Case Report Three Cases of Penile Paraffinoma: A Conservative Approach Eran Rosenberg, Igor Romanowsky, Murad Asali, and Jacob Kaneti Injection of foreign materials into different body parts has long been performed to change the body contour. The treatment of choice should be radical excision, otherwise recurrence of the symptoms can occur. However, in selected patients, conservative treatment should be considered. We report the cases of 3 Thai foreign workers, with a history of penile oil injections. UROLOGY 70: 372.e9 –372.e10, 2007. © 2007 Elsevier Inc.
A
ttempts to change the body contour have been made since the 19th century, with numerous foreign materials introduced into different body organs (eg, the penis, breast, cheek, nose, eyelids, and muscles).1–3 The injection of high-viscosity fluids such as paraffin to achieve penile autoaugmentation has been reported in Asia, Russia, and Eastern Europe.3–10 These injections can stimulate multiple undesired reactions that can eventually cause an inability to achieve sexual activities.1,5,8 We report the cases of 3 Thai foreign workers with paraffinoma of the penis who had a history of penile oil injections.
CASE REPORTS Case 1 A 30-year-old Thai foreign worker presented with penile pain and swelling that had surfaced 2 days before his hospital admission. He admitted performing injections of oil into his penis, but, because of the language barrier, it was not exactly clear when those had been performed. On physical examination, paraphimosis was observed, with subsequent penile edema (Fig. 1). Because reduction of the paraphimotic ring was impossible, the patient was taken to the operating room, and the ring was incised. Normal urination was observed the following day, and the patient was discharged. Case 2 A 28-year-old Thai foreign worker had undergone an injection of oil into the skin of his penis about 1 year before his hospital admission. He had reported penile pain and fever 24 hours earlier, with no urination difficulties. On examination, a tough disfiguring edema was observed, and the glans penis could not be exposed (phimosis; Fig. 2). He was treated with intravenous an-
From the Department of Urology, Soroka University Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Reprint requests: Eran Rosenberg, M.D., Department of Urology, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel. E-mail:
[email protected] Submitted: January 7, 2007; accepted (with revisions): April 27, 2007
© 2007 Elsevier Inc. All Rights Reserved
Figure 1. Preoperative penile paraphimosis.
Figure 2. Disfiguring phimosis.
tibiotics for 4 days. After reduction of the fever and swelling, the patient was discharged. Case 3 A 35-year-old Thai foreign worker was admitted to our department with inflammatory swelling (Fig. 3) of the penis and fever for the past 3 weeks. He had no urination 0090-4295/07/$32.00 372.e9 doi:10.1016/j.urology.2007.04.033
can occur.3–5,7,10 A few repair techniques have been described, including dermal grafts, scrotal flaps, and mesh grafts.3–7 These operations are complex plastic procedures, time consuming, and, in some cases, difficult to fully treat the first time, requiring a follow-up operation for two-stage repair or because of the development of a complication requiring surgery.1,4,10 Despite the successful reported surgical results, some patients with penile paraffinoma might prefer to maintain their previous penile condition (after the enlargement).9 This questionable preference could result from the psychological and physical benefits associated with penile enlargement or fear of the penile operation itself. In these patients, a nonoperative approach should be adopted, as long as the patient’s health is not endangered. We encountered difficulties in communicating with these patients. Various issues were not clear to us such as the exact time of injection, the type of oil used, previous episodes of injections, and any additional side effects. Our recommendation for circumcision was not understood nor performed. Treating these patients, while attempting to overcome the language barriers and cultural differences, and because it was quite certain that follow-up would not be maintained, led us to adopt a conservative approach toward these patients. Figure 3. Inflammatory swelling.
CONCLUSIONS
difficulties. He was treated with intravenous antibiotics for 3 days and, after reduction of the fever and swelling, he was discharged.
Penile autoaugmentation is not a common procedure these days. The treatment of choice should be radical excision. However, in selected patients, conservative treatment should be considered.
COMMENT
References
Paraffinoma (also described as oleoma or sclerosing lipogranuloma) results from an injection of foreign substance containing straight-chain saturated hydrocarbons, such as paraffin or mineral oil.1– 4,11 The body lacks the enzymes to metabolize interstitial exogenous oils, and a foreign body reaction occurs.11 The histopathologic features include thickening of the reticular dermis and replacement of normal subcutaneous fat by lakes of oil interspersed with fibrous tissue and granulomatous chronic inflammatory reaction.3 The microscopic changes manifest macroscopically in the form of undesired reactions, including inflammation, edema, scarring, necrosis, deformity, ulceration, sterile abscesses, painful erection, and, eventually, the inability to achieve sexual activities.1–3,5,8,9 Despite the lack of histologic examination in these patients, the diagnosis of paraffinoma correlated with the patients’ physical examination findings and medical history. Most complications require urologists to operate on these patients, either because of the possible immediate danger to the penis (as was the case for patient 1), voiding dysfunction, or simply because the paraffinoma has affected the patient’s ability to have intercourse. To achieve definitive treatment, complete radical excision is necessary to remove the foreign material, otherwise recurrence of the symptoms
1. Georgieva J, Assaf C, Steinhoff M, et al: Bodybuilder oleoma. Br J Dermatol 149: 1289 –1290, 2003. 2. Di Benedetto G, Pierangeli M, Scalise A, et al: Paraffin oil injection in the body: an obsolete and destructive procedure. Ann Plast Surg 49: 391–396, 2002. 3. Hohaus K, Bley B, Kostler E, et al: Mineral oil granuloma of the penis. J Eur Acad Dermatol Venereol 17: 585–587, 2003. 4. Lee T, Choi HR, Lee YT, et al: Paraffinoma of the penis. Yonsei Med J 35: 344 –348, 1994. 5. Jeong JH, Shin HJ, Woo SH, et al: A new repair technique for penile paraffinoma: bilateral scrotal flaps. Ann Plast Surg 37: 386 –393, 1996. 6. Odintsov BP, Panikratov KD, and Patsanovskii AG: The surgical treatment of penile oleogranulomas. Urol Nefrol (Mosk) 6: 46 – 49, 1991. 7. Podluzhnyi GA, Tigov AD, Braganets AM, et al: The clinical picture, classification and surgical treatment of paraffinomas of the external genitalia. Urol Nefrol (Mosk) 4: 69 –73, 1991. 8. Jindarak S, Angspatt A, Loyvirat R, et al: Bilateral scrotal flaps: a skin restoration for penile paraffinoma. J Med Assoc Thai 88: s70 –s73, 2005. 9. Moon DG, Yoo JW, Bae JH, et al: Sexual function and psychological characteristics of penile paraffinoma. Asian J Androl 5: 191– 194, 2003. 10. Steffens J, Koshaskyy B, Hiebl R, et al: Paraffinoma of the external genitalia after autoinjection of Vaseline. Eur Urol 38: 778 –781, 2000. 11. Del Rosario RN, Barr RJ, Graham BS, et al: Exogenous and endogenous cutaneous anomalies and curiosities. Am J Dermatopathol 27: 259 –267, 2005.
372.e10
UROLOGY 70 (2), 2007
