Complications of penile augmentation by use of nonmedical industrial silicone.

INTRODUCTION: Penile augmentation has been reported in the literature by injecting various materials by nonmedical persons. AIM: This study aims to present our experience in management of penile augmentation complications associated with injection or implantation of industrial silicone by lay persons. MAIN OUTCOME MEASURES: Early surgical intervention can lead to faster recovery and better cosmetic and functional outcome. METHODS: Two patients had injection of industrial silicone paste, and the other two had industrial silicone ring implantation. All the patients except one were presented after 13 months of the procedure. Patients with industrial silicone ring presented with multiple sinuses of penile skin in one, and abscess discharge pus from the site of implanted ring in the other. Both patients with injected silicone paste presented with swelling and deformity of the penis that interfered with their intercourse. Silicone ring patients underwent skin incision and drainage of the infected materials and extraction of the implants with delayed skin closure. The two patients with silicone paste injection underwent two-stage penile reconstructions using scrotal flap. RESULTS: Patients with extracted rings had smooth recovery with acceptable cosmetic outcome. One of them was not initially satisfied with the length of his penis that was overcome by short-term use of vacuum device. One of the patients with silicone paste injection had wound infection that was successfully treated with local wound care. Both had satisfactory penile length and acceptable cosmetic outcome. All patients had normal erectile function postoperatively. CONCLUSION: Complications of using industrial silicone injection can be drastic, and awareness of the public can avoid using of this material for penile augmentation.

Percutaneous nephrolithotomy: critical analysis of unfavorable results.

OBJECTIVE: To identify the risk factors of unfavorable results of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 602 patients were subjected to 616 PCNL procedures. Patients were divided into two groups according to the results of treatment. Group 1 with favorable results includes patients who became stone free after a single PCNL procedure without major complications. Group 2 with unfavorable results includes three subgroups: a) Patients who developed major complications, b) Those who required second major intervention to complete stone removal, and c) Patients with residual stones > 4 mm at 3 month. Risk factors for unfavorable outcome were studied by univariate and multivariate analyses. RESULTS: Unfavorable results were documented in 176 patients (28.6%) due to major complications in 40 (6.5%), need for second intervention in 124 (20%), and presence of residual stones > 4 mm at 3 month in 12 (1.9%). The remaining 440 patients (71.4%) were considered of favorable outcome. Independent risk factors of unfavorable results on multivariate analysis were staghorn stones, multiple stones and stone largest diameter > 50 mm. CONCLUSION: To optimize the results of PCNL, urologists should consider careful patient selection. Patients with staghorn stones, multiple stones or large stone burden are more susceptible to unfavorable outcome.