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Non-Autologous Penile Injectables — Paraffin, Mineral Oil, Vaseline, Liquid Silicone, PMMA

Non-autologous penile injectables — including liquid silicone (industrial), paraffin / mineral oil, Vaseline (petroleum jelly), and polymethylmethacrylate (PMMA) — represent a spectrum of substances injected subcutaneously into the penile shaft for girth augmentation. The oil-based substances (paraffin, mineral oil, Vaseline) and industrial liquid silicone are universally condemned because of devastating complications including sclerosing lipogranuloma (paraffinoma / siliconoma), necrosis, and penile destruction. PMMA occupies a more controversial position — one large series reports favorable short-term outcomes — but lack of FDA approval for penile use, irreversibility, and concerns about long-term capsular contracture mean PMMA is also not recommended in WARWIKI's framework.[1][2][3]

For the broader male cosmetic-genital-surgery decision framework see the Male Cosmetic Genital Surgery atlas page. For the foundations biomaterial profile of injected liquid silicone see Free Silicone Injection. For the operative atlas of the reconstructions these injections drive, see Penile Skin / Shaft Reconstruction (04e).

Do not offer or perform these injections

Reconstructive urologists and urogynecologists encounter the complications of these injections far more often than they encounter the original procedure. The injections themselves are performed almost exclusively by non-medical personnel, lay practitioners, the patient himself, or in incarcerated settings. Counseling messaging is uniform: oil-based and industrial-silicone injections are contraindicated; PMMA penile injection is off-label and not recommended despite favorable single-practitioner short-term data.[1][2][3]

I. Historical Context and Epidemiology​

The practice of injecting foreign materials into the penis for augmentation has been documented for over 1,500 years. In modern times the practice persists primarily in specific populations and geographic regions.[1][2][4][5][6]

  • Southeast Asia — particularly Thailand, Myanmar, Laos, Vietnam, the Philippines (mineral oil / Vaseline injection widespread among migrant workers and military personnel).
  • Central / Eastern Asia — Kazakhstan, Korea, parts of Russia.
  • Eastern Europe — Bulgaria, Romania, Hungary.
  • Immigrant communities — Laotian, Thai, and Southeast Asian immigrants in Western countries.
  • Incarcerated populations — prison settings worldwide; injections performed with improvised materials.

The largest published series — Svensøy 2018 — documented 680 patients presenting with complications from penile mineral-oil self-injection at a single Thailand–Myanmar border clinic in just 5 years; the true prevalence is far greater than case reports indicate.[4]

Demographics (Pang 2024 SR, 68 studies)[1]​

  • Mean age at presentation 36.9 years (range 17–68).
  • Mean time between injection and presentation 7.8 years (range 1 day – 20 years), with some presentations as late as 30 years after injection.
  • Most common injection site — penile shaft (94.3%); also scrotum, prepuce, glans.
  • Most injections are self-administered or performed by non-medical personnel (lay practitioners, traditional healers, fellow inmates).

II. Substances Used​

A. Paraffin / mineral oil / Vaseline (petroleum jelly)​

Most commonly injected substance worldwide — 47.7% of all cases in the Pang 2024 SR.[1]

  • Liquid paraffin (mineral oil) — saturated hydrocarbons (C24–C40) derived from petroleum distillation.[7]
  • Vaseline (petroleum jelly) — semi-solid hydrocarbons, often heated to liquid form before injection; the most common substance in Central Asian series (88.9% in the Kazakhstan series).[8]
  • "Super Extenze" — a mineral-oil compound with tocopherol acetate (vitamin E) marketed in the US; identified by mass spectroscopy in a series of Laotian immigrants.[5]
  • Baby oil, cooking oil, cod-liver oil also reported.[6]

All oil-based substances produce the same pathological response: sclerosing lipogranuloma (paraffinoma / oleogranuloma).[1][9]

B. Liquid silicone (industrial-grade)​

Second most commonly injected substance — 15.8% of cases in the SR; 45.7% in a UK single-center series.[1]

  • Industrial-grade liquid silicone (polydimethylsiloxane) — NOT medical-grade silicone.
  • Often obtained from hardware stores, automotive suppliers, or industrial sources.
  • Injected by non-medical practitioners or self-administered.
  • Produces a foreign-body granulomatous reaction distinct from paraffinoma — termed siliconoma.
  • Unlike medical-grade silicone (used in breast implants within a shell), free liquid silicone injected into tissues cannot be fully removed and migrates along tissue planes.[1][2]

This is a fundamentally different category from the FDA-cleared cured-elastomer silicone-sleeve devices (Penuma / Himplant) — see Penuma & Himplant for that contrast.

