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Accidental high-pressure injection of oils—grease-gun injury—has become increasingly common. We report a non-accidental variant.
At age 31 a man used a high-pressure pneumatic grease-gun to inject his penis in the hope of increasing its girth. Unfortunately the width continued to increase and he also developed erectile dysfunction. He sought urological advice 7 years after the initial incident.
On examination the penis was grossly deformed with areas of nodular subcutaneous thickening. An MRI scan, performed after intracavernosal injection of 5 μg prostaglandin E1, showed marked thickening of the penile skin and subcutaneous tissue with areas of calcification and globules of grease. There was no involvement of the corpora cavernosa or corpus spongiosum (Figure 1).
The affected subcutaneous tissue and globules of grease were excised in a staged procedure over three separate admissions. On histological examination the specimens showed extensive fibrosis and foreign-body granulomatous changes. Six months postoperatively, the patient had regained erectile function sufficient to permit sexual intercourse.
For over a century people have attempted to embellish the human body by injecting various oils beneath the skin1. Injection of the penis with material such as paraffin and Vaseline, to increase its circumference, has been particularly seen in South-east Asia2, 3. In addition, the subcutaneous self-implantation of spherical objects in the penis is a well-known practice among members of the Yakuza in Japan. Increased sexual confidence is a major reason for these implantations, which are usually performed under primitive conditions4. Complications, which are frequent, include penile deformity, necrosis/ulceration of the skin, erectile dysfunction and inability to have intercourse2.
Accidental injuries with high-pressure devices such as grease-guns most commonly affect the hand and fingers and pose a therapeutic challenge for the surgeon. Their severity is related to the nature, pressure, volume and toxicity of the injected substance. The major hazard of this injury is a toxic oedema followed by ischaemia, causing gangrene4.
We have not found any previous report of a self-inflicted high-pressure grease-gun injection into the penis. In this case the extent of tissue damage was difficult to establish, but MRI clearly showed that underlying corpora were not involved; thus all affected subcutaneous tissue could be excised without damage to normal tissue. Staging of the procedure was necessary to minimize the risk of devascularization of the overlying skin. As in all cases of self-injection, a referral for psychological counselling was warranted.