Maboso
JF-Expert Member
- Feb 18, 2013
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Low-grade liquid silicone injections as a penile enhancement procedure: Is bigger better?
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[TR]
[TD="class: pageSub"]Introduction
[/TD]
[TD="class: inthis, align: right"] [/TD]
[TD="width: 15%, align: right"]
[/TD]
[/TR]
[/TABLE]
Penis size has been a source of anxiety for men throughout history, and still today, men often feel a need to enlarge their penises in order either to improve self-esteem or to satisfy and impress their partners. This anxiety has been found to transcend ethnicity and cultural barriers. Sadhus, holy men of India and male of Cholomec tribe in Peru used weights to increase their penile lengths. Males of the Dayak tribe in Borneo resorted to self mutilation by forming holes on their penises and then sticking decorative items through them for their partner's pleasure. Brazilians of the Topinama tribe allowed poisonous snakes to bite their penises in order to enlarge them. [SUP][1][/SUP]
Men in some areas of Indonesia, the Philippines, Thailand, and Malaysia have a long history of inserting or implanting various objects in their penises. The origin of these practices is unclear, but some writers say that they were copied from Chinese traders who visited Southeast Asia, while others argue that it is an indigenous innovation. The implant objects range from the very simple, e.g., ball bearings sewn under the skin, to the elaborate, e.g., semiprecious stones, gold bars, or rings inserted through the glans. [SUP][2][/SUP]
Several documented papers have described the cultural-historical adventures of the male organ. "The bigger the better" appears to be the motto for more than a century and being too small is still regarded as very humiliating in many cultures. These stigmas of apparently small penises, as well as the increasing influence of the media on sexual issues have increased the demand for penile enhancements. The majority of men who request penile enhancement surgery usually have a normally sized and normally functioning penis. These patients interpret normal appearances as abnormal, and as such are distressed and depressed. Indications for penile enhancement surgery are poorly defined, and outcome measures for success are still unclear. Nonetheless, due to a huge demand, these procedures are commonly performed in Malaysia by unscrupulous shamans. Here, we present our experience with patients' post-penile enhancement with liquid silicone.
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Case Reports[/TD]
[TD="class: inthis, align: right"] [/TD]
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[/TABLE]
Case 1
The first case was a 62-year-old businessman, married with five children. He has a background history of diabetes mellitus on oral hypoglycemics. Patient was admitted with a diagnosis of penile lymphedema and was planned for excision and split thickness skin grafting of the penile shaft. He gave a history of being injected with silicone oil by a "traditional healer" 3 years ago. The patient experienced prepucial swelling which started 4 to 5 days later, especially on erection. The condition progressively worsened over the next 6 months with gross enlargement of the penis affecting sexual function. Patient did not complain of any difficulty in micturition.
Circumferential excision of the penile shaft skin down to buck's fascia was done extending from the base of the corona down to the base of the shaft. All fibrotic tissue was removed and split thickness skin graft harvested from the thigh was applied to the area [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Postoperative period was uneventful and patient was discharged home on postoperative day 5. The histopathology report confirmed the presence of foreign body granulomatous inflammation. On microscopic appearance, there were foamy macrophages and foreign-body-type multinucleated giant cells. On review, the split skin grafting site had taken well and patient was happy with the outcome and was sexually active again. He is currently still under follow up.[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 1: Prepucial swelling post silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 2: Post excision of penile shaft skin down to Buck's Fascia
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 3: Application of split thickness skin graft
Click here to view
[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 4: Post op 1 week with 100% take of skin graft
Click here to view[/TD]
[/TR]
[/TABLE]
Case 2
A 37-year-old factory employee presented with scarring and thickening over the proximal half of the penile shaft. The patient gives a history of foreign body injection into the penile shaft 2 years ago while working abroad. The following year, he had developed repeated ulceration over the penile shaft which eventually healed with scarring. He is single, smoker, and social drinker with history of unprotected intercourse. He was diagnosed to have penile shaft fibrosis secondary to foreign body injection.
