TOPIC: PMMA Gone Wrong: Bleeding, Obstruction, Necrosis

A lot of men are being sold on high-volume PMMA and deeper-plane placement as if that means better results.

This case study is a reminder that it can also mean urethral bleeding, obstruction, necrosis, and permanent tissue loss.

Dr. Carney has personally examined this patient and is involved in his care. This was not a minor irregularity. This was a severe PMMA complication in which the filler was placed too deep and in too much bulk, leading to urethral bleeding, urinary obstruction, catheterization, progressive glans necrosis, and tissue loss.

That is why we published this case.

We published it because patients deserve to see the other side of the story.

And to be very clear: we are not saying this just because we are urologists, and we are not saying it just to make more money. In fact, the easy thing would be to stay quiet and let the Internet keep treating penile filler like it is no different from a cosmetic face treatment.

But that would be irresponsible.

Dr. Carney has seen this complication firsthand. He personally examined this patient, reviewed the history, and is involved in the patient’s ongoing care. This was not a minor contour issue or a simple inflammatory flare-up. This was a real case of urethral bleeding, urinary obstruction, catheterization, progressive glans necrosis, and tissue loss after deeply placed, large-volume PMMA filler performed elsewhere.

Once you have looked at a man’s penis and seen real tissue death, real urethral obstruction, and real loss of the glans, it becomes very hard to stay quiet while non-urologists keep marketing penis enlargement like it is a routine aesthetic service.

This is not about turf.
This is not about ego.
This is about anatomy, safety, function, and preventing avoidable harm.

We put a link to the full case study below, along with infographics on:

• how the complication escalated
• early warning signs after penile filler
• what can happen when PMMA is placed too deep
• why urologic specialty matters in penis enlargement

Article: www.rejuvall.com/pmma-penis-filler-risks-case-study/

If you’ve had PMMA or any penile filler and are dealing with bleeding, trouble urinating, worsening pain, pain with erection, dark tissue, swelling, drainage, or anything that seems off, do not let someone brush it off as “normal healing.”

Thank you for the article. Horrifying images of the poor guy who had to go through that problem. I hope he’s on the mend with good results, given the complications.
Definitely makes one wonder if more complications are being seen by a popular provider sponsored by this site. But regardless, this article has made me reconsider and think a lot harder about the qualifications of the doctor I have do this procedure. Thanks again for going through the effort!

Just as we explain in the article, this is only one case out of a significant trend we have been seeing over the past few months. The patient is now under Dr. Carney's care, and Dr. Carney is confident that the patient will now continue to heal well.

Thank you for your kind words. "Going through the effort" is part of the job for us; we're urologists first and foremost and want to make sure the organ is protected, no matter who you go to.

Also worth noting is that the article is not about a specific provider. We have been seeing these Repair patients come to us with these same complications from a few different providers. These complications we have been seeing are a result of too much volume placed too deep, and that should be one of the main takeaways here.

I suspect a lot of us know who this is, I’m not gonna directly mention his name. I followed his reports and increasing complications when it happened, but had no idea it had gotten this bad. I was PMing another member just the other day advising him not to get too much at once for this very reason. Just because nothing happens 99x out of a 100 with high injection amounts doesn’t mean it can’t happen. Hopefully, the patient will give us a formal update and let us know how he’s doing. We miss you buddy.

I was PMing another member just the other day advising him not to get too much at once for this very reason. Just because nothing happens 99x out of a 100 with high injection amounts doesn’t mean it can’t happen.

Unfortunately, complications happen from too much volume too deep much more often than 1/100, you just don't see people reporting about them here. And again, the important thing to remember here is the problem is not only just high volume but also too-deep injection.

This is very unfortunate and the main reason why I would only feel comfortable having an actual Urologist injecting filler if I were to have a procedure like this done.I feel horrible for this guy.

Thank you for sharing.

Best wishes to the patient whose story we have read by his posts on this site.

Can you please clarify the statements related to injections “too deep”? Where was this patient injected at? My understanding is that the only proper injection location (plane) is between the two fascia walls.

If this is so critical why do more injectors not use ultrasound to confirm the right plane?

Thank you.

@Alittlebigger My apologies for not getting back to you sooner as I was out of the office for the weekend. I will try to get with Dr. Carney tomorrow when he's back in to get answers for you.

@Alittlebigger

Thank you for sharing.

Best wishes to the patient whose story we have read by his posts on this site.

Can you please clarify the statements related to injections “too deep”? Where was this patient injected at? My understanding is that the only proper injection location (plane) is between the two fascia walls.

If this is so critical why do more injectors not use ultrasound to confirm the right plane?

Thank you.

I got a chance to sit down with Dr. Carney and chat with him about your questions. Here's a transcript of what he had to say:

"Well, let's talk about the ultrasound first. Ultrasound of the penis really only works when the penis is erect. That's why, anytime we do an ultrasound on the penis, for Peyronie’s, or ED, or whatever, we always give them an injection, to have an erection.

So an ultrasound is really only good to measure the arterial flow, or a venous leak. But think about it, if you have an erection that squishes together all the layers of the penis because the body of the penis is so erect, the layers under the skin, and on top of the body of the penis, they get squished together, so you actually cannot see the layers on an ultrasound. So an ultrasound would not help an injector put it in the correct location.

So what is the correct location? Well, let me answer the question first that says, um, Please clarify what is meant by “too deep.”

Too deep. The deepest fascia layer is the Buck’s fascia. B-U-C-K-S, fascia. 
Immediately below the Buck’s fascia are the nerves, the veins, and arteries. You cannot inject it deep to Buck’s fascia. And you really shouldn't inject it even directly on top of Buck’s fascia, because that can still compress the blood supply.

So, anything below Buck’s fascia or even, immediately on top of Buck’s fascia, is too deep to be injecting because it risks vascular damage. If someone gets too much PMMA, that is also putting that compression against that neurovascular bundle, compressing the vessels together.

The only way to know definitively where to inject the penis is to have performed literally 100s of 1000s of operations on the penis, where you actually deglove the penis. Or you actually reveal a portion of the penis, or you do surgery for Peyronie’s disease. Or you do surgery for urethral strictures. Or you do surgeries to correct a broken penis if they break their penis.

The only way to fully understand the fascial layers and know exactly where you are is to have done 100s of 1000s of operations on the penis. So if you think about the penis being put together like an onion in layers, to where you have actually opened the penis up and separated those layers and you understand the layers.

Someone who has not done thousands of surgeries on the penis, so a family practitioner, a general practitioner, a DO who is not a urologist, anybody without that level of penile surgical experience does not truly understand those layers. They have not lived in that anatomy. And if they have not lived in that anatomy, then they do not really know where they are putting the filler."