Case Report of Surgical Removal of Illegally Injected Silicone from the Penis

Case Report #1295643: Removal of illegally injected silicone from the penis

History: This is a 48-year-old Black male who had foreign bodies injected electively into his penis one year before presentation. A friend suggested these injections while he was on vacation in Miami, Florida. The injector was non-certified non-medical personnel illegally injecting patients in a hotel room. The patient was unaware of what product was injected and was injected on four occasions. The patient was told that the product was “collagen.” Over the next 12 months, the patient began experiencing localized pain, dyspareunia, and painful erections. Due to the pain, he stopped having intercourse with his wife. Also, he noticed masses along the shaft of his penis and migration of the product from the glands to the pubic region. He sought medical advice.

Physical Examination: A physical examination revealed a circumscribed male with normal scrotum and testicles. The length of the penis was 14.5 cm (non-erect) long and 20 cm in circumference. Further examination showed multiple firm, painful masses from the glans to the base of the penis. Most masses were fused, contributing to an almost solid mass of scar tissue circumferentially around the entire penile shaft. In addition, there was a palpable nodule measuring 2x1cm at the dorsal right side of the base of the penis. No palpable abnormal scrotal masses. No inguinal node involvement.

Figure 1: Physical examination of penis

Figure 2: Physical examination with markings showing areas of illegally injected silicone, granulation tissue, and scar tissue,

MRI: An MRI revealed T1 hypointense and T2 hypointense diffuse thickening of the space between the proximal fascia and the skin overlying the penis. This was noted circumferentially throughout the entire penile shaft. On T2 STIR images, the thickening was hyperintense consistent with the silicone. The impression was suggestive of penile parafinoma with associated granulomatous foreign body reaction.

Surgery: Surgery was suggested for foreign body removal. The surgery was performed under general anesthesia. A circumferential incision was made in a skin crease fold in his prior circumcision scar. Tissue dissection was carried to Colle’s fascia. Dissection was completed from the proximal portion of the glans penis to the base of the penis. The penile shaft skin was retracted proximally. Dissection revealed extensive foreign body injections, granulomas, and scar tissue throughout the shaft of the penis.

Figure 3: Dissection from subcorona to the base of the penis. Examination shows multiple silicone foreign bodies and granulomas along the shaft. There were significant silicone foreign bodies in the thickened skin of the shaft of the penis.

The masses removed were clear and consistent with silicone. Tissue exploration and foreign body and scar tissue removal were also done on the retracted skin flap to ensure complete removal. The wound base was irrigated with antibiotics and saline. The skin was re-approximated with dissolvable sutures. A minimally compressive dressing was applied. A Foley catheter was left in place.

Postoperative course: On postoperative day three, the Foley catheter was removed. The patient was encouraged to massage the penis. Two weeks after surgery, cavitation massage was prescribed twice a week for three weeks to minimize scar tissue formation. The patient was instructed to achieve erections twice a day. Due to prior difficulties with painful erections, the patient was prescribed Viagra. Three weeks after surgery, the patient reported nighttime erections for the first time since his foreign body injections. Six weeks after surgery patient was allowed to have intercourse. For the first time in over one year, the patient could have painless intercourse. The patient has been pain-free without any palpable masses on the penis. The patient is thrilled with his results.

Conclusion: If you are considering silicone injections to the penis, DO NOT GET THEM. Do not be tricked by a "medical professional" saying that silicone injections in the penis are safe. Never follow a "friend's" recommendation without doing your due diligence first!

If you already have silicone injection to the penis, please have the injections and associated scar tissue removed before complications start.

If you have a foreign substance (including silicone) or you do not know what was injected into your penis and you do not know where to start, please call Dr. Katzen at (310) 859-7770. Dr. Katzen will carefully examine you and determine your options. For your convenience, Dr. Katzen has offices in Beverly Hills, CA, and Dubai, UAE.