Do penile Fillers for girth enhancement cause tight foreskin in uncircumcised men?

Penile girth enhancement procedures have gained popularity in recent years, which will cause tight foreskin in uncircumcised men. Penile girth enhancement procedures, however, come with various risks and complications, some of which are not widely discussed in medical literature. One such complication is phimosis, a condition where the foreskin becomes tight and cannot be easily retracted over the glans penis after filler insertions to increase the girth of the penis. The risk of phimosis after filler insertion is higher in adults who already have mild tightness of the foreskin.

Overview of Penile Girth Enhancement Procedures

Penile girth enhancement procedures can involve a range of techniques, including dermal injections and fillers. These methods aim to increase the circumference of the penis by injecting substances such as autologous fat, silicone, hyaluronic acid (HA), and collagen into the penile shaft. Despite their growing popularity, it is crucial to understand that these procedures have not been approved by the Food and Drug Administration (FDA) in the United States, primarily due to the lack of extensive research and documented safety profiles.

Common Fillers Used in Penile Augmentation

1. Autologous Fat: This involves harvesting fat from another part of the patient's body and injecting it into the penis.

2. Silicone: A more permanent option but associated with significant complications.

3. Hyaluronic Acid (HA): HA is commonly used in cosmetic procedures and is favoured for its temporary effects and biocompatibility.

4. Collagen: Used to provide volume and structure, though it also carries risks of allergic reactions and complications.

The Risk of Phimosis with Penile Fillers

Phimosis is a condition where the foreskin becomes too tight to be pulled back over the head of the penis after uncircumcision penis filler insertions. Tight foreskin can cause pain, swelling, and difficulty with hygiene, potentially leading to balanitis. In particular, HA fillers have been noted to cause this dermatologic complication in some cases.

The mechanism behind this complication can be multifactorial:

- Excessive Filler Volume: Over-injection can lead to excessive swelling and tightness of the foreskin.

- Inflammatory Reaction: The body's response to the injected material can cause inflammation and scarring, leading to phimosis.

Improper Technique: Inaccurate placement or uneven filler distribution can create localised swelling around the foreskin, which can become tight.

- Phimosis is higher in patients who already have mild to severe phimosis. Uncircumcised men may be more prone to filler migrating to the foreskin, which becomes tight (phimosis)

Case Representation and Management

A recent case highlighted the occurrence of phimosis following HA penile girth enhancement. The patient developed significant foreskin tightness, making retraction difficult and painful. The management of this complication required a comprehensive approach:

- Prevention measures immediately after the procedure: Those who have filler recently should Keep the penis upright in supportive tight underwear for the first 7-15 days following the procedure. This is to prevent gravity and reduce the impact of walking so it does not cause the filler to migrate down towards the foreskin. If you notice excessive product around the foreskin, try to massage this back up the penile shaft towards the base of the penis before the filler settles down after 1-2 weeks.

- Medical Management: Initial treatment involved anti-inflammatory medications and topical corticosteroids to reduce swelling and inflammation. Injections to dissolve the fillers in some cases.

- Surgical Intervention – circumcision: In severe cases, surgical intervention such as a dorsal slit or circumcision may be necessary to relieve the tightness and restore normal function.

 Conclusion

 While penile girth enhancement procedures offer solutions for men seeking to increase their penile circumference, the risks and complications, including phimosis, should not be overlooked. Patients must be fully informed about the potential dangers, and surgeons must exercise caution and follow stringent protocols to minimise these risks.

Without FDA approval and comprehensive studies, the medical community must rely on case reports and ongoing research to understand and mitigate the complications associated with penile fillers. Patients considering these procedures should consult with experienced urologists and weigh the potential benefits against the risks of tight foreskin.

This blog aims to describe the under-discussed complications of penile fillers and emphasise the importance of informed decision-making and professional guidance in girth enlargement surgery.

Some clinics advise that for a patient having girth enlargement surgery, having a circumcision before can improve the aesthetic appearance of girth increase. Some clinics asked for circumcision before the girth enlargement surgery to prevent the phimosis.

 We are a specialist London circumcision centre that can deal with phimosis with filler procedures. Please ask for professional advice and treatment at our London centre.

Can Men with Diabetes Undergo Circumcision?

