Do you recommend hospital admission for penile paraffinoma?

Hospital Admission for Penile Paraffinoma

Hospital admission is strongly recommended for penile paraffinoma requiring surgical excision and reconstruction, which represents definitive management for this condition. 1, 2, 3

Clinical Context and Presentation

Penile paraffinoma results from subcutaneous injection of liquid paraffin or similar substances (mineral oils, Vaseline) for illicit penile augmentation, causing chronic granulomatous inflammatory reactions. 1, 3 Patients typically present with:

• Pain and penile swelling (most common presenting symptom) 1
• Ulceration and fistula formation requiring wound care 1, 2
• Penile deformity affecting both function and appearance 1, 3
• Sexual dysfunction including painful erections and inability to achieve satisfactory intercourse 3, 4

The mean age at presentation is 36 years, with liquid paraffin being the injected material in 80.6% of cases. 1

Indications for Admission

Admit patients with penile paraffinoma when:

• Surgical excision is planned (the definitive treatment for this condition) 1, 2, 3
• Active ulceration or fistulae are present requiring inpatient wound management 1, 2
• Significant pain or infection necessitates IV antibiotics and monitoring 2, 3
• Complex reconstruction is anticipated requiring plastic surgery involvement 1, 4

Surgical Management Approach

The treatment of choice is radical excision of all affected tissue with immediate or staged reconstruction. 1, 3 This typically requires:

• Complete removal of skin and subcutaneous tissue infiltrated by foreign material 3, 4
• Early involvement of plastic surgeons for reconstruction planning 1
• Reconstruction options include:
  • Split-thickness or full-thickness skin grafting 1, 5
  • Bilateral scrotal flap coverage (particularly effective for extensive defects) 4
  • Prepuce grafting 1
  • Spiral stitch full-thickness skin graft technique 5

The majority of reported cases required surgical excision followed by reconstruction, with mean follow-up of 15.8 months showing successful functional and aesthetic outcomes. 1

Important Clinical Pitfalls

Complete removal may not always be possible when foreign material has infiltrated the corpus cavernosum or corpus spongiosum, potentially leaving permanent granulomas that preclude simple skin graft coverage. 4 In such cases, vascularized flap coverage (bilateral scrotal flaps) provides more reliable results than skin grafting alone. 4

Conservative management has unclear long-term outcomes and should generally be avoided. 1 While intralesional or systemic steroids have been attempted for primary sclerosing lipogranuloma, radical excision with reconstruction remains the definitive approach. 3

Outpatient Management Considerations

Conservative outpatient management may be considered only in highly selected cases with:

• Minimal symptoms
• No ulceration or infection
• Patient refusal of surgery
• However, long-term outcomes with conservative management remain unclear 1

Postoperative Outcomes

When properly managed with surgical excision and reconstruction, patients achieve:

• Good aesthetic results without hypertrophic scarring or penile shortening 5
• Normal erectile function and sexual satisfaction at one-year follow-up 5
• Preserved urinary function 2
• Resolution of pain and deformity 2, 3