C. Polymethylmethacrylate (PMMA)​

PMMA occupies a unique position as the only substance in this group with quasi-medical use and published prospective data.[3][10]

  • Metacrill — a suspension of PMMA microspheres (30–50 µm diameter) in carboxymethyl-cellulose carrier gel; used primarily in Latin America.
  • Lipen-10 — a cross-linked dextran + PMMA mixture developed in South Korea.
  • Bellafill (ArteFill) — FDA-approved for nasolabial folds and acne scars (NOT for penile use); contains PMMA microspheres in bovine collagen.
  • PMMA is permanent and non-resorbable — microspheres become encapsulated by fibrous tissue, creating a permanent volumizing effect.
  • Not FDA-approved for penile injection — all penile use is off-label or with non-FDA-approved formulations.[3]

D. Other substances (less common)​

  • Polyacrylamide hydrogel (PAAG) — Eastern European and Asian series.
  • Cod-liver oil, sesame oil, olive oil — isolated case reports.
  • Metallic mercury — extremely rare; reported in psychiatric patients.

III. Pathophysiology — The Foreign-Body Granulomatous Response​

All non-autologous injectable substances trigger a chronic foreign-body granulomatous reaction; the specific histopathology varies by substance.[7][9][11][12]

A. Sclerosing lipogranuloma (paraffinoma / oleogranuloma) — oil-based substances​

First described by Gruber 1950 and redefined by Oertel & Johnson 1977 as "a local reactive process following injection of exogenous lipids into the subcutaneous tissues."[9]

Histopathological features.[7][9][13]

  • "Swiss cheese" pattern — multiple variably sized round-to-oval vacuoles (lipid spaces) within a dense fibrous stroma, giving the tissue a sponge-like appearance.
  • Multinucleated foreign-body giant cells surrounding and engulfing lipid vacuoles.
  • Dense fibrosis and sclerosis — progressive replacement of normal subcutaneous tissue with dense collagenous scar.
  • Chronic inflammatory infiltrate — lymphocytes, histiocytes, plasma cells.
  • No birefringence under polarized light (distinguishing from crystalline foreign bodies).
  • Infrared absorption spectrophotometry confirms paraffin hydrocarbons in 21/23 cases in the Oertel series.[9]
  • Field-desorption mass spectrometry identifies saturated hydrocarbons (C24–C40), confirming exogenous origin.[7]

Differential diagnosis on histology — adenomatoid tumor, sclerosing liposarcoma, lymphangioma.[9]

Pathological progression.[1][4][8][11]

  1. Acute phase (days–weeks) — local inflammation, edema, erythema.
  2. Subacute phase (weeks–months) — granuloma formation, induration, nodularity.
  3. Chronic phase (months–years) — progressive fibrosis, skin ulceration, fistula formation, tissue necrosis.
  4. Late complications (years–decades) — penile deformity, buried penis, urethral obstruction, erectile dysfunction, lymphedema, autoamputation.

B. Siliconoma — liquid silicone​

  • Foreign-body giant cell reaction with silicone droplets visible as clear vacuoles.
  • Fibrotic encapsulation of silicone deposits.
  • Migration along tissue planes — silicone can migrate to the scrotum, perineum, inguinal lymph nodes, and beyond.[1][14]
  • More difficult to excise completely than paraffinoma due to diffuse tissue infiltration.

C. PMMA granuloma​

  • Individual microsphere encapsulation — each PMMA microsphere becomes surrounded by a thin fibrous capsule.[12]
  • Capsular contracture — when capsules are close together they form concentric capsular groups, leading to tissue hardening and clinical nodulation.[12]
  • Late-phase complications include nodule formation, extrusion of filler material, and local tissue hardening.[12]
  • The pathological process differs from oil-based granulomas in that PMMA microspheres maintain their spherical shape and do not dissolve or migrate as readily.

