Glanular Ischemia Following Glans Penis Augmentation: A Rare Case Report

Abstract

Introduction: Premature ejaculation is a common problem in men and filler injection into the glans penis has become a prevalent practice in treatment. Since the glans penis augmentation is an invasive treatment method, it also carries the risk of complications. Herein, we aimed to present a case of glans penis ischemia due to hyaluronic acid filler injection. Case Presentation: The patient was a 29-year-old male with premature ejaculation. The physical examination was normal, and sensory testing with a biothesiometer revealed vibration perception threshold values of 5.3V for the glans, 4.1V for the frenulum, and 3.9V for the penile shaft. Under local anesthesia, hyaluronic acid filler was applied with the multiple puncture technique, 2 mL in total, 0.2 mL per injection. One day after the procedure, the patient referred with complaints of discoloration of the glans penis. The physical examination revealed blackening at the distal tip of the glans with a visible demarcation line. Hyaluronidase was applied for the treatment of glanular glans penis ischemia secondary to hyaluronic acid filler injection. A significant improvement in the glans penis color was observed after hyaluronidase injection. The patient was prescribed 100 mg of aspirin, a warm saline dressing, and a nitroglycerin-containing cream and was discharged for daily follow-up. Conclusion: Although vascular complications are rare after hyaluronic acid filling into the glans penis, early diagnosis and treatment are crucial. Patients should be informed about possible adverse events. The main treatment method for vascular complications is urgent hyaluronidase injection. In addition, prevention of clot propagation with oral aspirin and vasodilatation treatments should be applied. In the glans penis ischemia after hyaluronic acid injection, early diagnosis and immediate hyaluronidase administration can reverse ischemia without necrosis or surgical intervention.