difference between the groups in terms of increase in penile girth or change in satisfaction level. Both groups showed significant improvements in PEP index scores. Self-estimated IELT also significantly increased in the HA group (from 5.36±3.51 to 7.86±4.73 minutes, p=0.0001) and control group (from 5.23±3.55 to 6.43±4.22 minutes, p=0.021). No serious adverse events (AEs) were reported. Conclusions PGE with HA and PLA fillers resulted in significant enhancement of girth without serious AEs with no significant differences. Furthermore, PGE using filler improved clinical symptoms related to ejaculation.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Pereira-Lourenço M, Vieira E Brito D, Godinho R, Rabaça C. Giant Penis paraffinoma. Rev Int Androl 2020; 19:213-216. [PMID: 32778451 DOI: 10.1016/j.androl.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/19/2019] [Accepted: 01/19/2020] [Indexed: 10/23/2022]
Abstract
A fifty-year-old healthy, Portuguese male, with prior history of paraffin injections into the penis 30 years ago, was referred for urological consultation because of a large, hardened ulcerated mass on the base of the penis causing deformity and pain. The patient underwent a biopsy that showed a benign granulomatous lesion, and then excision of the mass and penile plasty with a scrotum flap in the same surgical time. Histology confirmed the diagnosis of paraffinoma. Three months after surgery, the patient is satisfied with the functional (urinary function and erectile function) and aesthetic results. Penile paraffinoma is a rare disease (most common in Asia and Eastern Europe) and results from an inflammatory response to the subcutaneous injection of paraffin, Vaseline or other mineral oils. Treatment is usually surgery.
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Affiliation(s)
- Mário Pereira-Lourenço
- Portuguese Oncology Institute of Coimbra, Urology Department, Av. Bissaya Barreto 98 Aptd. 2005, Coimbra, Portugal.
| | - Duarte Vieira E Brito
- Portuguese Oncology Institute of Coimbra, Urology Department, Av. Bissaya Barreto 98 Aptd. 2005, Coimbra, Portugal
| | - Ricardo Godinho
- Portuguese Oncology Institute of Coimbra, Urology Department, Av. Bissaya Barreto 98 Aptd. 2005, Coimbra, Portugal
| | - Carlos Rabaça
- Portuguese Oncology Institute of Coimbra, Urology Department, Av. Bissaya Barreto 98 Aptd. 2005, Coimbra, Portugal
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Kim JS, Shin YS, Park JK. Penile skin preservation technique for reconstruction surgery of penile paraffinoma. Investig Clin Urol 2019; 60:133-137. [PMID: 30838347 PMCID: PMC6397932 DOI: 10.4111/icu.2019.60.2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/30/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose Penile resurfacing with various scrotal flaps is a simple, effective, and reliable reconstructive armamentarium to treat penile paraffinoma. However, scrotal flaps often result in heavy hair-bearing penile skin causing dyspareunia or shortening of penile length. We introduce a new penile skin preservation technique for reconstruction surgery of penile paraffinoma. Materials and Methods From March 2007 to April 2018, 23 patients underwent excision of paraffinoma with the penile skin preservation technique. Complete removal of the subcutaneous tissue was done, including paraffinoma. No. 10 surgical blades were used to peel off the skin as thin as possible in order to get paraffinoma-free skin. The preserved penile skin was given an end to end anastomosis to the circumferential incision site. Multiple anchoring fixation sutures of the penile skin were made on the underlying tissue. Dressing of chopped gauze soaked with antibiotic saline solution was done on the skin to help preserve it and keep it fixed on the penis. Results The skin survived completely without necrosis in 19 patients (82.6%), with the mean duration of healing being 21.9 days. The penis after the operation looked natural in color and shape. Partial necrosis after the operation was shown on 4 patients (17.4%), whom were all later treated with the scrotal skin free graft. The final results were successful without any cosmetic or functional complications, such as skin contracture. Conclusions Penile resurfacing with the penile skin preservation technique is a new effective reliable method for skin-intact paraffinoma which produces good functional and cosmetic results.
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Affiliation(s)
- Jong Sung Kim
- Department of Urology, Kim Jong Sung Urological Clinic, Iksan, Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
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Downey AP, Osman NI, Mangera A, Inman RD, Reid SV, Chapple CR. Penile Paraffinoma. Eur Urol Focus 2018; 5:894-898. [PMID: 30007541 DOI: 10.1016/j.euf.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma. A systematic search of PubMed and Scopus was performed with 10 case series and 26 case reports identified between 1956 and 2017. A total of 124 cases, with a mean age of 36.29 yr, were identified. The majority originated in Korea, and the most common injected material was liquid paraffin (80.6%). Patients presented with pain/swelling, ulceration/fistulae, and penile deformity. The majority required surgical excision of paraffinoma followed by reconstruction with a variety of procedures including split skin grafting, scrotal skin flap reconstruction, and prepuce grafting. Mean duration of follow-up was 15.8 mo. Penile paraffinoma remains a rare presentation; however, it can present management difficulties. We have had an increase in cases, with three patients presenting with complications following injection of paraffin in our unit in the past 2 yr. Definitive management includes surgical excision and reconstruction as required with early involvement of plastic surgeons. There may be a role for conservative management; however, long-term outcomes are unclear. There may be a need for targeted preventative measures through public health agencies in communities where the practice is more prevalent. PATIENT SUMMARY: Penile paraffinoma can occur following injection of liquid paraffin or similar substances, generally used by non-healthcare personnel for the purpose of penile augmentations, and can cause significant pain, ulceration, and penile deformity. Definitive management includes surgical excision with reconstruction as required. Prevention of its use through awareness and education may be required in communities where the practice is more common.
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