IV. Clinical Presentation​

A. Presenting symptoms (Pang 2024 SR)[1]​

SymptomIncidence
Pain, swelling, or penile deformity77.9% of all literature patients
Cosmetic dissatisfaction57.1% (single-center series)
Pain and / or swelling45.7%
Penile necrosis8.6% (single-center); up to 72.2% (Kazakhstan Vaseline series[8])
Purulent secretion21.8% (680-patient Thai series[4])
Ulceration12.8%[4]
Induration42.9%[4]
Erectile dysfunctionVariable; reported in multiple series[15][16]
Voiding difficulty / urethral obstructionWhen granuloma compresses the urethra[15][16]
PhimosisWhen prepuce involved[16]
LymphedemaChronic penile and scrotal lymphedema from lymphatic obstruction[1]

B. Time course​

The latency between injection and clinical presentation is highly variable.[1][4][6][16]

  • Acute presentations (days–weeks) — pain, swelling, infection, necrosis.
  • Delayed presentations (months–years) — progressive induration, deformity, cosmetic dissatisfaction.
  • Mean time to presentation — 7.8 years (Pang); 10.8 years (Kazakhstan series); 36.7 months (Thai series).
  • Presentations as late as 20–30 years after injection have been documented.

V. Imaging​

A. Ultrasound[11][15][17]​

  • Heterogeneous echogenicity of the subcutaneous tissue.
  • Hyperechoic foci with posterior acoustic shadowing — characteristic of calcified granulomatous deposits.
  • Color Doppler — may show hypervascularity in acute inflammation or avascularity in necrotic areas.
  • Useful for initial assessment and guiding surgical planning.
  • Limitations — operator-dependent; may not fully delineate the extent of disease.

B. MRI[11][18][19][20][21][22]​

  • T1-weighted — heterogeneous signal; oil-based substances may show intermediate-to-high signal (lipid content).
  • T2-weighted — heterogeneous, often with areas of low signal (fibrosis) and high signal (inflammation / edema).
  • Post-contrast — enhancement of granulomatous tissue and surrounding inflammation.
  • Key role — delineating the extent of tissue involvement, differentiating granuloma from malignancy, and surgical planning.
  • Paraffinoma can mimic liposarcoma on imaging — clinical history of injection is critical for correct diagnosis.[22]
  • Small round components hypointense on all sequences may be seen.[22]

C. Ascending urethrography[11]​

  • Indicated when urethral involvement is suspected.
  • May demonstrate urethral compression, stricture, or fistula.

VI. Complications — Comprehensive List​

Complications range from cosmetic dissatisfaction to life-threatening emergencies.[1][2][4][8]

Local.

  • Penile deformity — irregular nodularity, asymmetry, grotesque enlargement.
  • Penile pain — 84% in the 680-patient series.[4]
  • Penile swelling / induration — 82.5%.[4]
  • Skin ulceration — 12.8%.[4]
  • Purulent discharge / infection — 21.8%.[4]
  • Penile necrosis — 8.6–72.2% depending on series.[1][8]
  • Erectile dysfunction — from fibrosis encasing the corpora cavernosa.
  • Urethral obstruction — from circumferential granuloma compressing the urethra.
  • Phimosis — when prepuce involved.
  • Fistula formation — urethrocutaneous or cutaneous.

Regional.

  • Scrotal involvement — migration of injected material to the scrotum.
  • Perineal extension — granuloma extending to the perineum.
  • Inguinal lymphadenopathy — granulomatous involvement of regional lymph nodes.[5]
  • Penile / scrotal lymphedema — chronic lymphatic obstruction.

Catastrophic.