The patient subsequently underwent excision of the penile shaft and suprapubic foreign body with split thickness skin graft application. Excision was done from the base of the glans to the base of the penile shaft down to the level of tunica vaginalis. On excision, we noted yellowish foreign body embedded in the excised tissue. Split thickness skin graft was harvested from the right thigh and secured to the defect on the penis. On postoperative day five, we noted that the skin graft had taken 100% and there were no inherent complications to the wound. He was discharged well. He is currently under follow up with our clinic and has been advised scar massage.
Case 3
A 32-year-old welder, married with four children presented with infected skin graft over the penis shaft. History obtained from patient was that he sustained a small burn wound to his genitalia while welding 2 years ago, which developed into an infected wound. He subsequently underwent wound debridement and skin grafting of the penile shaft skin. According to the patient, the skin graft had taken well but patient had defaulted treatment and had sought traditional medication. He was noted to have an infected skin graft around the penile shaft with slough and eschar with bilaterally enlarged inguinal nodes [Figure 5].
Patient had undergone wound debridement of penile shaft skin circumferentially from the base of the glans to the base of the shaft [Figure 6], and subsequently split thickness skin graft was applied over the defect [Figure 7] and [Figure 8]. Tissue sample sent for culture and sensitivity showed growth of Acinetobacter species which was found to be sensitive to the prophylactic antibiotics. Antibiotic regime was continued for a period of 7 days postoperatively. Histopathology specimen sent was diagnosed as chronic granulomatous inflammation with foreign body granuloma. Five days postoperatively, the skin graft had 100% take, patient was afebrile and well with no evidence of localized or systemic infection. On postoperative day 6, however, it was noted that the take of the skin graft was 98% and a week later, the areas of nonviable skin was debrided under local anesthesia and patient was discharged home on daily dressing, as he had requested to go home. Patient is still on follow up.[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 5: Chronic inflammatory reaction post liquid silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 6: Post debridement down to Buck's fascia
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 7: Split thickness skin graft applied to penile shaft. Post op day 5- (Ventral aspect penile shaft)
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 8: Split thickness skin graft applied to penile shaft. Post op day 5 - (Lateral aspect of penile shaft)
Click here to view[/TD]
[/TR]
[/TABLE]
Case 4
A 33-year-old male presented with penile shaft soft tissue swelling for 10 years. He gives a history of traumatic injury in an alleged motor vehicle accident. Patient was riding a motorcycle when it hit the back of a car causing the trauma. There was a swelling post-injury which he managed himself by self-massage and did not seek medical attention. There is no problem with micturition and erection. Patient denied foreign body injection of the penis and requested surgery as it was uncomfortable for him to wear jeans. Examination revealed a generalized swelling of the penile shaft skin with fibrotic thickenings over the base of the penis. He was diagnosed as a case of penile lymphedema [Figure 9] and underwent excision of penile shaft skin and simultaneous skin grafting of the penile shaft [Figure 10], [Figure 11], [Figure 12].[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 9: Penile granuloma post liquid silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 10: Post excision of penile skin down to Buck's. Fascia from subcorona to base of shaft of penis
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 11: Excised penile granulommatous tissue
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[/TD]
[TD="bgcolor: #eaeaea"]Figure 12: Post application of split thickness skin graft.
Click here to view[/TD]
[/TR]
[/TABLE]
Post operative period was uneventful and patient was discharged home on day five. On review five weeks later, there was 100% SSG take with much reduction of edema and patient was able to wear jeans. He was advised massage with olive oil and is still under follow up.
Case 5
A 44-year-old contractor presented to us with lumpy swelling on penile shaft. He gave a history of silicone injection by a traditional medicine practitioner 2 years ago for erectile dysfunction and had experienced swelling over the injected site. He had no problems in micturition; however, there were recurrent episodes of ulceration and serous discharge from the site. He is married with four children and has a background history of hypertension on tablet atenolol. The patient was diagnosed as a case of foreign body granuloma post-silicone injection and was planned for operative intervention; however, patient defaulted treatment.
