Young Urologists/Residents Corner
Self-injection for penile enlargement Guidelines for residents to avoid serious complications
guidance); with the EAU Section of Uro-Technology (e.g. imaging simulation for focal therapy); and/or with the EAU Robotic Urology Section (e.g. augmented reality for surgical guidance during robotic surgery). ESUI will be committed to strengthening these collaborations such as promoting Joint Sessions in the relevant meetings, for example. ESUI is already actively working with the European School of Urology and sharing the challenging task of taking to a new (upper) level the courses involving urological imaging. This new approach will allow the trainee to go through a standardised stepwise process to achieve proficiency in undertaking a complex intervention by using different sources of urological imaging. We will also welcome new and fresh forces, from the Young Academic Urologists working groups as well as any other enthusiastic youngsters who share the aims and the vision of our Section. We strongly believe that our Section is the perfect podium for those talented people who desire to emerge from the crowd. Join the Section Interested in contributing your knowledge and skills to ESUI? You are highly encouraged to apply. Please send an email to Mrs. Terberg (a.terberg@uroweb. org). We look forward to welcoming you. • Local examination can find either a palpable mobile mass or a thickening of the skin with atrophic or ulcerated lesion on it, a penile deformity, oedema or a phimosis, sometimes urinary retention is the cause of ED presentation. • If there is doubt in diagnosis, an ultrasound and an MRI may be of help. [4] • If there is any sign of infection, a broad spectrum antibiotic should be initiated. If the patient has a fever, admission to a ward should be discussed, or if he is unstable, intensive care would be needed. • All patients should be informed of further complications and the necessity of surgical intervention in the future. Conclusion Self-induced penile enlargement with permanent fillers is dangerous, with possible severe complications in the long term- migration, granulation and infection. This potentially harmful practice should be avoided at all costs. Management of these patients may be quite intricated due to the lack of information in the literature and the inconsistency of patients being lost during treatment or follow-up for different reasons such as: shame, financial restrictions, unbalanced psycho-emotional environment, or dissatisfaction with cosmetical or functional results. Therefore, young urologists should be aware of the implications of such practices and manage the patients in a psychological supportive manner for the best compliance with minimal complications and optimal results. References 1. Sergent B. Homosexuality in Greek myth. Continuum International Publishing Group; 1987. 2. Kim W. 2: History and cultural perspective. In: Park N, Cheol, Moon D, Geon, Kim S, editors. Penile augmentation. Berlin and Heidelberg. Germany: Springer-Verlag; 2016. p. 11–26. 3. Kadouch JA, van Rozelaar L, Kanhai RJC, Sawor JH, Karim RB. Complications of penis or scrotum enlargement due to injections with permanent filling substances. Dermatol Surg [Internet] 2012;38(7):1244– 50. Available from: www.dx.doi. org/10.1111/j.1524-4725.2012.02479.x 4. Ahmed U, Freeman A, Kirkham A, Ralph DJ, Minhas S, Muneer A. Self injection of foreign materials into the penis. Ann R Coll Surg Engl [Internet] 2017;99(2):e78–82. Available from: www.dx.doi.org/10.1308/ rcsann.2016.0346
Injecting non-resorbable substances into the penis can cause serious complications, such as infection with subsequent sepsis, scarring, phimosis, deformities, acute urinary retention, substance migration, trophic ulcers [3] and even death. Moreover, the injected substances may also cause allergies, inflammation, and irreversible tissue damage, leading to pain, discomfort and erectile dysfunction. Self-induced penile enlargement with non-resorbable allogeneic substances is not only physically harmful but also mentally distressing. Men who engage in this practice may experience feelings of shame, guilt and anxiety due to insecurity about their size. However, it is important to note that penis size does not determine a man's sexual ability or satisfaction. "Injecting non-resorbable substances into the penis can cause serious complications, such as infection with subsequent sepsis, scarring, phimosis, deformities, acute urinary retention, substance migration, trophic ulcers and even death." These male patients usually come to the emergency department (ED) with complications such as urinary infection and infected ulcers, urinary retention or considerable oedema. In most of the cases the patients can be managed conservatively but unfortunately they may need surgical therapy later in life to remove affected skin and in some cases a graft will be used. Even if the procedure goes perfectly, the cosmetic outcome may be unsatisfying. [3] Below are two patient cases that presented at our outpatient clinic, and after further management, needed surgery. Case number I A 35-year-old male patient had his first presentation in our outpatient clinic with a narrow phimosis, a big bulge in his front foreskin and complaining of erectile disfunction, all after penile injection of petroleum jelly 10 years ago. His second visit was 6 months later, when he came with the same bulge but with a dorsal
Dr. Stefan Tiganu Medlife Genesys Dept. of Urology Oradea (RO)
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tiganustefan@ gmail.com
Dr. Madalina Sava Medlife Genesys Dept. of Dermatology Oradea (RO)
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slit that was performed 2 months prior presentation due to acute urinary retention. At this time he accepted removal only of the bulge that on ultrasound appeared to be an abscess. The mass was removed and the skin defect closed without grafting. Intense fibrous process under the skin was revealed. Fig. 1: Preoperative aspect after dorsal slit Fig. 2: Immediate postoperative aspect Fig. 3: Healing process 10 days after surgery Case number II A 28-year-old male had injected Kanamycin 2 years before presentation. All the injected mass migrated in the front part of his foreskin, inducing a very tight phimosis, with an inability to achieve orgasm. After counselling the patient and explaining possible complications, he agreed to have a circumcision performed.
