Penile oleogranuloma: what's what?
The condition, which will be discussed in the article, develops due to the introduction of substances under the skin of the penis, which then harden. As a result, both the fascia and the skin of the organ change in the trophic and inflammatory vein. Dense infiltrates are formed on the body of the penis, and also the penis is deformed by scars. To this should add lymphatic edema and pain during an erection. As complications, experts call the movement of the abnormal process not only to the urethra, but also to the scrotum. In addition, doctors warn that paraphimosis may develop. Some form fistulas and ulcers. To diagnose oleogranuloma, examination and palpation of the affected area is necessary, including procedures such as biopsy, ultrasound and ultrasound of the member. They treat the disease promptly, that is, they excise the foreskin and perform the Sapozhkov-Reich operation.
Understanding Penile Oleogranulomas
From a medical point of view, the ailment is that granulation tissue spreads in the subcutaneous layers of the genital organ. This can happen after the man himself introduced a substance into the penis so that a thickening or increase in “dignity” occurs. Urologists and andrologists understand the problem under consideration as a combination of pathological reactions that began in response to the introduction of a foreign component or object into a member (these can be gels, balls, rods, etc.).
By the way, the procedure is not necessarily carried out by the patient himself. It happens that an unskilled "specialist" is involved in the problem. In any case, statistics show that young men (that is, up to 30 years old) are most often faced with oleogranuloma. But there are those who are much older (for example, 55 years old). It is important for “experimenters” of different ages to know one way or another - the described condition can spread to healthy tissues of the penis, pubis, perineum and scrotum, provoking dangerous complications.
Types of penile oleogranuloma
When studying the pathogenesis of an ailment, it turns out that it consists of phases. In particular, this is a productive, cystic phase. There is also a phase of hyalinosis. Finally, there is a period of lymph outflow with the onset of regular granulomatous lesions. In the proliferative (productive) phase, reactive inflammation occurs as a response to the introduction of a foreign component or object under the skin. And the inflammatory infiltrate will be surrounded by granulation tissue, and it grows. Against the background of deteriorated blood supply to this area of the body, tissue ischemia and trophic disorders occur. Skin ulcers come to light.
Gradually, cysts arise in the altered tissues. If they fester and open onto the skin surface, fistulas form. They will not heal long enough. After a couple of years (relatively), the period of hyalinosis will begin. Here the main difference is connective tissue dystrophy. In the future, failures in microcirculation and lymph drainage are inevitable (applies to surrounding tissues). After a cyclic repetition of abnormal reactions is started. Oleogranuloma spreads infiltratively, and the granulomatous process progresses.
The disease itself has three degrees, depending on how wide the lesion has spread.:
- I degree - localization of oleogranuloma occurs at the injection site, no more than 1/3 of the stem of the penis is affected,
- II degree - the problem has spread to most or all of the skin of the organ,
- III degree - the skin of the pubis, perineum, scrotum suffer.
From the point of view of the clinical course, an uncomplicated stage (granulomatous infiltrate) and, accordingly, complicated when purulent necrotic changes, cicatricial deformity, etc.
The root causes of oleogranuloma member
As mentioned above, the source of the problem was initially the introduction of substances or objects foreign to it under the skin of the organ. Often the goal for such manipulations is the desire of a man to make his penis thicker, voluminous, firm. According to experts, mostly petroleum jelly or petroleum jelly is commonly used. Some use paraffin. It happens that the “correct” member is taken with the help of baby cream and ointments (tetracycline and prednisolone). It is noted that most cases of this practice happen in closed groups, where some men (for example, in the army or in prison).
Do not deduct from the accounts and ordinary living conditions. The motivation in most cases is the desire to assert oneself in an intimate plan. A man who goes to a questionable-dangerous procedure is not able to be critical of negative examples, is subject to influence from the outside and has a low level of sexuality education. Also, the simplicity and cheapness of the method provokes the manipulation. Since the process of conducting often takes place under conditions in which not only cleanliness but also basic medical requirements are neglected, the procedure as a whole can be considered true self-harm in all senses of the word.
The main reason for the formation of oleogranulomas is the introduction under the skin of various substances that can subsequently harden. Highly often patients themselves buy these substanceswithout suspecting the possible consequences. Really, the penis becomes harder and slightly enlarged, but this process has its consequences.