  • Penile autoamputation — 2 cases reported in the SR.[1]
  • Gangrene — requiring emergency debridement.[2]
  • Fournier's gangrene — necrotizing fasciitis extending from infected injection sites.
  • Sepsis and death — reported in the literature.[2]

VII. PMMA — The Controversial Exception​

PMMA stands apart from oil-based substances because it has been used in a controlled medical setting with published prospective data, though significant concerns remain.[3][10][12]

Casavantes & Lemperle 2016 (n = 752)[3]​

  • The largest published series of penile PMMA injection.
  • Product — Metacrill (PMMA microspheres in carboxymethyl-cellulose), injected subcutaneously.
  • 1–3 injection sessions.
  • Mean girth increase 3.5 cm (134%) — 10.2 → 13.7 cm.
  • Mean length increase 0.7 cm — attributed to the weight / stretching force of the implant.
  • Overall satisfaction 8.7/10.
  • ~ 50% perceived some irregularities (not clinically problematic).
  • Complications requiring surgery 0.4% (3 patients with PMMA nodules requiring excision, all in uncircumcised men).
  • Authors' verdict — PMMA is "a natural, safe, and permanently effective method."

Lipen-10 (PMMA + cross-linked dextran) — Yang 2013 (n = 20)[10]​

  • Girth increase 3.7–4.2 cm (50–59%) at 6 months.
  • Length increase 2.3 cm (63%).
  • Complications — 1 mild asymmetry, 1 small nodule (5 mm).
  • No serious adverse events.

Critical concerns about PMMA[2][12][23]​

  • Permanence is a double-edged sword — PMMA cannot be dissolved or easily removed if complications arise, unlike hyaluronic acid (dissolved with hyaluronidase).
  • Capsular contracture — progressive fibrotic encapsulation of PMMA microspheres can cause tissue hardening, nodulation, and eventual extrusion.[12]
  • Late complications may take years to manifest — Casavantes had limited long-term follow-up.
  • Not FDA-approved for penile use — Metacrill is not FDA-approved at all; Bellafill is FDA-approved only for nasolabial folds and acne scars.[3]
  • Non-standardized products — many PMMA formulations used internationally lack regulatory oversight.
  • Bias concerns — the Casavantes series was conducted by the developer / practitioner of the technique, with only 203/729 (27.8%) patients completing questionnaires.
  • The Ramazan 2026 narrative review classified oil-based injectables as causing "sclerosing lipogranuloma requiring complex treatments" and noted that even regulated injectables carry risks.[2]

VIII. Surgical Management of Complications​

For the dedicated atlas page covering operative steps, six reconstructive options, single- vs two-stage scrotal-flap selection, NPWT-assisted STSG protocol, and outcomes by series, see Paraffinoma Excision and Penile Resurfacing.

A. Principles[1][8][24][25][26][27]​

  • Complete excision of all grossly affected tissue is the treatment of choice.
  • Incomplete excision leads to recurrence.[16]
  • Reconstruction of the denuded penile shaft is required after excision.
  • A multidisciplinary approach (urology + plastic surgery) is often necessary.[26]

B. Surgical techniques​

Per the Pang 2024 SR and multiple case series.[1][8][24][25][26][27]

  1. Local excision with primary closure — for limited disease; the most common procedure (59.4% in Pang; 50% in the Kazakhstan series). Feasible when sufficient uninvolved penile skin remains. Circumcision may be performed concurrently (15.6%).
  2. Excision with split-thickness skin graft (STSG) — for extensive disease where primary closure is not possible. Kang 2026 described a simplified protocol using NPWT + dermal substitute (Matriderm) + STSG, achieving 90.9% near-complete graft take and median satisfaction 37/45 in 11 patients.[25]
  3. Excision with full-thickness skin graft (FTSG) — better cosmetic outcome than STSG; requires more donor tissue.[15][27]
  4. Scrotal-skin flap reconstruction — the most commonly used flap technique:[8][24][27]
    • Bipedicle scrotal-skin flap (Murányi 2022, n = 49) — denuded penis pulled through a subcutaneous tunnel created between a scrotal incision and proximal penile incision; 90% success rate; overall complication rate 26.5%; all patients reported sexual-intercourse ability.[24]
    • Two-stage scrotal-skin flap — Stage 1: excision and burial of denuded penis in scrotal skin; Stage 2: release of penis from scrotum after skin maturation.
  5. Medial prepuce-suprapubic advancement flap — for cases with intact prepuce and suprapubic skin.[27]
  6. Penile amputation — 2 cases reported in the SR; the most extreme outcome.[1]

