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Case Reports
. 2017 Feb;99(2):e78-e82.
doi: 10.1308/rcsann.2016.0346. Epub 2016 Nov 21.

Self Injection of Foreign Materials Into the Penis

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Free PMC article
Case Reports

Self Injection of Foreign Materials Into the Penis

U Ahmed et al. Ann R Coll Surg Engl. .
Free PMC article

Abstract

Injection of the subcutaneous tissues of the penis for enlargement of penile girth has been practised for many years by laypeople and medical practitioners alike. However, with recognition of the complications, the practice has died out. We report a series of five patients who presented having injected foreign materials into the subcutaneous tissues of their penises, including paraffin and mineral oils. Our patients had a variable time course of presentation ranging from 1 day following injection to over 26 years. Self-injection of the subcutaneous tissues of the penis is an unusual presentation for a penile mass but should be considered as a differential diagnosis in patients with a long latent period to presentation or with characteristic magnetic resonance imaging and histological appearances.

Keywords: Andrology; Disease; Penis; Self-Injurious Behaviour; Silicones.

Figures

Figure 1
Figure 1
Case 1: T2 weighted spin echo sagittal magnetic resonance imaging (midline). The oil is high in signal and it can be difficult to distinguish it from subcutaneous fat. However, note how the dorsum of the penis is asymmetrically thickened by high signal material lacking the normal lobulations of fat (white arrows). Black arrows mark the low signal tunica albuginea of the corpora cavernosa. There is associated marked scrotal oedema (white arrowheads) around a normal testis (asterisk).
Figure 2
Figure 2
Haematoxylin and eosin staining of resected specimens. A and B: Case 2 – Areas of fibrosis and chronic inflammation surrounding the vacuoles that remain after processing of the histopathological specimen has leached out the injected foreign material (400x magnification); C: Case 3 – Some cases show more florid inflammation with granuloma formation and few vacuoles (200x magnification); D: Case 4 – Some cases show predominance of vacuoles with little intervening chronic inflammation (400x magnification)
Figure 3
Figure 3
Case 4: T1 (A) and T2 (B) weighted spin echo axial magnetic resonance imaging at presentation, and T2 sequences at three months after presentation (C and D). Nodules of silicone are seen (large arrows), as are less well defined foci (arrowheads). Note that on the T2 sequences (and on short tau inversion recovery sequences [not pictured]), both the oedematous surrounding fat and the silicone, as well as the testes (asterisks), are of high signal, the silicone being most intense. On the T1 sequence, all of these components are of intermediate signal. However, a chemical shift artefact (seen best around the nodule indicated by the large arrows) is produced by the different resonant frequencies of the silicone and oedematous fat, resulting in an artefactually bright left border and dark right border to the silicone. At three months, most of the large lobules of silicone have been removed or have diffused but several small nodules are still visible (large arrows). Reactive oedema, thickening and induration (small arrows) remain in the scrotal skin.
Figure 4
Figure 4
Case 5: Photograph indicating the large volume of material that had been injected into the penis circumferentially and extending down into the scrotum.

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