Usually, boron paraffin, petroleum jelly, tetracycline or sterile paraffin is used for these purposes. Almost immediately after the introduction of one of these substances, serious inflammation begins under the skin. After that in its place there is a formation of connective tissue that can very quickly increase in size. After a certain period of time, the granuloma grows, penetrating into the deepest parts of the body of the penis. Subsequently, the patient's erection is seriously impaired or completely lost.
Penile oleogranuloma and its signs
First of all, at the site of insertion of anything into the penis, nodes appear. They are dense, resemble a tumor and vary in size and shape. Therefore, the surface of the penis is uneven. At the very beginning, there is no pain, and the skin is exactly the same color as the surrounding tissue. Further, a more or less favorable condition is replaced by the soreness of a tumor-like formation. Lymphatic edema is present. The member is deformed. An erection becomes impossible. The skin of the organ is motionless and soldered to the tissues that are nearby.
The manifestation of complications of oleogranuloma is possible 7-10 years after substances or objects were introduced. For example, experts call paraphimosis. In the same list are ulcerative defects. Subcutaneous fistulas are no exception. Some come to necrosis of the skin or gangrene of the penis. If the process affects the scrotum, pubis or perineum, oleogranuloma of the external genitalia is triggered.
At the earliest stages of the disease, granuloma is detected in the form of a small but dense formation on the penis.
On palpation she does not cause pain, so patients may not pay attention to it. However, then the granuloma rapidly increases in size, interfering with a normal erection and ejaculation. At the site of granuloma formation, the outflow of blood and lymph is disturbed, therefore some areas of the penis may undergo necrotic changes.
Diagnosis options for penile oleogranuloma
As a rule, diagnosing the problem is not difficult at the first examination. A urologist or andrologist is based on the complaints of a man, taking into account the anamnesis. Thus, it is possible to understand that in the past there was a fact of independent “improvement” of the parameters of the member, and also the connection of these actions with the symptoms is established. During the examination and palpation, the specialist learns about knotty seals. Cicatricial changes (if any) will be clearly visible.
To understand the state of cavernous tissue, as well as what is the blood supply, ultrasound and ultrasound of the vessels of the penis are performed. Since the problem under consideration is similar to a hard chancre and is sometimes combined with it, it is important to exclude syphilis with other STDs. Here to help doctors IFA, PCR, RIF (laboratory diagnostics). If there are still doubts about the origin of the nodes (for example, if a man refuses to admit that he injected certain substances into the penis), you can do a biopsy and further examine the resulting biopsy for cancer.
Treatment options for penile oleogranulomas
To restore the normal condition of the penis, conservative therapy is not used, since in this case it does not give an effect. Unless in preparation for surgery, antibiotics are used to stop inflammation. Sometimes use baths with special antiseptic solutions or dressings with ointments. Physiotherapy is recommended for some. Radically cope with oleogranuloma of the genital organ is only capable of surgery. The intervention of the surgeon in terms of volume and type depends on the severity of the pathological process and the presence of complications.
Circular excision of the foreskin is considered a gentle method. Circumcisio is appropriate when the lesions are small and have not spread beyond the foreskin. Remove limited seals on the penis itself by a one-step operation, if it is possible to simultaneously close the skin defect with local tissues. If it is impossible to replace the latter with local skin, use skin flaps on the vascular pedicle. Well, if the lesions are extensive, you can not do without a two-stage operation of Reich-Sapozhkov.
During the first stage, the member's integumentary tissues are removed to immerse it under the skin of the anterior surface of the scrotum. The head is withdrawn in this case. After a few months, they begin the second stage, that is, the penis is separated from the scrotum and its plastic is performed (local tissues are used). In the future, falloprosthetics may be performed to eliminate impotence. In especially difficult cases, when it comes to gangrene, the organ is amputated.
Experts emphasize that oleogranuloma is a purely self-mutilating crippling procedure that provokes sexual problems in 100% of men. That is, a person runs the risk of encountering erectile impotence and, as a result, psychological difficulties. Do not forget about the complications of manipulation.
All this to the fact that you don’t need to try to make your dick bigger or thicker yourself, wielding means not intended for this purpose. This is at least unacceptable and at most dangerous. Plastic correction of an organ of any kind is carried out only in a medical institution by a qualified doctor. And as preventive measures, it is recommended to correctly educate sexually with benefits for sex education.
The main difficulty that arises during the diagnosis of penile oleogranuloma is the differential diagnosis of the disease with a hard chancre formed during syphilis. To completely exclude syphilis, urologists conduct a Wasserman reaction on blood taken from a patient's vein.