Source: http://www.urologyannals.com
[TABLE="class: leftNav, width: 100%"]
[TR]
[TD="class: pageSub"]Introduction
[/TD]
[TD="class: inthis, align: right"] [/TD]
[TD="width: 15%, align: right"]
[/TD][/TR]
[/TABLE]
Penis size has been a source of anxiety for men throughout history, and still today, men often feel a need to enlarge their penises in order either to improve self-esteem or to satisfy and impress their partners. This anxiety has been found to transcend ethnicity and cultural barriers. Sadhus, holy men of India and male of Cholomec tribe in Peru used weights to increase their penile lengths. Males of the Dayak tribe in Borneo resorted to self mutilation by forming holes on their penises and then sticking decorative items through them for their partner's pleasure. Brazilians of the Topinama tribe allowed poisonous snakes to bite their penises in order to enlarge them. [SUP][1][/SUP]
Men in some areas of Indonesia, the Philippines, Thailand, and Malaysia have a long history of inserting or implanting various objects in their penises. The origin of these practices is unclear, but some writers say that they were copied from Chinese traders who visited Southeast Asia, while others argue that it is an indigenous innovation. The implant objects range from the very simple, e.g., ball bearings sewn under the skin, to the elaborate, e.g., semiprecious stones, gold bars, or rings inserted through the glans. [SUP][2][/SUP]
Several documented papers have described the cultural-historical adventures of the male organ. "The bigger the better" appears to be the motto for more than a century and being too small is still regarded as very humiliating in many cultures. These stigmas of apparently small penises, as well as the increasing influence of the media on sexual issues have increased the demand for penile enhancements. The majority of men who request penile enhancement surgery usually have a normally sized and normally functioning penis. These patients interpret normal appearances as abnormal, and as such are distressed and depressed. Indications for penile enhancement surgery are poorly defined, and outcome measures for success are still unclear. Nonetheless, due to a huge demand, these procedures are commonly performed in Malaysia by unscrupulous shamans. Here, we present our experience with patients' post-penile enhancement with liquid silicone.
[TABLE="class: leftNav, width: 100%"]
[TR]
[TD="class: pageSub"]
[TD="class: inthis, align: right"] [/TD]
[TD="width: 15%, align: right"]
[/TD][/TR]
[/TABLE]
Case 1
The first case was a 62-year-old businessman, married with five children. He has a background history of diabetes mellitus on oral hypoglycemics. Patient was admitted with a diagnosis of penile lymphedema and was planned for excision and split thickness skin grafting of the penile shaft. He gave a history of being injected with silicone oil by a "traditional healer" 3 years ago. The patient experienced prepucial swelling which started 4 to 5 days later, especially on erection. The condition progressively worsened over the next 6 months with gross enlargement of the penis affecting sexual function. Patient did not complain of any difficulty in micturition.
Circumferential excision of the penile shaft skin down to buck's fascia was done extending from the base of the corona down to the base of the shaft. All fibrotic tissue was removed and split thickness skin graft harvested from the thigh was applied to the area [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Postoperative period was uneventful and patient was discharged home on postoperative day 5. The histopathology report confirmed the presence of foreign body granulomatous inflammation. On microscopic appearance, there were foamy macrophages and foreign-body-type multinucleated giant cells. On review, the split skin grafting site had taken well and patient was happy with the outcome and was sexually active again. He is currently still under follow up.[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 1: Prepucial swelling post silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 2: Post excision of penile shaft skin down to Buck's Fascia
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 3: Application of split thickness skin graft
Click here to view
[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 4: Post op 1 week with 100% take of skin graft
Click here to view[/TD]
[/TR]
[/TABLE]
Case 2
A 37-year-old factory employee presented with scarring and thickening over the proximal half of the penile shaft. The patient gives a history of foreign body injection into the penile shaft 2 years ago while working abroad. The following year, he had developed repeated ulceration over the penile shaft which eventually healed with scarring. He is single, smoker, and social drinker with history of unprotected intercourse. He was diagnosed to have penile shaft fibrosis secondary to foreign body injection.
