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Complication of Penile Injection of Autologous Fat
0022-5347 /94/1512-0429$03_00/0 VoL 151,
THE JOURNAL OF UROLOGY
Copyright© 1994 by AMERICAN UROLOGICAL ASSOCIATION, INC,
COMPLICATION OF PENILE INJECTION OF AUTOLOGOUS FAT BRETT A. TROCKMAN, CRAIG J. BERMAN, KARLA SENDELBACH
AND
JOHN R CANNING
From the Departments of Urology and Pathology, Loyola University School of Medicine, Maywood, Illinois
ABSTRACT
A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. We report on a 36-year-old man who suffered 2 painful inflammatory nodules requiring surgical excision 3 months after undergoing this new penile enlargement procedure. KEY WORDS:
penis, fat body, penile erection, liposuction
A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. 1 Although to our knowledge this method has not been reported in the medical literature for penile augmentation, autologous fat injection has been used clinically in the treatment of many cosmetic surgical defects as well as stress urinary incontinence. 2• 3 The success of these various procedures has been variable. However, the reported complication rates have been low. 4 • 5 Known possible complications from injection of autologous fat include oil cyst formation, infection, and transient edema and ecchymosis. 6 A large painful inflammatory cyst requiring excision after breast augmentation using autologous fat injection has also been documented. 7 We report the development of 2 painful inflammatory penile nodules 3 months after penile augmentation using autologous fat obtained by liposuction. Accepted for publication July 16, 1993.
Fm. 2. Fibroadipose tissue with fat necrosis, giant cell reaction and focal chronic inflammation. H & E, reduced from X20. CASE REPORT
A 36-year-old man first presented to our institution 3 months after undergoing penile injection of autologous fat obtained by liposuction. The patient complained of 2 painful nodules at the base of the penis. He reported no subjective increase in penile size or change in erections after the procedure. Physical examination revealed 2 discrete masses (1 and 3 cm. in diameter) at the penoscrotal junction. The remainder of the physical examination was unremarkable. Urinalysis was normal. At operation 2 discrete subcutaneous nodules were identified and excised (fig. 1). Histopathological study of the lesions revealed fibroadipose tissue with fat necrosis, cell reaction and focal chronic inflammation (fig. 2). Convalescence was unremarkable. DISCUSSION
Free fat grafts have been used for many years to correct soft tissue defects. The ultimate long-term survival of autotransplanted fat cells is unpredictable and some clinical benefit is believed to be derived from secondary inflammation and fibrosis. 2 The newer technique of injecting autologous fat obtained by liposuction yields autograft survival rates of 10 to 50% and significant inflammation has been noted in animal models. 5• 6• 8 In a rabbit model the acute inflammatory response after fat autotransplantation was shown to reach a peak at about 10 days followed by a chronic inflammatory response, with macrophages and multinucleated giant cells scavenging the nonviable portions of the graft. Then, 40 days after autotransplantation marked fibrosis was noted throughout the graft along with persistent severe chronic inflammation. 8 The long-term
Fm. 1. Intraoperative view of larger nodule 429
430
COMPLICATION OF PENILE FAT INJECTION
consequences of a similar chronic inflammatory and fibrotic reaction in the penis after injection of autologous fat are unknown. However, other inflammatory and fibrotic processes in the penis have been associated with pain and functional impairment. Undoubtedly, recent media publicity will raise questions from patients concerning the use of this technique for penile enlargement. Our case documents a failure of the procedure and the development of a complication requiring a secondary operation. Hopefully, further information concerning the efficacy and safety of this new procedure will be forthcoming in the medical literature. REFERENCES 1. DeSantis M.: Help for the teeny weeny. Cosmopolitan, p. 40, July 1992. 2. Chajchir, A., Benzaquen, I.: Fat-grafting injection for soft-tissue augmentation. Plast. Reconstr. Surg., 84: 921, 1989.
3. Gonzalez de Garibay, A. S., Castillo Jimeno, J. M., Villanueva Perez, I., Figuerido Garmendia, E., Vigata Lopez, M. J. and Sebastian Borruel, J. L.: Treatment of urinary stress incontinence using paraurethral injection of autologous fat. Arch. Esp. Urol., 44: 595, 1991. 4. Pinski, K. S. and Roenigk, H. H., Jr.: Autologous fat transplantation. Long-term follow-up. J. Dermatol. Surg. Oncol., 18: 179, 1992. 5. Ersek, R. A.: Transplantation of purified autologous fat: a 3-year follow-up is dissappointing. Plast. Reconstr. Surg., 87: 219, 1991. 6. Horl, H. W., Feller, A. M. and Biemer, E.: Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann. Plast. Surg., 26: 248, 1991. 7. Montaiiana Vizcaino, J., Baena Montilla, P. and Benito Ruiz, J.: Complications of autografting fat obtained by liposuction. Letter to the Editor. Plast. Reconstr. Surg., 85: 638, 1990. 8. Bartynski, J., Marion, M. S. and Wang, T. D.: Histopathologic evaluation of adipose autografts in a rabbit ear model. Otolaryngol. Head Neck Surg., 102: 314, 1990.
