Various non-medical grade materials have been injected into the genital subcutaneous region. Unfortunately patients suffer symptomatic granuloma formation. We aim to provide a contemporary series and discuss diagnostic and management aspects.
A retrospective review of penile sclerosing granuloma cases was performed (2006-2017). Outcomes included patient demographics, comorbidities, reason, date, site and type of substance injected, presenting symptom, type and number of surgeries required and post operative complications.
21 patients were noted – 7 Eastern European, 5 British; the remainder any other background. Average age was 40, whilst the average time until presentation was 8.2 (1-18) years. 19% were HIV or hepatitis B/C positive (4/21).
Reasons include augmentation (16), right of passage (2), intoxication (1). Location included penile shaft (13), foreskin (7) and scrotum (1/). 15 injected in more than 1 site.
Symptoms included cosmetic dissatisfaction (7), pain (5), painful intercourse (5) or phimosis (3), lymphedema (4) and erectile dysfunction (2).
Histology reveals subcutaneous tissue with variably sized spaces; areas where foreign material has dissolved during processing. Chronic inflammation is present with lymphocytes, histiocytes, plasma cells and fibrosis. Morphological findings are similar for the different materials.
Ultrasound may show thickened echogenic layer. MRI showed subcutaneous soft tissue swelling, nodularity and fibrosis. No lymph node involvement was demonstrated in any of the preoperative scans.
34 Operations were completed; average 1.6 procedures per patient. Surgeries included excision and primary closure +/- local flap (21), preputial slit /circumcision (8), skin graft (full 2, partial 2) and orchidectomy/testis implant (1).
4/21 Patients suffered wound breakdown or skin necrosis. These were managed conservatively. 1 patient whom underwent full-thickness skin grafting complained of reduced sensation. No specific treatment was required.
Complications of sclerosing granuloma may affect cosmesis or sexual function requiring surgical excision. Treatment often consists of multiple resections with primary closure, or complete excision with grafting or local flaps.