After syphilis is excluded, it is necessary to accurately confirm that the man develops oleogranuloma. For this, the doctor studies the patient’s history in detail, however after such "home" plastic surgery, patients prefer to hide the fact of the introduction of oily ointments. Doctors try to find out about this with questions about the army or prison, where such injections are especially popular.
In order to make the diagnosis as accurate as possible, some experts take a biopsy of several damaged areas at once, since the collection of material from one part of the penis may not be informative.
After an accurate diagnosis, specialists refer the patient to an ultrasound examination.aimed at identifying the boundaries of the neoplasm before surgery.
Penile oleogranuloma - the growth of granulation tissue in the subcutaneous layers of the penis due to the patient’s self-injection 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 developed in response to the presence under the skin of the penis of any foreign object or substance (gel, balls, rods, etc.) that are introduced there by the patient himself or another unqualified person .
Typically, penile oleogranuloma is diagnosed in men aged 20 to 55 years, however, the vast 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 region and is extremely dangerous for its immediate and distant complications.
Unfortunately, this disease can be completely cured only with the help of a surgeon. For these purposes, urologists use the Sapozhkov-Reich operation. Usually it is carried out in two difficult stages. At the first, the doctor makes an excision of all tissues of the penis, which began their pathological change. Often, patients get an appointment with a doctor with already irreversible necrotic changes in the penis, so it is very important to remove absolutely all damaged tissue so that in the future not to treat a man for new unpleasant symptoms.
After this, the penis in a naked state is completely immersed under the skin of the pubis or scrotum. To carry out this manipulation, the urologist makes a special move under the skin, where the penis is carefully inserted, and its head goes into another small incision. This completes the first stage of the surgical procedure.
Antibiotics prescribed for men to prevent infection. Usually, ceftriaxone and ampicillin are used, which can be purchased without a prescription in any city pharmacy.
Features of oleogranuloma
Disease characterized by abnormal growth of granulation tissue due to improper administration of hazardous chemicals and foreign substances. Most often, the disease is recorded in representatives of the stronger sex aged 20 to 55 years. In a desire to enlarge the penis and prolong the sexual intercourse, men also introduce rods, balls and other objects into the organ.
Such a procedure is very dangerous and has a rather high risk. There are several phases of the course of oleogranuloma:
- productive, at this time, severe inflammation occurs, characterized by the growth of granulation tissue around the injection site,
- during cystic phase significantly reduced blood supply to the organ and tissues, their ischemia is observed,
- on the the same phase in the second part ulcers, trophic changes appear, cysts come out and form fistulas,
- on the last stage dystrophy of the connective tissue develops, complete impotence.
According to the extent of damage to the oleogranuloma, there can be several degrees:
- 1 degreein which no more than a third of the penis is affected,
- 2 degreein which the entire skin of the organ or its most part is affected,
- 3 degree, the disease already affects the scrotum, perineum and pubic region.
In the pathogenesis of penile oleogranulomas, 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 administration of foreign substances in the tissues of the penis, reactive inflammation develops, granulation tissue grows around the inflammatory infiltrate. The deterioration of the blood supply to the affected area is accompanied by tissue ischemia and trophic disorders, the appearance of ulcerative defects on the surface of the skin. In the thickness of the altered tissues, cysts form, which, when suppurated, open on the surface of the skin with the formation of long-healing fistulas. A few years later, the phase of hyalinosis begins, characterized by disorganization (dystrophy) of the connective tissue. Further disturbances in microcirculation and lymph drainage in the surrounding tissues lead to a cyclic repetition of pathological reactions, the infiltrative spread of penile oleogranuloma and the progressive nature of the course of the granulomatous process.
According to the extent of distribution of granulomatous lesions, 3 degrees of penile oleogranuloma are distinguished:
- I degree - oleogranuloma is localized at the injection site and affects no more than 1/3 of the trunk of the penis
- II degree - oleogranuloma affects most or all of the skin of the penis
- III degree - oleogranuloma spreads to the skin of the scrotum, perineum or pubic region.
In the clinical course of penile oleogranulomas, an uncomplicated stage (granulomatous infiltrate) and a complicated stage (cicatricial deformity, purulent-necrotic changes, etc.) are distinguished.
Rehabilitation after surgery
Sickwho underwent such surgical interventions, it is necessary to behave correctly during the rehabilitation periodto avoid new troubles. Usually, after surgery, patients suffer from erectile dysfunctiontherefore they should attend psychotherapy courses with professionals. Unfortunately, this method of recovery does not always help patients, since they are by nature usually antisocial and do not perceive conversations with psychotherapists.
