Oleogranuloma of the penis is inflammatory and trophic changes in the skin and fascia of the penis caused by local subcutaneous administration of various oily substances capable of solidification. Oleogranuloma of the penis is manifested by the formation of dense infiltrates on the body of the penis, scarring of the penis, lymphatic edema, pain during erection. Complications may include the spread of the process to the urethra and scrotum, paraphimosis, the formation of ulcerative defects and fistulas. Diagnosis of oleogranuloma is based on anamnestic data, the results of examination and palpation, ultrasound and ultrasound of the penis, biopsy. Treatment of oleogranuloma of the penis is operative (excision of the foreskin, Sapozhkov-Reich operation).
Oleogranuloma of the penis is the proliferation of granulation tissue in the subcutaneous layers of the penis due to self-injection by the patient of various substances in order to thicken the penis. Currently, in urology and andrology, the oleogranuloma of the penis is understood as a complex of pathological reactions that have developed in response to the presence of any foreign object or substance (gel, balls, rods, etc.) under the skin of the penis, which are introduced there by the patient himself or another unqualified person.
Usually, oleogranuloma of the penis is diagnosed in men aged 20 to 55 years, but the absolute majority of them are young patients (up to 30 years). Oleogranuloma of the penis is capable of infiltrative spread to healthy tissues of the penis, scrotum, perineum, pubic area and is extremely dangerous for its immediate and long-term complications.
The formation of the oleogranuloma of the penis is a consequence of subcutaneous administration of oily substances or solid objects. As a rule, this is done in order to thicken the penis, giving it additional hardness and volume. Most often, vaseline, vaseline oil, paraffin, baby cream, prednisolone and tetracycline ointments are used for subcutaneous administration. This manipulation is usually performed in closed male groups (places of imprisonment, army collectives) or in domestic conditions. The immediate motivation for the procedure in most cases is a man’s desire to assert himself in the field of intimate relationships, a low level of sexual education, exposure to someone else’s influence, lack of critical attitude to a negative example.
The simplicity of the technical side of the procedure and the lack of financial costs makes it very common among men. Since manipulation is often carried out in unsanitary conditions, with disregard for medical requirements, independently or with the help of other unqualified “specialists”, it can rightfully be classified as self-mutilation.
In the pathogenesis of oleogranuloma of the penis, the following phases are distinguished: productive (proliferation), cystic, hyalinosis, lymphatic edema and the formation of new granulomatous foci along the periphery. In the proliferative phase, in response to subcutaneous injection of foreign substances, reactive inflammation develops in the tissues of the penis, granulation tissue grows around the inflammatory infiltrate. Deterioration of blood supply to the affected area is accompanied by tissue ischemia and trophic disorders, the appearance of ulcerative defects on the skin surface. In the thickness of the altered tissues, cysts form, which, when suppurated, open to the surface of the skin with the formation of long-term non-healing fistulas. A few years later, the hyalinosis phase begins, characterized by disorganization (dystrophy) of connective tissue. Further disturbances of microcirculation and lymph outflow in the surrounding tissues lead to a cyclic repetition of pathological reactions, infiltrative spread of oleogranuloma of the penis and the progressive nature of the course of the granulomatous process.
According to the vastness of the distribution of granulomatous foci, there are 3 degrees of oleogranuloma of the penis:
- I degree – oleogranuloma is localized at the injection site and affects no more than 1/3 of the trunk of the penis
- Grade II – oleogranuloma affects most or all of the skin of the penis
- Grade III – oleogranuloma spreads to the skin of the scrotum, perineum or pubic area.
In the clinical course of the oleogranuloma of the penis, there is an uncomplicated stage (granulomatous infiltrate) and a complicated stage (scar deformation, purulent-necrotic changes, etc.).
The presence of oleogranuloma of the penis is characterized by the appearance of dense tumor-like nodes of various sizes and shapes at the injection site of foreign substances. The surface of the penis becomes lumpy. In the initial stages, the oleogranuloma of the penis does not cause painful sensations and does not differ in color from the surrounding skin. In the future, after a period of relative clinical well-being, soreness develops in the area of tumor-like formation, lymphatic edema and penile deformity, erectile dysfunction. The skin of the penis is soldered to the surrounding tissues and is immobile.
Complications of oleogranuloma of the penis may occur 7-10 years after the introduction of foreign substances. Among them there are paraphimosis, ulcerative defects, subcutaneous fistulas, necrosis of the skin of the penis, gangrene of the penis. During the transition of granulomatous infiltrate to the scrotum, perineum, pubic area, oleogranuloma of the external genitalia develops.
Usually, the oleogranuloma of the penis is unmistakably diagnosed already during the first appointment of a urologist or andrologist based on the patient’s anamnesis and complaints indicating the presence in the past of the fact of the introduction of chemicals or other substances under the skin of the penis and the development of currently disturbing symptoms. During examination and palpation, nodular seals and scarring changes in the penis area are detected.
In order to assess the condition of the cavernous tissue and blood supply, ultrasound and ultrasound of the vessels of the penis are performed. Since the oleogranuloma of the penis resembles a solid chancre, and sometimes it is combined with it, it is necessary to exclude syphilis and other STDs using laboratory diagnostics (ELISA, PCR, RIF). In case of doubt about the origin of the formation (for example, if the patient denies the fact of introducing substances under the skin of the penis), it is possible to conduct a biopsy of the formation of the penis with subsequent morphological examination of the biopsy.
Conservative therapy of penile oleogranuloma is ineffective and can only be undertaken as a preoperative preparation in order to stop the inflammatory process. Patients are prescribed antibacterial therapy, local ointment dressings and baths with antiseptic solutions, physiotherapy. A radical method of treating oleogranuloma of the penis can only be an operation, the volume and type of which is determined by the degree of spread of the granulomatous process and concomitant complications.
The most gentle type of operation is circular excision of the foreskin (circumcision), which is indicated for small oleogranulomatous foci located in the foreskin. Limited oleogranulomas located on the body of the penis can be removed during a one-stage operation with simultaneous closure of the skin defect to local tissues. If it is impossible to replace the defect with local tissues, skin flaps on the vascular pedicle are used.
With extensive lesions, a two-stage Reich-Sapozhkov operation is performed to remove the oleogranuloma of the penis. At the first stage, the removal of the penis’s own integumentary tissues and its immersion under the skin of the anterior surface of the scrotum with the removal of the head is performed. A few months later, during the second stage of the operation, the penis is separated from the scrotum, its plastic is carried out by local tissues. In the future, for the treatment of impotence, the patient may need a falloprosthesis. In some particularly severe cases, complicated by gangrene, according to vital indications, the penis is amputated.
Oleogranuloma of the penis is an amateur crippling manipulation, which in 100% of cases negatively affects the sexual function of patients and leads to serious consequences: erectile dysfunction, psychological disorders, complications. Attempts to independently increase the length and thickness of the penis with the help of means not intended for this are unacceptable. Any type of penile plastic surgery should be performed only in a medical facility by qualified specialists. Preventive measures should include competent sexual education and education.