OBJECTIVE: The authors share their experience on four different cases of penile paraffinoma surgically treated at the Bicol Medical Center from January 2011 - September 2014.

METHODOLOGY: Four patients with subcutaneous injection of foreign body (Vaseline, petroleum jelly or Baby oil) into their penises were treated. The authors applied two kinds of technique: anterolateral thigh pedicle flap and scrotal advancement flap, depending on the skin defect after excision of the paraffinoma. Outcomes measured were immediate post-operative complications (flap necrosis, hematoma, infection) and 3 months post-operative follow-up (contracture, pain on erection, improvement in sexual function and acceptable cosmetic appearance).

RESULTS: All patients had a relatively uneventful post-operative course. There were no instances of flap necrosis, bleeding, hematoma or dysuria. Morbidity was minimal and no secondary surgical intervention was done. All had acceptable cosmetic appearance based on the satisfaction of both the patients and the surgeons. All reported decrease in pain during erection, except for one, who underwent scrotal advancement flap, complaining of vague penoscrotal pain when his penis was erect.

CONCLUSION: Penile paraffinoma remains a reconstructive surgical challenge requiring application of varying techniques depending on the pre-operative foreign body involvement.

Human ; Male ; Adult ; Foreign Bodies ; Injections ; surgery

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) remains to be a cost-effective strategy for treating patients with urolithiasis. In the Philippines, Philhealth shoulders a portion of medical expenses to minimize out-of-pocket (OOP) payment by its members. However, since the establishment of the case-based payment scheme in 2012, no studies have yet assessed its impact on OOP in ESWL. OBJECTIVE: To determine the factors associated with out-of-pocket payment among Filipinos seeking treatment in ESWL centers located in the Philippines. METHODS: The study utilized a mixed method sequential explanatory design. Twelve ESWL facilities were purposively selected to represent each facility type and location. A total of 2241 patients who underwent ESWL from January to December 2017 in twelve facilities were included in the quantitative study. For the qualitative portion of the research, focus group discussions and key informant interviews were done. RESULTS: It was found that 77% of the studied population had to pay OOP for ESWL with a median OOP expense to be Php37,769 ($750) after deductions by PhilHealth, private insurance, and other funding agencies. Factors affecting OOP payment differ by facility location. In Metro Manila, factors associated with OOP payment include facility type and private insurance membership. In Luzon, factors associated are facility type, professional fee, Philhealth membership, and private insurance membership. OOP payment was found to be associated with private insurance membership in Visayas, and professional fee in Mindanao. CONCLUSION A high proportion of urolithiasis patients in the country require out-of-pocket (OOP) payment for ESWL despite the deductions from Philhealth, private insurance, and other supporting organizations. The large variation in ESWL charge by facility and location explains the high variability in OOP payment, especially in Visayas and Mindanao. Factors affecting OOP payment were also found to vary depending on the location of the facility.