Patients may not like this, as excess hair brings hygienic and aesthetic inconveniences. That is why patients are advised to sign up for a course of laser hair removal.
Most often patients with oleogranuloma complain of ulcerative skin defects occurring on the penis. They grow rapidly due to poor blood supply to this area of the skin. Moreover, such ulcers do not heal well, forming large scars that have an irregular shape. Such scars easily deform the penis, bringing aesthetic inconvenience to a man.
Also severe penile curvature may occur. This may be due to the active growth of granulation tissue. If in this case the patient does not quickly make an appointment with a urologist, then he may be at risk of dying of the cavernous those of the penis. This process is completely irreversible, therefore, even after the operation, the member remains curved.
Oleogranulomas can be prevented very simply - it’s enough not to make “home” injections of oily substances in the penis. Such problems never arise in men who live normal lives, so this is more true for the military and prisoners. Among them should be conducted educational conversations that will help men to find out what harm this simple procedure can cause.
Methods for diagnosing the disease
In most cases, the urologist or andrologist can make an accurate diagnosis to the patient at the first visit. To do this, it is enough for him to interview the patient about whether he had previously been injected with any chemical or other substance under the epidermis of the penis.
After an oral examination, be sure to the penis is examined and palpated. With such a diagnosis, small nodules of a dense nature are felt under the skin, there may be cicatricial changes in the organ.
After visiting the office of the andrologist or urologist, it is mandatory check the state of cavernous tissues and blood circulation in the penis. For this, an ultrasound examination and an ultrasound scan of the vascular system of the organ are prescribed.
It is mandatory to exclude the presence of infections of any nature. For this, the patient is recommended to pass analyzes like ELISA, PCR, RIF. If the patient denies the possibility of introducing any chemical substances in the past, a tissue biopsy is prescribed to exclude cancer.
It should immediately be noted that the prognosis for the future life of such patients is quite favorable. In medical practice, not a single case of oleogranuloma is known that could have been fatal.
At the same time, a man who has undergone surgery can work at any job, since this disease is not considered an excuse for transferring a person to the status of a disabled person.
Unfortunately, the prognosis for recovery is only relatively favorable. Doctors can help get rid of the granulomas themselves, but it’s very difficult and almost impossible to return to normal sex later. Most often, an erection is restored in patients, but the usual sexual intercourse does not bring its former pleasure, which affects the quality of life.
Find out how phimosis can be treated without surgery and to what extent it can be done.
Click here and go to the article that details hypertrophic phimosis.
Pathogenesis of penile oleogranuloma
The pathogenetic changes that occur with the introduction of various oil solutions / substances into the tissues of the penis are based on several pathogenetic phases:
- productive phase (proliferation),
- cystic phase
- hyalinosis phase
- lymphatic edema phase
- phase of formation of new peripheral granulomatous lesions.
After the introduction of a foreign substance, a significant violation of microcirculation and lymphatic outflow occurs, which subsequently triggers the process of sequential cellular and tissue reactions. The outcome of pathological changes is the development of foci of hyalinosis - deposition of translucent dense masses of hyaline resembling cartilage occurs in the tissues. All pathological reactions are cyclically repeated, and disturbances in microcirculation and lymph outflow affect not only the affected area, but also the surrounding tissues. Thus, the mechanism of an autonomous self-sustaining granulomatous process is launched.
Pathomorphological changes that occur after injection of oil substances under the skin of the penis are also characterized by the presence of acute purulent inflammation, followed by a typical granulomatous reaction.
In the future, the described lesion is replaced by fibrous inflammatory tissue.
The period between the initial injection and the onset of clinical symptoms lasts from 2 days to 37 years. In most cases, the disorder is limited to damage to the penis without involving surrounding organs. Often, a limited lesion is accompanied by regional lymphadenitis.
In remote oleogranulomas, many inflammatory cells are often present, including giant cells, neutrophils, lymphocytes, and macrophages.
Oleogranulomas are practically not terrible for educated people. They pose the greatest danger to prisoners and men serving in the army. To reduce the number of cases of such a disease, it is necessary to conduct educational work among all military personnel, prisoners and children living in problem families. It is in adolescence that a person wants to try absolutely everything.
This treatment for oleogranuloma makes sense only at the stage of preparation for the operation and after it. With the help of medications, you can slightly reduce the inflammatory process, remove the activity of bacteria and viruses. For this, a man is prescribed antibacterial drugs that are taken orally or in place.