C. Outcomes of surgical reconstruction​

StudynTechniqueGraft / flap takeErectile functionComplications
Murányi 2022[24]49Bipedicle scrotal flap90% successED in 2 (6.7%)26.5% overall (Clavien 1–3b)
Kang 2026[25]11NPWT + Matriderm + STSG90.9% near-completeNot reportedPartial graft loss 9.1%
Marín-Martínez 2023[26]8Single / two-stage (algorithm)Successful in allPreserved in allVariable
Napolitano 2023 (SR)[27]152Multiple techniquesVariableVariableFistula, stricture, dehiscence
Suleiman 2024[8]18Excision ± scrotal flap100%Not reportedNecrosis 72.2% at presentation
Svensøy 2018[4]680Excision (74.6% surgical)Not reportedNot reported75% required surgery

D. Repeat procedures​

A striking feature of surgical management is the high rate of repeat operations.[1]

  • Pang 2024 single-center series — 18/35 (51.4%) required > 1 procedure.
  • 8/35 (22.9%) required 3 or more procedures.
  • Reflects the difficulty of achieving complete excision and satisfactory reconstruction in a single operation.

For the operative atlas of these reconstructions see Penile Skin / Shaft Reconstruction (04e).

IX. Comparison of Non-Autologous Injectables​

FeatureParaffin / mineral oil / VaselineLiquid silicone (industrial)PMMA (Metacrill)
Regulatory statusUniversally condemned; no approvalNo approval for injectionNot FDA-approved for penile use
SettingSelf-injection / lay practitionersSelf-injection / lay practitionersMedical office (single-practitioner series)
PermanencePermanent (cannot be removed without surgery)Permanent (cannot be removed)Permanent (cannot be dissolved)
PathologySclerosing lipogranulomaForeign-body granuloma (siliconoma)Capsular encapsulation ± contracture
Girth gainVariable, uncontrolledVariable, uncontrolled3.5 cm (134%) in Casavantes series
Complication rateVery high (75–100% require surgery)Very high0.4% (Casavantes); concerns about underreporting
Necrosis risk8.6–72.2%HighLow (in controlled series)
ReversibilityIrreversible; requires surgical excisionIrreversibleIrreversible; nodules require excision
MigrationYes (along tissue planes)Yes (extensive migration)Minimal (microspheres stay in place)
Malignancy riskCase reports of SCC arising in paraffinomaNot establishedNot established
MortalityReported (sepsis, gangrene)ReportedNot reported

X. Comparison With Approved / Regulated Injectables​

For context, the non-autologous permanent injectables contrast sharply with hyaluronic acid (HA), the most-studied regulated injectable for penile girth.[2][23][28][29][30]

  • HA is biodegradable (resorbed over 12–24 months), reversible (dissolved with hyaluronidase), and has a 4.3% mild complication rate in the largest series (n = 230).[28]
  • HA produces 1.7–3.4 cm girth increase with 75–100% satisfaction.[23][28]
  • The Ramazan 2026 review concluded that HA fillers "are better tolerated" than oil-based substances, though follow-up periods remain short.[2]
  • The only RCT comparing fillers (Yang 2019, HA vs PLA, n = 72) found both safe with comparable efficacy at 48 weeks.[30]

For the canonical HA deep-dive see Hyaluronic Acid Filler. For PLA see Polylactic Acid Filler.

XI. Psychological Considerations​

A recurring theme is persistent body-dysmorphic dissatisfaction even after successful surgical reconstruction.[2][15]

  • Lauria 2026 noted "persistent dissatisfaction with penile size" in their paraffinoma patient despite satisfactory graft take, "highlighting the need for integrated psychological assessment alongside surgical management."[15]
  • Ramazan 2026 emphasized that "most men seeking these interventions have penile dimensions within the normal range" and recommended "a multidisciplinary approach" including psychological evaluation.[2]
  • The practice of self-injection is often driven by small penis syndrome (SPS) — see Small Penis Syndrome / PDD.

XII. Clinical Summary​

Non-autologous penile injectables fall into two distinct categories.

