New England Section of the American Urological Association
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The Risk of Fillers in Penile Enhancement
Daniel Leslie, MD1, Jerilyn Latini, MD2, Lori B. Lerner, MD2.
1Boston Medical Center, Boston, MA, USA, 2VA Boston Healthcare System, West Roxbury, MA, USA.

BACKGROUND:
In the quest for enhanced penile size, men have sought out options and supported the development of many Men's Health clinics. These clinics advertise injections and guarantee success, generally with a hefty cash only price tag. Fillers of organic materials have been described, including hyaluronic acid, polymethylmethacrylate and other substances, some of which may be inorganic, such as silicone. Many fillers cause uneven distribution and nodule formation, prompting efforts by industrious clinicians to develop novel substances. Unfortunately, fillers represent foreign bodies within tissue and are at risk for infection, which can be catastrophic. We present a case of penile abscess formation after placement of two rounds of fillers.
METHODS:
A 39 yr old man found a Male Enhancement clinic advertising improved "sexual morale and self esteem" using a proprietary blend of permanent fillers. Two procedures were performed 6 months apart in the office under local therapy. The patient was instructed to wrap the penis with gauze for 35 days (change every 4-5 days). He noticed yellow drainage immediately after the second injection and was given 3 courses of oral antibiotics (5-15 days, each) at his cosmetic surgeon's instructions. Eight weeks post injection, penile swelling increased significantly along with fevers up to 103. He was admitted for IV antibiotics, imaging, surgical incision and drainage, repeat debridement, and VAC dressing application.
RESULTS:
Ultrasound was initially obtained, but echogenic debris prevented adequate evaluation. MRI revealed evidence of substance along the entire length of the penis into the suprapubic area (no air). A small amount of material was seen within one corporal body. Frank purulent material was expressed and sent for culture, ultimately growing Group B and G Strep. While tempting to remove the entire shaft skin given its appearance, we left all skin that revealed some evidence of blood flow on needle prick (approximately 1/3 of the shaft skin was removed). On day 5, a VAC dressing was placed (see attached images for patient course). At first change, the wound had evidence of granulation tissue and further debridement and skin removal were not indicated. Fevers resolved and entry into the corpora wasn't necessary. Skin grafting was planned.
CONCLUSIONS:
Most published articles in the sphere of penile enhancement using fillers are reported by dermatologists and plastic surgeons, with urologists much less involved. However, urologists are the ones likely to deal with the complications. Not knowing what the filler is can lead to degloving and aggressive debridement, which can lead to devastating results for these young men. While alarming in appearance both grossly and on imaging, we found "less is more" to be the preferred approach. Urologists should inform themselves of what is being done in their communities and resist the temptation to over debride.


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