Complications of subcutaneous penile modifications: a discussion of emergency department presentations and management

BACKGROUND: Subcutaneous penile modifications (SPMs) are more prevalent in Southeast Asian culture and have been growing in popularity in Western culture. SPMs are often made of domino tiles, or other available pieces of plastic, shaved into a desired shape and placed in unsterile conditions. Previous literature indicates a high risk of infection and the need for surgical removal. CASE PRESENTATIONS: Seven patients presented to the emergency department in the Southwest border region with complications from SPMs. All the patients complained of pain, four presented with signs of infection, and four SPMs required removal in the emergency department. Removal consisted of a dorsal penile nerve block and making an incision over the SPM to remove the foreign body. Three of the patients had their SPMs done during a previous incarceration under unsterile conditions. CONCLUSIONS: SPMs appear to be growing in popularity among Western culture, and emergency department health care providers should be aware of trends in body modifications as well as potential complications. The conditions in which SPMs are often placed pose a high risk for infection. In some cases, placement and/or removal of SPMs pose a risk of damage to the corpora, arteries, and nerves of the penis. In the absence of overt bleeding, or suggestion of neurologic injury, dorsally placed superficial foreign bodies of the penis may be amenable to emergency department removal.