Oil-based substances (paraffin, mineral oil, Vaseline, liquid silicone) are universally condemned and represent a global public-health problem, particularly in Southeast Asia and among immigrant / incarcerated populations. The practice produces sclerosing lipogranuloma with devastating consequences including pain (84%), necrosis (up to 72%), penile deformity, ED, and rarely penile amputation or death.[1][2][4][8] The largest series (680 patients) demonstrates that 75% require surgical intervention, often multiple procedures.[4] Complete excision with penile-skin reconstruction (primary closure, skin grafting, or scrotal flap) is the treatment of choice, ideally in a multidisciplinary urology / plastic-surgery setting.[1][24][26]

PMMA occupies a controversial middle ground — one large series (n = 752) reports favorable short-term outcomes with 134% girth increase and 0.4% complication rate, but concerns about long-term capsular contracture, irreversibility, lack of FDA approval for penile use, and potential reporting bias mean it cannot be recommended.[3][12] The 2021 Romero-Otero BJU Int SR concluded that "the quality of studies on penile-enhancement procedures is still low" and prevents evidence-based recommendations.[31]

All major reviews emphasize that psychological assessment should precede any penile-augmentation procedure, as most men seeking these interventions have normal penile dimensions and may have underlying body-dysmorphic concerns that persist even after successful treatment.[2][15]

See Also​

References​

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2. Ramazan M, Øbro LF, Wiborg MH, et al. Complications of penile augmentation: a narrative review of injectables, implants, and surgical grafts. Int J Impot Res. 2026;38(3):238–246. doi:10.1038/s41443-025-01190-8

3. Casavantes L, Lemperle G, Morales P. Penile girth enhancement with polymethylmethacrylate-based soft-tissue fillers. J Sex Med. 2016;13(9):1414–1422. doi:10.1016/j.jsxm.2016.06.008

4. Svensøy JN, Travers V, Osther PJS. Complications of penile self-injections: investigation of 680 patients with complications following penile self-injections with mineral oil. World J Urol. 2018;36(1):135–143. doi:10.1007/s00345-017-2110-9

5. Manny T, Pettus J, Hemal A, Marks M, Mirzazadeh M. Penile sclerosing lipogranulomas and disfigurement from use of "Super Extenze" among Laotian immigrants. J Sex Med. 2011;8(12):3505–3510. doi:10.1111/j.1743-6109.2010.01980.x

6. Ahmed U, Freeman A, Kirkham A, et al. Self injection of foreign materials into the penis. Ann R Coll Surg Engl. 2017;99(2):e78–e82. doi:10.1308/rcsann.2016.0346

7. Nakamura M, Sakurai T, Yoshida K, et al. Sclerosing lipogranuloma of the penis: chemical analysis of lipid from the lesional tissue. J Urol. 1985;133(6):1046–1048. doi:10.1016/s0022-5347(17)49373-6

8. Suleiman M, Mustafa A, Ainayev Y, et al. The surgical management of penile oleogranuloma: case series. Int J Impot Res. 2024;36(5):509–514. doi:10.1038/s41443-023-00779-1

9. Oertel YC, Johnson FB. Sclerosing lipogranuloma of male genitalia: review of 23 cases. Arch Pathol Lab Med. 1977;101(6):321–326.

10. Yang DY, Lee WK, Kim SC. Tolerability and efficacy of newly developed penile injection of cross-linked dextran and polymethylmethacrylate mixture on penile enhancement: 6 months follow-up. Int J Impot Res. 2013;25(3):99–103. doi:10.1038/ijir.2012.41

11. Abo-Hedibah SA, Badawi AN, Aly SA, Ismail SRM, Elmokadem AH. Penile girth augmentation by injectable fillers: a comprehensive review of imaging features and inflammatory complications. Abdom Radiol. 2021;46(4):1703–1717. doi:10.1007/s00261-020-02788-w

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13. Foucar E, Downing DT, Gerber WL. Sclerosing lipogranuloma of the male genitalia containing vitamin E: a comparison with classical "paraffinoma." J Am Acad Dermatol. 1983;9(1):103–110. doi:10.1016/s0190-9622(83)70114-3