THE JOURNAL OF UROLOGY
Copyright© 1994 by AMERICAN UROLOGICAL ASSOCIATION, INC,
COMPLICATION OF PENILE INJECTION OF AUTOLOGOUS FAT BRETT A. TROCKMAN, CRAIG J. BERMAN, KARLA SENDELBACH
AND
JOHN R CANNING
From the Departments of Urology and Pathology, Loyola University School of Medicine, Maywood, Illinois
ABSTRACT
A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. We report on a 36-year-old man who suffered 2 painful inflammatory nodules requiring surgical excision 3 months after undergoing this new penile enlargement procedure. KEY WORDS:
penis, fat body, penile erection, liposuction
A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. 1 Although to our knowledge this method has not been reported in the medical literature for penile augmentation, autologous fat injection has been used clinically in the treatment of many cosmetic surgical defects as well as stress urinary incontinence. 2• 3 The success of these various procedures has been variable. However, the reported complication rates have been low. 4 • 5 Known possible complications from injection of autologous fat include oil cyst formation, infection, and transient edema and ecchymosis. 6 A large painful inflammatory cyst requiring excision after breast augmentation using autologous fat injection has also been documented. 7 We report the development of 2 painful inflammatory penile nodules 3 months after penile augmentation using autologous fat obtained by liposuction. Accepted for publication July 16, 1993.
Fm. 2. Fibroadipose tissue with fat necrosis, giant cell reaction and focal chronic inflammation. H & E, reduced from X20. CASE REPORT
A 36-year-old man first presented to our institution 3 months after undergoing penile injection of autologous fat obtained by liposuction. The patient complained of 2 painful nodules at the base of the penis. He reported no subjective increase in penile size or change in erections after the procedure. Physical examination revealed 2 discrete masses (1 and 3 cm. in diameter) at the penoscrotal junction. The remainder of the physical examination was unremarkable. Urinalysis was normal. At operation 2 discrete subcutaneous nodules were identified and excised (fig. 1). Histopathological study of the lesions revealed fibroadipose tissue with fat necrosis, cell reaction and focal chronic inflammation (fig. 2). Convalescence was unremarkable. DISCUSSION
Free fat grafts have been used for many years to correct soft tissue defects. The ultimate long-term survival of autotransplanted fat cells is unpredictable and some clinical benefit is believed to be derived from secondary inflammation and fibrosis. 2 The newer technique of injecting autologous fat obtained by liposuction yields autograft survival rates of 10 to 50% and significant inflammation has been noted in animal models. 5• 6• 8 In a rabbit model the acute inflammatory response after fat autotransplantation was shown to reach a peak at about 10 days followed by a chronic inflammatory response, with macrophages and multinucleated giant cells scavenging the nonviable portions of the graft. Then, 40 days after autotransplantation marked fibrosis was noted throughout the graft along with persistent severe chronic inflammation. 8 The long-term
Fm. 1. Intraoperative view of larger nodule 429
430
COMPLICATION OF PENILE FAT INJECTION
consequences of a similar chronic inflammatory and fibrotic reaction in the penis after injection of autologous fat are unknown. However, other inflammatory and fibrotic processes in the penis have been associated with pain and functional impairment. Undoubtedly, recent media publicity will raise questions from patients concerning the use of this technique for penile enlargement. Our case documents a failure of the procedure and the development of a complication requiring a secondary operation. Hopefully, further information concerning the efficacy and safety of this new procedure will be forthcoming in the medical literature. REFERENCES 1. DeSantis M.: Help for the teeny weeny. Cosmopolitan, p. 40, July 1992. 2. Chajchir, A., Benzaquen, I.: Fat-grafting injection for soft-tissue augmentation. Plast. Reconstr. Surg., 84: 921, 1989.
3. Gonzalez de Garibay, A. S., Castillo Jimeno, J. M., Villanueva Perez, I., Figuerido Garmendia, E., Vigata Lopez, M. J. and Sebastian Borruel, J. L.: Treatment of urinary stress incontinence using paraurethral injection of autologous fat. Arch. Esp. Urol., 44: 595, 1991. 4. Pinski, K. S. and Roenigk, H. H., Jr.: Autologous fat transplantation. Long-term follow-up. J. Dermatol. Surg. Oncol., 18: 179, 1992. 5. Ersek, R. A.: Transplantation of purified autologous fat: a 3-year follow-up is dissappointing. Plast. Reconstr. Surg., 87: 219, 1991. 6. Horl, H. W., Feller, A. M. and Biemer, E.: Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann. Plast. Surg., 26: 248, 1991. 7. Montaiiana Vizcaino, J., Baena Montilla, P. and Benito Ruiz, J.: Complications of autografting fat obtained by liposuction. Letter to the Editor. Plast. Reconstr. Surg., 85: 638, 1990. 8. Bartynski, J., Marion, M. S. and Wang, T. D.: Histopathologic evaluation of adipose autografts in a rabbit ear model. Otolaryngol. Head Neck Surg., 102: 314, 1990.