Complications of penile augmentation: A narrative review of injectables, implants, and surgical grafts

Penile augmentation procedures are controversial, primarily because most men seeking these interventions have penile dimensions within the normal range, and due to the associated risks of severe complications. This narrative review explores the effects of foreign body implantations and injections in the penis. Retrospective case series reveal the use of unapproved oil-based substances injected in non-sterile conditions, leading to sclerosing lipogranuloma and requiring complex treatments such as tissue excision and skin transplantation. The prevalence of this practice is unknown. Retrospective reports of foreign body implantation for enhancing sexual pleasure highlight complications such as pain, erosion, inflammation, nodules, skin ulcer, necrosis, penile deformity, gangrene and even death. In contrast, prospective studies on Hyaluronic acid filler injections show that these are better tolerated, however the follow-up period is short. Retrospective series of graft implantation reported improvement in penile girth and patient satisfaction; however, it had a negative impact on penile length. Silicone implants, examined in prospective cohorts carry risks of infection, erosion, seroma and necrosis, resulting in some cases of severe penile deformities and are associated with a removal rate of up to 10%. A multidisciplinary approach is essential for men requesting penile augmentation, and further research is needed to successfully manage patients seeking these procedures.