The patient subsequently underwent excision of the penile shaft and suprapubic foreign body with split thickness skin graft application. Excision was done from the base of the glans to the base of the penile shaft down to the level of tunica vaginalis. On excision, we noted yellowish foreign body embedded in the excised tissue. Split thickness skin graft was harvested from the right thigh and secured to the defect on the penis. On postoperative day five, we noted that the skin graft had taken 100% and there were no inherent complications to the wound. He was discharged well. He is currently under follow up with our clinic and has been advised scar massage.
Case 3
A 32-year-old welder, married with four children presented with infected skin graft over the penis shaft. History obtained from patient was that he sustained a small burn wound to his genitalia while welding 2 years ago, which developed into an infected wound. He subsequently underwent wound debridement and skin grafting of the penile shaft skin. According to the patient, the skin graft had taken well but patient had defaulted treatment and had sought traditional medication. He was noted to have an infected skin graft around the penile shaft with slough and eschar with bilaterally enlarged inguinal nodes [Figure 5].
Patient had undergone wound debridement of penile shaft skin circumferentially from the base of the glans to the base of the shaft [Figure 6], and subsequently split thickness skin graft was applied over the defect [Figure 7] and [Figure 8]. Tissue sample sent for culture and sensitivity showed growth of Acinetobacter species which was found to be sensitive to the prophylactic antibiotics. Antibiotic regime was continued for a period of 7 days postoperatively. Histopathology specimen sent was diagnosed as chronic granulomatous inflammation with foreign body granuloma. Five days postoperatively, the skin graft had 100% take, patient was afebrile and well with no evidence of localized or systemic infection. On postoperative day 6, however, it was noted that the take of the skin graft was 98% and a week later, the areas of nonviable skin was debrided under local anesthesia and patient was discharged home on daily dressing, as he had requested to go home. Patient is still on follow up.[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 5: Chronic inflammatory reaction post liquid silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 6: Post debridement down to Buck's fascia
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 7: Split thickness skin graft applied to penile shaft. Post op day 5- (Ventral aspect penile shaft)
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 8: Split thickness skin graft applied to penile shaft. Post op day 5 - (Lateral aspect of penile shaft)
Click here to view[/TD]
[/TR]
[/TABLE]
Case 4
A 33-year-old male presented with penile shaft soft tissue swelling for 10 years. He gives a history of traumatic injury in an alleged motor vehicle accident. Patient was riding a motorcycle when it hit the back of a car causing the trauma. There was a swelling post-injury which he managed himself by self-massage and did not seek medical attention. There is no problem with micturition and erection. Patient denied foreign body injection of the penis and requested surgery as it was uncomfortable for him to wear jeans. Examination revealed a generalized swelling of the penile shaft skin with fibrotic thickenings over the base of the penis. He was diagnosed as a case of penile lymphedema [Figure 9] and underwent excision of penile shaft skin and simultaneous skin grafting of the penile shaft [Figure 10], [Figure 11], [Figure 12].[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 9: Penile granuloma post liquid silicone injection
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 10: Post excision of penile skin down to Buck's. Fascia from subcorona to base of shaft of penis
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 11: Excised penile granulommatous tissue
Click here to view[/TD]
[/TR]
[/TABLE]
[TABLE="width: 100%"]
[TR]
[TD="width: 200px, bgcolor: #f3f3f3, align: center"]
[TD="bgcolor: #eaeaea"]Figure 12: Post application of split thickness skin graft.
Click here to view[/TD]
[/TR]
[/TABLE]
Post operative period was uneventful and patient was discharged home on day five. On review five weeks later, there was 100% SSG take with much reduction of edema and patient was able to wear jeans. He was advised massage with olive oil and is still under follow up.
Case 5
A 44-year-old contractor presented to us with lumpy swelling on penile shaft. He gave a history of silicone injection by a traditional medicine practitioner 2 years ago for erectile dysfunction and had experienced swelling over the injected site. He had no problems in micturition; however, there were recurrent episodes of ulceration and serous discharge from the site. He is married with four children and has a background history of hypertension on tablet atenolol. The patient was diagnosed as a case of foreign body granuloma post-silicone injection and was planned for operative intervention; however, patient defaulted treatment.
Source: http://www.urologyannals.com
