Penile enlargement with methacrylate injection

Sao Paulo Med. J. vol.131 no.1 São Paulo 2013


Penile enlargement with methacrylate injection: is it safe?

Fabio Cesar Miranda TorricelliI, Enrico Martins de AndradeI, Giovanni Scala MarchiniI, Roberto Iglesias LopesI, Joaquim Francisco Almeida ClaroI, Jose CuryII, Miguel SrougiIII
A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months.

Today, several interventions for penile enlargement are sold to men who desire a bigger and more attractive penis, both by physicians and by lay people, often with media support. However, the “experimental” nature of this kind of approach is almost never completely explained to these patients, who believe that they are undergoing a modern and safe procedure. The best option and outcome for penile girth augmentation remain unclear. None of the penile enhancement techniques have been approved by any of the professional societies, and the majority are performed in private settings, thereby leading to medical-legal implications and paucity of specific data. 1 Another important issue is how to identify patients who would benefit from penile augmentation. Moreover, concerns continue with regard to deciding what the valid indications for performing such procedures would be, selecting the most suitable procedure and designating the outcome measurements.

Invasive filler injection procedures have been reported to be capable of meeting patient expectations. Yacobi et al. 7 reported their experience with ultra-purified liquid injectable silicone for penile shaft augmentation among a considerable sample of 324 patients. Three to six sessions were performed and, after a mean follow-up of 20 months (range 1-36 months), these investigators reported that an increase in penile girth of 27% had been achieved. No complications were noted.

Many fillers are available for tissue augmentation, 2−5 but the ideal filling substance remains unknown. Such a substance would be biocompatible, non-antigenic, non-pyrogenic, non-inflammatory, nontoxic, easy to use, stable after injection, non-migratory, natural looking and not too expensive. In our case, methacrylate injection was used for penile enhancement. Methacrylates are the salts or esters of methacrylic acid and are common monomers in polymer plastics, forming the acrylate polymers. In comparison, other synthetic fillers such as polytetrafluoroethylene and silicone, with irregular surfaces, are more prone to cause chronic granulomas reactions. 8 Table 1 shows the lack of experience in the literature, regarding methacrylate for penile girth augmentation.

Although several options are available for penile girth augmentation, none of them is free from complications.
Wassermann and Greenwald 9 reported the case of a 42-year-old man who had had silicone injected into his corpora cavernosa 14 years prior to his presentation with edema of the penis and scrotum. The patient had palpable siliconomas obstructing the glans and required surgical resection.

More recently, Silberstein et al. 6 reported the case of a 61-year-old male hospitalized for treatment of cellulitis in his right lower extremity who, in the physical examination, was found to present a grossly edematous circumcised penis with marked firm swelling. A computed tomography scan revealed a diffusely enlarged penis, with multiple rounded structures showing peripheral calcification, of which the largest measured 2.3 cm, distortion of the soft tissues, and poor viewing of the corpus cavernosum and spongiosum. The patient admitted that a nonmedical practitioner had injected a “silicone mixture” several years earlier (the patient could only guess at around 10-15 years earlier). He was “pleased” and declined any further intervention. Shaeer et al. 10 reported the case of a 28-year-old male who presented with a subcutaneous mass in the penile shaft, which had resulted in deformity and difficult intromission, as well as coital pain for the female partner. He had injected gel into the penis two years prior to presentation. The injected material had started to migrate and had coalesced into a painless mass. The patient requested surgical removal of the mass, which was done without complications. These cases have many points in common with the case that we presented here, thus showing that penile deformity and sexual dysfunction may be serious complications from injection of fillers for girth augmentation.

Moreover, a report on complications after injection of various polymethyl methacrylate-based dermal fillers had already been published by Salles et al., 8 such as tissue necrosis, granulomas, chronic inflammatory reaction and infection.