Surgical Treatment of Genital Manifestations of Lymphatic Filariasis: A Systematic Review

Abstract

Genital manifestations of lymphatic filariasis (genital LF) are a significant cause of disfigurement and disability in the developing world. Surgery is the standard treatment; however, definitive publications are lacking and best practice remains unclear. An exhaustive search strategy using keyword and subject headings was applied to Medline, EMBASE, Web of Science, CINAHL, and Scopus. Additionally citation lists, Google and Google Scholar, archives of relevant journals and websites were searched systematically. Studies with data on one or more human patient(s) who underwent surgery for genital LF were included. Articles were screened and data extracted by the first author with data verification by the second author. Fifty-seven studies were included: 18 series of ablative surgery, four series of non-ablative surgery and 35 case reports. Poor study quality, heterogeneous case definitions, lack of severity grading and limited follow-up precluded meta-analysis. Two series of simple hydrocelectomies performed in resource-limited settings reported early complication rates of 3.0-3.5 % using eversion and 5-7 % using excision, with recurrence of 7 % and 3-5 %, respectively. Complications were minimal for single-surgeon series and greater (12-18 %) when scrotal reconstruction was performed. There is little useful evidence for lymphatic bypass procedures in genital LF. Under-recognition of atypical manifestation of genital LF leads to potentially unnecessary surgeries. Surgery for genital LF is safe in resource-limited settings; however, more well-designed studies with better follow-up are needed. Research priorities include validation of case definitions and severity grading systems, and solutions to improve post-operative follow-up in resource-limited settings.

Global surgery and the sustainable development goals

“…Increasing access to safe blood products is a priority outlined in the Tanzanian NSOAP, and this intervention is expected to benefit all patients and prevent transmission of infection. Furthermore, surgery, obstetrics and anaesthesia care is needed to address the sequelae of infectious disease for the millions affected; patients with multidrug‐resistant tuberculosis, trachoma and filariasis can benefit from surgical management, ultimately reducing mortality and morbidity from neglected tropical diseases.…”

Evaluation and management of adult acquired buried penis

“…It is most commonly transmitted by the filarial nematode Wuchereria bancrofti , Brugia malayi , and B . timori ( 12 ). Patients with filarial penoscrotal lymphedema are often successfully managed with surgical treatment with either STSGs or prepucial skin flaps, when available ( 13 ).…”

Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs

“…Lymphatic filariasis, caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori, affects between 67 to 120 million people worldwide [108,109]. Most of the burden falls on LMICs in Asia, Latin America and the Caribbean, and sub-Saharan Africa [110].…”

“…Most of the burden falls on LMICs in Asia, Latin America and the Caribbean, and sub-Saharan Africa [110]. Although acute infection is treated with anti-filarial drugs, chronic stigmata of infection such as hydrocele, lymphedema, and elephantiasis may require operative intervention [109,111,112]. Approximately 37% of infected personsin historical analyses experienced hydrocele, although this frequency is likely lower today given improved surveillance and treatment [110].…”