14. Caskey CI, Berg WA, Hamper UM, et al. Imaging spectrum of extracapsular silicone: correlation of US, MR imaging, mammographic, and histopathologic findings. Radiographics. 1999;19(Spec No):S39–S51. doi:10.1148/radiographics.19.suppl_1.g99oc11s39

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16. Cohen JL, Keoleian CM, Krull EA. Penile paraffinoma: self-injection with mineral oil. J Am Acad Dermatol. 2001;45(6 Suppl):S222–S224. doi:10.1067/mjd.2001.103995

17. Bertolotto M, Pavlica P, Serafini G, Quaia E, Zappetti R. Painful penile induration: imaging findings and management. Radiographics. 2009;29(2):477–493. doi:10.1148/rg.292085117

18. Parker RA, Menias CO, Quazi R, et al. MR imaging of the penis and scrotum. Radiographics. 2015;35(4):1033–1050. doi:10.1148/rg.2015140161

19. Rajamohan N, Kapoor H, Khurana A, et al. MR imaging of penile pathology and prostheses. Abdom Radiol. 2025;50(1):305–318. doi:10.1007/s00261-024-04417-2

20. Lindquist CM, Nikolaidis P, Mittal PK, Miller FH. MRI of the penis. Abdom Radiol. 2020;45(7):2001–2017. doi:10.1007/s00261-019-02301-y

21. Kirkham AP, Illing RO, Minhas S, Allen C. MR imaging of nonmalignant penile lesions. Radiographics. 2008;28(3):837–853. doi:10.1148/rg.283075100

22. Wong KT, Lee PS, Chan YL, Chow LT. Paraffinoma in anterior abdominal wall mimicking liposarcoma. Br J Radiol. 2003;76(904):264–267. doi:10.1259/bjr/31110098

23. Manfredi C, Romero Otero J, Djinovic R. Penile girth-enhancement procedures for aesthetic purposes. Int J Impot Res. 2022;34(4):337–342. doi:10.1038/s41443-021-00459-y

24. Murányi M, Varga D, Kiss Z, Flaskó T. A new modified bipedicle scrotal-skin flap technique for the reconstruction of penile skin in patients with paraffin-induced sclerosing lipogranuloma of the penis. J Urol. 2022;208(1):171–178. doi:10.1097/JU.0000000000002480

25. Kang D, Hong SE, Kim YH. Single-stage penile resurfacing for foreign-body granuloma: a simplified negative-pressure-wound-therapy-assisted protocol with dermal substitute. Urology. 2026. doi:10.1016/j.urology.2026.04.013

26. Marín-Martínez FM, Guzmán Martínez-Valls PL, Dekalo S, Weiss J, Haran O. Aesthetic and functional results after single- and two-stage resection and reconstruction of penile paraffinomas — experience from two tertiary centers and a surgical management algorithm. Urology. 2023;171:227–235. doi:10.1016/j.urology.2022.09.022

27. Napolitano L, Marino C, Di Giovanni A, et al. Two-stage penile reconstruction after paraffin injection: a case report and a systematic review of the literature. J Clin Med. 2023;12(7):2604. doi:10.3390/jcm12072604

28. Quan Y, Gao ZR, Dai X, et al. Complications and management of penile augmentation with hyaluronic acid injection. Asian J Androl. 2021;23(4):392–395. doi:10.4103/aja.aja_78_20

29. Salloum A, Bazzi N, Haber R. Nonsurgical methods for penile augmentation: a systematic review. Dermatol Surg. 2021;47(3):e81–e85. doi:10.1097/DSS.0000000000002816

30. Yang DY, Ko K, Lee SH, Lee WK. A comparison of the efficacy and safety between hyaluronic acid and polylactic acid filler injection in penile augmentation: a multicenter, patient/evaluator-blinded, randomized trial. J Sex Med. 2019;16(4):577–585. doi:10.1016/j.jsxm.2019.01.310

31. Romero-Otero J, Manfredi C, Ralph D, et al. Non-invasive and surgical penile-enhancement interventions for aesthetic or therapeutic purposes: a systematic review. BJU Int. 2021;127(3):269–291. doi:10.1111/bju.15145