Circumcision in Diabetic Men

Yes, men with diabetes can safely undergo circumcision. Operation for freoskin may be a beneficial treatment option for foreskin conditions in diabetic men. This blog will cover several aspects of circumcision for diabetic men, including reasons for the procedure, necessary health metrics, where to get it done, and who performs the surgery,

1. Reasons for circumcision in diabetic men

2. Normal HbA1c results of diabetes required for the procedure

3. Locations where men can get circumcision 

4. Types of anaesthesia needed for circumcision 

5. Specialist doctors for performing the circumcision 

6. Risks of circumcision in diabetes 

7. Aftercare for circumcision with diabetes 

Reasons for Circumcision in Diabetic Men:

Men with diabetes are more susceptible to developing balanitis, inflammation, BXO, and infection of the foreskin. Fungal infection or other factors often cause these conditions. Despite antifungal and antibiotic treatments, recurring infections can lead to scarring due to BXO and phimosis. Circumcision becomes the most effective option for managing these conditions in diabetic men, especially when phimosis is severe and less responsive to non-surgical treatments.

Importance of Diabetic Control:

Reasonable diabetic control is crucial for optimal healing and reducing the risk of complications. Even if diabetes is not perfectly controlled, circumcision may still be an option, but HbA1c must be less than 7.6%.

Where to Find Adult Circumcision for Diabetic Men:

At the London Circumcision Centre, specialist consultants who are NHS urologists perform circumcisions for diabetic men.

Anesthesia for Circumcision:

Most circumcisions with glue or stitches can be done under local anaesthesia. However, some patients with needle phobia may require general anaesthesia.

Benefits of Local Anesthesia:

Local anaesthesia is a safer alternative for diabetic patients about to undergo circumcision, especially when considering other health conditions that make general anaesthesia risky.

Minimising Infection Risk:

Antibiotics are typically administered after circumcision, and waterproof glue is applied to reduce the risk of infection in diabetic patients. Diabetic patients are also advised to keep diabetes under control afterwards and are given antibiotic cream to use for ten days. Showers or washing are recommended after three days postoperatively.

Specialist doctor:

We are experienced specialist doctor who does circumcision in diabetes patients at London Circumcision Centre

Disclaimer:

This blog post is for informational purposes only and should not be a substitute for professional medical advice. It is essential to consult with a specialist to discuss your situation and determine if circumcision is the right choice for you.

Which disposable stapler device is better for adult circumcision: CircCurer or ZSR

Stapler Options for Adult Circumcision: CircCurer vs. ZSR Circumcision Stapler Devices

I. Introduction

In the UK, new stapler options for adult circumcision have been introduced.

We look at the performance, postoperative healing, complications, and stapler removal rate of two disposable circumcision stapler devices used in adult male circumcision: CircCurer and ZSR.

II. Comparison of CircCurer and ZSR Circumcision Stapler devices

   A. Operative Efficiency and Safety

      1. Performance in operative time

      2. Complication rates

      3. Infection and bleeding rates

Operative Efficiency and Safety: Both stapler devices demonstrated similar performance in operative time (around 7 minutes) and complication rates. Patients experienced minimal infections and hematomas in both groups, underscoring the safety of these devices. Pain scores were comparable between the CircCurer and ZSR stapler circumcision groups.

   B. Postoperative Considerations

      1. Healing outcomes

      2. Swelling rates

      3. Stapler’s removal rates

Postoperative Considerations: While both devices resulted in successful circumcision, some subtle differences emerged regarding post-surgical experiences. The CircCurer group showed a slightly higher swelling rate (oedema) than ZSR. However, a significant difference arose with staple removal. The ZSR group had a substantially higher incidence of staples spontaneously falling out (62.9%) than the CircCurer group (38%).

III. Patient Satisfaction and Considerations

   A. Patient satisfaction levels

   B. Healing time comparison

   C. Staple removal considerations

Despite the difference in staple retention, patients in both groups reported remarkably high satisfaction levels at the two-month follow-up, instilling confidence in the effectiveness of these devices. However, it's essential to consider some additional factors when choosing a stapler device for adult circumcision:

Healing Time: At two months, patients of both groups reported satisfaction with the outcome. This means that stapler circumcision takes longer to heal compared to traditional methods of circumcision.

Staple Removal: The study highlighted that ZSR exhibited a higher rate of staple fallout, necessitating an additional follow-up procedure for removal in the CircCure method, sometimes requiring local anaesthesia. More patients (40-60%) in the CircCurer group must return for a follow-up procedure to remove the staplers

IV. Making an Informed Decision

   A. Empowering doctors to make informed choices.

   B. Factors for patient consideration

   C. Highlighting distinctions in stapler devices

This information provides valuable insights for doctors and patients considering stapler circumcision for adults. While both CircCurer and ZSR proved effective and safe for the procedure, the higher rate of staple fallout with ZSR is a noteworthy distinction. Understanding these differences empowers doctors and patients to actively participate in decision-making, selecting the most suitable device based on individual needs and preferences.

