The stigma of a perceived small penis is well documented, with reports of penile enhancement procedures dating back hundreds of years. Unrealistic expectations of penile size and performance have increased in recent years, partly due to widespread exposure to pornography and the increasing influence of the media.

Consequences of penile self-injection include impaired sexual function, difficulty voiding and psychological disturbance. Penile MRI features are of great clinical relevance in planning surgical strategy, counseling patient’s about cosmetic and functional results of surgery, and establishing the differential diagnosis with other penile diseases including cancer. 

We report our experience with 3 cases of complications of penile enhancement procedures secondary to self-injection with different agents. Preoperative MRI was performed in all cases to determine the extent of tissue to be removed and the possibilities of penile reconstruction. All cases were discussed at a Uroradiology MDM.

All three patients had self-injected their penis with industrial silicone, liquid paraffin or Kanamycin A with the stated intention of increasing girth and length. The extent of tissue destruction was difficult to assess on physical examination and penile MRI was used in all cases. Findings included penile deformity with shaft lymphoedema, granulomatous reaction, scarring and regional complications including perineal and scrotal abscess’ and peri-anal fistula formation.

All cases were treated surgically with penile degloving, excision of penile shaft skin down to buck's fascia and phallic reconstruction. One patient required a ‘Batman’ degloving penectomy and scrotectomy and colorectal involvement for severe perianal disease. All excised histology was benign.

Complications following phallic self injection can be devastatinhg and anatomic and functional recovery depends on early detection and complete excision of the foreign body. The multiplanar capability of penile MRI is crucial in evaluating the extent of inflammation, involvement of Buck’s fascia, presence of deep seated collections, perianal, scrotal and loco regional lymph node involvement.