For local use, dressings or compresses with an antiseptic and antibiotic are prescribed, for example, Baneocin, Tetracycline, Levomekol other. They are applied with sterile bandages. As an oral antibiotic, drugs of the broad spectrum group are used: Erythromycin, Ampicillin, Azithromycin.
When using a compress, it is important to change it every day or several times a day, if the condition of the patient requires it. Bacteria can accumulate under the bandage, which can lead to a significant deterioration.
For severe pain, painkillers of the type prescribed No-Shpy, Miga, Nurofen. The temperature during inflammation is removed with traditional medicines Paracetamol or Ibuprofen, they also increase the effect of painkillers.
Surgical intervention is the only way to save the patient’s life and prevent the spread of necrosis to other organs and tissues.
The most gentle way is an operation in which the attending physician performs excision of the foreskin in a circle. Such manipulations can be done only with small locations of ole granulomas and only when it is in the skin of the foreskin.
With a limited type of oleogranuloma, which is localized on the stem of the penis, it is removed using a single-stage surgical intervention. During the manipulation, the doctor cuts out the neoplasm and closes the focus of the pathology with the patient's tissues. If local tissue cannot be taken, skin flaps on the vascular pedicle should be used. In each case, the doctor decides on the transplant individually.
If the lesion is already extensive, only two-stage can help the patient Reich-Salozhkov operation. It provides for the initial removal of affected penile tissue. At the same stage, the penis is immersed under the skin of the anterior region of the scrotum and the head is brought out.
Only after a few months, taking into account the speed of recovery of the patient, during the second part of the surgical intervention, the doctor performs penile plastic surgery. In many cases, after such manipulations, the patient needs to undergo prosthetics, which can help restore his erectile function.
In those situations when a man’s condition is complicated by gangrene, complete organ amputation is performed. In this case, the doctor may need to remove other organs of the reproductive and reproductive system. In such a situation, the restoration of erectile function is impossible.
Video: "Operation Reich (18+)"
Complications of penile oleogranuloma
With a long course, the pathological process can spread to the pubis, scrotum or perineum with the formation of oleogranulomas of the external genitalia. The rate of progression of the pathological process depends on the general condition of the patient’s body, the type of injected oil substance, as well as the hygienic conditions of the manipulation.
The progression of the disease and the varying degree of violations of the lymph and blood circulation of the skin-fascial flap trigger the mechanism of development of a large number of serious complications:
- ulcerative defects
- subcutaneous fistula
- penile skin necrosis (11%)
Injection of mineral oils is sometimes associated with squamous cell carcinomas.
32% of men surveyed with experience in managing various oil substances noted the presence of erectile dysfunction of varying severity, and 15.5% complained of pain during erection.
Diet for oleogranuloma
There is no special diet for this disease. A man is simply recommended to maximize his nutrition by including vegetables, white meat, fruits. This will support the body at the preoperative and postoperative stage. Alcoholic drinks, cigarettes and physical activity are excluded without fail. Alternative methods of therapy for oleogranuloma are not used, since the patient's condition can be sharply worsened.
Nutrition and lifestyle features
Patients need to adhere to a special regimen after the first stage of surgery, in order to approach the second stage of treatment in an optimal state. To do this, it is necessary to conduct a toilet of the external genital organs after each act of urination, as well as regularly change the bandages. If purulent processes begin in the area of the postoperative wound, then for their resolution it is necessary to use a left-ointment ointment, which contributes to the discharge of pus and the speedy formation of granulations.
In cases where plastic of the penis is performed under the skin of the pubis, the act of urination becomes extremely uncomfortable, since the stream of urine is directed upwards. In such situations, patients in the postoperative period are recommended to have a urethral catheter, up to the second stage of surgical treatment.
Rehabilitation after an illness
As a rule, all patients who underwent two stages of a complex operation suffer from erectile dysfunction. Therefore, they are recommended courses of psychotherapy by professional psychologists before the second stage. As practice shows, carrying out such rehabilitation is not always effective, since patients with oleogranuloma in most cases are asocial or immoral citizens.
The second direction in the rehabilitation of patients with oligranuloma is the epilation of the skin of the penis. Since the plastic of the penis is performed by the skin of the scrotum or pubis, where hair growth is actively occurring, after the second stage of Sapozhkov’s surgery, hair growth continues on the penile shaft. This brings great aesthetic and hygienic disadvantages. After regular shaving, hair growth is activated even more, so patients are advised to undergo laser hair removal, after which bristles do not form.