Surgical solutions for the complications of the Vaseline self-injection of the penis.
BACKGROUND
Penile girth enhancement by the injection of Vaseline is an existing practice. Many cases develop severe complications that need surgery.


OBJECTIVE
To report on the reconstructive surgical solutions of the complications of Vaseline self-injection and the outcomes. To develop a modification of a one-step reconstruction method involving the use of pedicled scrotal flaps.


METHODS
The complications and their surgical solutions were classified as regards severity and difficulty. The outcomes were observed and a newly introduced one-step surgical method was investigated.


METHODS
Seventy-eight consecutive patients (87.2% of them with a history of imprisonment) were divided into three groups. In group A, aesthetic penile defects or phimosis caused by the Vaseline necessitated circumcision or local excision. In group B, the whole penile skin was involved, and total skin removal and two- or (a newly modified) one-step reconstructive surgery were performed. In group C, both the whole penile skin and the scrotum were involved: complete skin removal and skin grafting or skin pedicled flap transplantation were carried out.


RESULTS
In five cases in group B, postoperative skin necrosis made a second operation necessary. There was one intraoperative urethral injury, where a urethral fistula developed and a second urethral reconstruction was performed. There was no major complication with the newly developed one-stage pedicled flap procedure. At the end of the therapy, all the cases were healed. All of the patients reported successful sexual intercourse after the operations and 91% were satisfied with the result.


CONCLUSIONS
The complications depend mainly on the amount of Vaseline injected, the hygienic circumstances, and the personal tolerability. In the worst cases, only radical skin removal and skin transplantation can solve the problem. The newly developed one-step arterial branch-preserving scrotal skin flap reconstruction appears to be a suitable and cost-effective solution for these patients.
Department of Urology, University of Szeged, 6724 Szeged Kálvária sgt. 57, Szeged, Hungary. bajory.zoltan@med.u-szeged.hu
Zoltán
Z
Bajory
Gábor
G
Mohos
Agnes
A
Rosecker
Noémi
N
Bordás
László
L
Pajor
D002944:Circumcision, Male; D004643:Emollients / Q000008:administration & dosage / Q000009:adverse effects*; D004954:Esthetics; D006099:Granuloma / Q000139:chemically induced / Q000601:surgery; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D009336:Necrosis / Q000139:chemically induced / Q000601:surgery; D017060:Patient Satisfaction; D010409:Penile Diseases / Q000139:chemically induced* / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D010577:Petrolatum / Q000008:administration & dosage / Q000009:adverse effects*; D010688:Phimosis / Q000139:chemically induced / Q000601:surgery; D011329:Prisoners; D011446:Prospective Studies; D012883:Skin Ulcer / Q000139:chemically induced / Q000601:surgery; D013524:Surgical Flaps
D004643:Emollients; D010577:Petrolatum