(476) Contemporary Mmanagement of Penile Foreign Body Injections

Abstract

Abstract Introduction Foreign body injections were first used, in the form of mineral oil, in 1899 to augment men post orchidectomy for tuberculous orchitis. In the 1940s and 1950s, documented cases of purposeful penile foreign body injections started to be reported as “penile paraffinomas.” Their surgical correction is challenging due to the risk of skin necrosis and wound breakdown. Objective The aim of the study is to present a large case series of 31 penile paraffinomas to examine the management and complication rates in the modern era. Methods Retrospective review of penile paraffinomas managed at a single institution over a 15-year period (2006-2021). Patient demographics, surgical management and functional outcomes were extracted from both paper and electronic medical records. Results Median age at time of referral was 34 (IQR=10.5). Median age at time of first injection was 30 years (IQR=11.5). The substances injected were silicone (47%), paraffin (25%), mineral oils (22%), and unknown (6%). The most common presenting symptoms was pain (44%) but other reasons included concerns for cosmesis (21%) and penile tightness or phimosis (21%). Only 1 man presented with ulceration and skin necrosis. Most (97%) underwent surgical reconstruction with a median of 2 operations per man (range 1-7) and 66 operations in total. Excision with primary closure was possible in 62% of the operations with circumcision required in 18% (Table 1). Closure was by local tissue flap in 3% but split (5%) or full (5%) thickness skin grafts were sometimes required. Complications occurred in 15% (n=10) with the most common being wound breakdown (n=6) followed by skin necrosis (n=3). There was 1 scrotal haematoma that required surgical drainage (Clavien 3b). Median follow-up after the last operation was 2 months (range 0-19 months) with 70% (n=22) lost to follow-up at some point. Erectile dysfunction and loss of penile sensation were uncommon following surgery (7%, n=2 and 3%, n=1 respectively). Only 7% (n=2) of men expressed dissatisfaction with the overall result of their treatment. Conclusions Penile paraffinomas are rare and difficult to treat. Performing repeated staged revision surgery reduces the risk of complications by allowing time for healing between each procedure. Our complication rates are consistent with other contemporary reports. Very few men expressed dissatisfaction with their treatment despite their limited follow-up due to the severity of their presenting problem. Disclosure No