V. Conclusion

   A. Summary of benefits of both devices

   B. Noteworthy distinctions

   C. Impact of healing time and staple removal on decision-making

In conclusion, both devices offer similar benefits, including short surgery times, low complication rates, and high patient satisfaction. However, the ZSR device showed a significantly higher rate of metal clips falling out spontaneously and less need for a follow-up procedure for staple removal. Healing time is much longer in stapler circumcision compared to traditional methods.

VI. References

• Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicentre study, International Journal of Impotence Research June 2024, Italy, and Spain DOI:10.1038/s41443-024-00933-3

• Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: a Cochrane review. BJU Int. 2022 Jul; 130(1): 26–34. doi: 10.1111/bju.15604

• Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial Braz J Med Biol Res. 2015 Jun; 48(6): 577–582. doi: 10.1590/1414-431X20154530

• A Comparative Study on the Clinical Efficacy of Two Different Disposable Circumcision Suture Devices in Adult Males, Urol J 2017 Aug 29;14: 5013-17

Cuts or tears of foreskin

Cuts and Tears in the Foreskin: Causes, Treatment and When to See a Doctor

The foreskin in men is delicate and prone to minor cuts or tears during sexual activities. While these cuts usually heal within a week, knowing their cause, how to care for them, and when to seek specialist urologist advice are essential. Possible causes of foreskin cuts or tears include rough sex, tight foreskin, diabetic complications, skin lesions like lichen sclerosis (BXO), STDs, and fungal infections. Treatment options include simple care, medications, controlling underlying conditions, and surgery, e.g. circumcision or preputioplasty in some cases.

This blog will explore the potential causes of foreskin cuts or tears, treatment options, and when to see a specialist.

Causes of Foreskin Cuts or Tears

Rough Sex

Friction during sexual activity can cause minor tears. While these minor cuts usually heal within a week, it is essential to know how to care for them in case you have some medical conditions.

Tight Foreskin

A condition called phimosis can make it difficult to retract the foreskin over the head of the penis, leading to tearing during retraction.

Diabetic Complications

Poorly controlled diabetes can decrease blood flow and slow healing, making the foreskin more susceptible to cuts and infections. The repeated infection will require prompt treatment, and tight freoskin will require circumcision in diabetes.

Skin Lesions

Eczema, Balanitis Xerotica Obliterans (BXO) or other skin conditions on the foreskin can cause cuts or tears.

Balanitis

Balanitis is an infection and swelling of the foreskin and the tip of the penis (called the glans penis). Balanoposthitis is called a more severe infection of the head of the penis along with the foreskin.

Sexually Transmitted Diseases (STDs)

Certain STDs can cause sores or ulcers on the penis, including the foreskin.

Fungal Infections

Yeast infections can irritate and inflame the foreskin, making it more prone to tearing.

Treatment Options

Simple Care

For minor cuts, gentle cleansing with warm water and a saline solution, followed by applying petroleum jelly or lubricant, can promote healing.

Medical treatment

Depending on the cause, your doctor might prescribe:

• Antifungal creams for fungal infections.

• Antibiotic creams to prevent bacterial infections.

• Steroid creams to reduce inflammation in early BXO

Controlling Underlying Conditions

If diabetes or an STD is the culprit, managing those conditions can help prevent future cuts and promote healing.

Surgical Options

In some cases, surgery might be necessary. Here are some potential procedures:

• The Dorsal Slit

A small incision was made on the upper side of the foreskin to relieve tightness and prevent future tearing.

• Preputioplasty

Preputioplasty repositions the foreskin to allow for easier retraction and reduce the risk of tears.

• Circumcision

Complete or partial removal of the foreskin.

• Biopsy

Sometimes, a small tissue sample might be taken to rule out more serious conditions or BXO.

Post-Operative Care:

Following surgery, your doctor will provide specific instructions on wound care, pain management, and follow-up appointments after circumcision or other procedures. This might include using steroid creams to reduce inflammation in BXO and monitoring for signs of recurrence of BXO on different parts of the penis.

When to See a Urologist

See our specialist if you experience any of the following:

*  Severe pain or bleeding

*  Signs of infection, such as redness, swelling, pus, or fever

*  Difficulty urinating

*  The cut doesn't heal within a week

*  The foreskin is exceptionally tight

*  You suspect an STD

Conclusion

Most foreskin cuts heal with simple care. However, seeking medical attention is crucial if you experience any concerning symptoms. Early diagnosis and treatment can prevent complications and ensure a speedy recovery.

Disclaimer

This blog is for informational purposes only and should not be a substitute for professional medical advice. Always consult with our consultant urologist for diagnosis and treatment.