madalina.sava0508@ gmail.com
From ancient times, the size of the male genitals had a separate place in the definition of masculinity. Among the ancient Greeks, the small size of the genitals was considered a sign of beauty and intelligence, whilst a large penis was considered hideous and unattractive. [1] Other cultures like Arabic, Chinese, Japanese and Norsemen in their early times depicted men having larger penises than normal and this was considered a sign of masculinity. [2] Contemporary men under the influence of culture, society and the media tend to underestimate their size, therefore, they want to increase it. Unfortunately for various reasons they end up resorting to dubious self-treatments and injections with allogeneic substances such as petroleum jelly, kanamycin and other mineral oils. The practice of self-induced penile enlargement with allogeneic non-resorbable substances involves injecting foreign substances between the corpora cavernosa and penile skin to increase its girth and length. The idea behind this practice is that the injected substance will cause the penis to expand and create a larger size. However, this practice is extremely dangerous.
Fig. 4: Preoperative image Fig. 5: Immediate postoperative image
Follow-up results for both patients included a quality of life (QoL) evaluation, and surgery satisfaction was further assessed at control examination. For a young urologist managing such cases, it can be very challenging because of the lack of information and the rarity of cases, so we have provided some guidelines to follow. Some guidelines • History is of utmost importance, usually patients know the type of fillers, when it was done and the order of symptoms onset.
Setting a new course for ESUI: A manifesto New Chair shares aspirations for the Section
mean “to see something”, it also means information (real or predicted) and it is up to us as clinicians and surgeons to make proper use of this information. How this will be realised is the current challenge. Words from the previous and new Chairs When Prof. Georg Salomon (DE) named me as his successor to leading the ESUI, I felt honoured and thrilled about my new role. I would like to express my gratitude to him, as well as to the ESUI Board members who have provided support and approved my candidature. Although this new role brings challenges, the inherent structure of the section is the perfect platform to undertake new and ambitious initiatives.
thank the board members for their continuous support and what would the sections and the EAU be without the hardworking and dedicated staff such as Mrs. Claudia Van Ijzendoorn, Mrs. Angela Terberg, Mrs. Sabrina Van Scherpenseel and Mrs. Soňa Lukačovičová, to name a few. Imaging in urology has changed significantly in recent years, both from a diagnostic and therapeutic point of view, and will change immensely in the near future. Throughout these changes, I’m sure ESUI will continue to be a reliable platform and channel of vital updates on imaging under the leadership of Francesco.” Among the new initiatives, there will be the need to strengthen the collaboration with the natural “specialist partners” such as the urological working groups of the European associations of imaging (e.g. EAU Section of Urological Research, European Association of Nuclear Medicine, etc.). These strategic alliances will help identify those aspects of urological imaging worth of public debate and interaction, both in research and clinical practice. As part of the Sections Office, ESUI will promote transversal collaborations. Nowadays most of innovation in urological imaging is applied in uro-oncology, clearly making the EAU Section of Oncological Urology a strategic partner, but other fields of interest will be shared with the EAU Section of Urolithiasis (e.g. new imaging modalities for stone characterisation, or augmented reality for PCNL
Prof. Francesco Sanguedolce Fundació Puigvert Dept. of Urology Barcelona (ES)
fsanguedol@ fundacio-puigvert.es
The EAU Section in Urological Imaging (ESUI) is among the most challenging Sections of the EAU. From one side, urological imaging is a field in rapid expansion; on the other, imaging is at a crossroads of different medical and technological specialisations whose interaction might require special balance and extra effort. In fact, urological imaging involves radiological and nuclear medicine expertise, as well as software innovation for augmented/virtual reality, artificial intelligence, and deep learning. The role of urologists is evolving in a way to better interact with imaging specialists and optimise the use of technology for the best clinical applications and outcomes. Urological imaging does not merely
Prof. Georg Salomon, outgoing ESUI Chair
Prof. Georg Salomon shared the following parting words: “It was my pleasure to contribute as Chair of the ESUI. I am pleased to hand the office over to Prof. Francesco Sanguedolce and I am sure that the activities of the ESUI will be expanded further under his leadership. I would like to take this opportunity to
EAU Section of Urological Imaging (ESUI)
European Urology Today
April/May 2023
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