2. Introduction
Obsession for a larger penis
In 1899, Robert Gersuny, an Austrian surgeon from
Vienna
paraffin, mineral, silicone, vaseline, motor
transmission fluid, cod liver oil, and autologous fat, as
well as nandrolonedecanoate and mercury
sclerosing lipogranuloma of male genitalia
produced by penile paraffin injections for the purpose
of penile enlargement
2
3. Pathology
granulomatous foreign-body reaction
inflammation and induration, edema, scarring,
deformity, necrosis, ulceration, painful erections,
eventually, the inability to achieve sexual activities.
migration of the material, with invasion of the corpora
cavernosa and regional lymphadenitis.
Gross specimen shows tan yellow firm fibrous
appearance.
3
4. Histopathology
Hyaline necrosis of stromal septa
fat droplets coalesce into large globules of various sizes
separated by fibrous connective tissue
Surrounded by syncytial giant cells, endothelial cells or
fibrous eosinophilic tissue
Numerous macrophages containing phagocytosed fat
and moderately heavy round cells
giant cell of foreign type
4
5. Clinical manifestation
mean age of affected patients is around 28 years
(spain)
symptoms typically develop a year after implantation
of the materia
deformity, impotence, erythema, and edema leading
to paraphimosis and pain
complications are infection, ulceration, necrosis,
Fournier’s gangrene, formation of fistulas, embolism &
pneumonitis
migration
5
6. 1981- 1993
Total 26 pt
Average age at the time of injection 39.6 yr
(19 - 77 yr)
6
8. another study (2003)
357 Korean men
91 % - not satisfied with the result of the injection
74 % - want to remove the injected material
85 % - had side effects
the majority complained of inflammation , necrosis
and pain
8
21. Dx
Mostly clinical
If patient denied previous injection, some chemical
procedures were needed to prove the causative
material
DDx
Liposarcoma
infectious diseases
Squamous cell carcinoma
21
24. USG
Diffuse subcutaneous swelling of penile shaft with
increased echogenicity
extent of dermal inflammation
depth of ulcers
if the plane between the indurated inflammatory
tissue and the Buck’sfascia is preserved
Proximal extension of granulation tissue, scrotal
involvement and loco regional lymph node
involvement
24
28. MRI - to evaluate the extension of foreign body to
ant: abdomen
28
29. Treatment
from conservative measures, including intralesional
steroid injections and hot-water baths, to more
extensive radical operations
the aggressive wide excision of skin and subcutaneous
tissue infiltrated by the foreign material with
appropriate phalloplasty
29
30. Principle of sugery
Complete excision of foreign body and associated
reaction with closure by first intention if possible
Skin flaps, graft & staged procedure
30
31. Depend on
Extent of paraffinoma
Condition of penile and scrotal skin
31
71. Integra
Dermal substitute which gradually replaces and
regenerates into a histologically normal dermis
thin split-skin graft was applied over the Integra to
provide a compliant covering to the shaft of the penis,
to gradually accommodate a solid erection
71
72. Conclusion
Patients should be informed about the disfiguring
effects of oil injections into the genitals,
do not result in improved satisfaction of the penis
result in significant side effects, which often leave
patients wanting the injection material removed.
72
73. new modalities being used by medical professionals for
penile augmentation,
injections of autologous fat or hyaluronic acid gel
grafts of dermal-fat strips, and
allograft dermal matrix grafts
release of suspensory ligaments
are methods currently being investigated
73
