Penile sclerosing granuloma – surgical excision
Blecher, G1; Asher, N1; Garaffa, G1; Ralph, D1
1: University College London Hospitals (UCLH), United Kingdom
Objective: 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.
Material and Methods: A retrospective review of penile sclerosing granuloma cases was performed (2006-2017). Outcomes include patient demographics, comorbidities, reason, date, site and type of substance injected, presenting symptom, type and number of surgeries required and post operative complications.
Results: 21 patients were noted. Average age was 40, with average time until presentation 8.2 years. 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. Ultrasound may show thickened echogenic layer. MRI showed subcutaneous soft tissue swelling, nodularity and fibrosis. 34 operations were completed including 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.
Conclusion: 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.
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