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Oleogranuloma of the penis is a complex set of pathological processes caused by the injection of a foreign substance (gel, balls, rods, etc.) into the penis with the purpose of penile augmentation. In this case series, we investigated a variety of clinical presentations of oleogranuloma and described our experience in managing the complications. We analyzed data on 18 patients with penile self-injections admitted to the hospitals of Astana City, Kazakhstan, during an 11-year period. The mean age of patients at admittance was 37.4 ± 6.4 years. The most common substance of injection was Vaseline (n= 16, 88.9%). The mean interval between the time of injection and the first presentation to the hospital was 10.8 ± 6.5 years. Complications included necrosis (n= 13, 72.2%), pain or swelling (n= 6, 33.3%) and cosmetic dissatisfaction (n= 5, 27.8%). All patients received surgical treatment (n= 18, 100%): simple excision with primary closure was performed for one-half of the patients (n= 9, 50%), while another half of patients underwent the two-stage scrotum skin flap surgery (n= 9, 50%). The findings of this study should raise the awareness about the diverse clinical presentations of penile self-injections among physicians for early diagnosis and timely management.

Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative management. Failures in MDSC could be due to small diameter nerves (=1?mm) left behind on the spermatic cord. The objective of this study was to assess if hydrodissection (HD) of the spermatic cord after MDSC could decrease the number of residual nerve fibers without compromising blood flow. Prospective blinded randomized control trial: bilateral MDSC was performed on 22 adult rats (44 cords). HD of the spermatic cord was performed on one side of each rat (side randomized) using the ERBEJET2. The contralateral cord (no HD) was the control for each animal. Blood flow through the vessels was monitored using a micro-Doppler probe. After completion a cross-section of the residual cord was sent to pathology (blinded to technique) to assess for small diameter nerves and signs of damage in vascular integrity. Blood flow had been maintained in the vessels when the ERBEJET2 was set to 6?bar (87?psi). The cord where HD had been performed had a significantly lower total median residual nerve count of 5 (0–10), compared to 8 (2–12) on the non-HD side (p?=?0.007). No structural damage was seen in the vessels in the spermatic cord that had undergone HD (gross exam and histology). HD of the spermatic cord significantly decreases residual nerve density without compromising vascular integrity in a rat model.

Microsurgical denervation of the spermatic cord (MDSC) is a treatment option in patients with chronic orchialgia. This procedure requires precise care to avoid any thermal damage to crucial adjacent tissues (arteries, veins, and lymphatics). Monopolar electrocautery is the standard ligation energy source, but may cause extensive collateral damage to the tissues. However, CO2laser is known to produce a very predictable tissue penetration and minimal collateral spread. The goal of this study was to compare the extent of collateral thermal damage in both monopolar electrocautery and CO2laser ablation in the spermatic cord during a robotic assisted MDSC (RMDSC) procedure as well as the feasibility for utilizing the flexible fiber-optic CO2laser probe after “RMDSC” procedure. RMDSC was performed using standard monopolar electrocautery on the spermatic cord of one side of a fresh human male cadaver (randomly selected) and then compared to RMDSC using the CO2laser on the contralateral spermatic cord. Nine histological cross-sections from each cord were measured for depth of collateral thermal/cautery injury. The mean collateral thermal injury with CO2laser was 0.17 ± 0.031 mm (range: 0.15–0.25 mm), and with standard electrocautery 0.72 ± 0.046 mm (range: 0.60–0.75 mm). CO2laser resulted significantly less collateral thermal injury than standard electrocautery (p< 0.0001). The CO2laser probe was easy to manipulate with the Black Diamond micro-forceps (Intuitive Surgical, CA) and allowed for convenient tissue plane dissection. Human cadaveric targeted RMDSC using a flexible CO2laser energy results in significantly decreased collateral thermal injury compared to standard monopolar electrocautery. These initial findings suggest potential advantages of the CO2laser over traditional monopolar cautery in cases requiring minimal collateral tissue damage. Future studies are needed to assess its clinical potential in microsurgery.