Surgical Treatment of Lymphedema of the Penis and Scrotum

Abstract

. Surgical treatment of lymphedema of the penis and scrotum. Clinics. 2006;61(4):289-94. PURPOSE:Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. MATERIALS AND METHODS:Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. RESULTS: Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. CONCLUSIONS: The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.

Chronic Idiopathic Penile Edema: Three Cases and a Review of the Literature

“…Afterwards, the penis is covered with a split-thickness skin graft with a zigzag suture on its ventral surface. This treatment option of CIPE is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse and better cosmetic results [25]. Other authors also related excellent cosmetic and functional results using this technique [22,24].…”

Results of surgical treatment of massive localized lymphedema in severely obese patients

“…The histopathological diagnosis is evidenced by widespread interstitial edema, associated with reactive fibroblast proliferation, acanthosis and dermal sclerosis, vascular and lymphatic ectasia, with inflammation. Macroscopically, the hardened tumor mass and the skin with the "orange peel" appearance feature the frequent pachydermia that accompany MLL 4,[7][8][9][10] . Any lymphatic obstruction may precipitate regional lymphedema.…”

“…In this sense, the differential diagnosis should be made with either congenital malformations and acquired conditions, including lipomas, sarcomas and other tumors, sequelae of surgery, radiation therapy, trauma and filariasis. Lipodystrophy and massive abdominal panicles may also be involved [8][9][10][11] . The precise mechanism of the formation of MLL remains intact.…”

“…In patients with a high BMI, given the higher level of interstitial fluid resulting from a greater volume of adipose tissue, there is increased pressure, thereby compromising lymph draining. Consequently, the body condition of these patients causes a significant obstacle to mechanical lymphatic drainage 10,11 , which worsens with inactivity.…”

“…This lymphedema framework, associated with the local inflammatory reaction, distends the tissues and increases tissue ischemia, which causes severe fibrosis with interspersed fatty tissue, generating septa and blocks. The evolution of is progressive and results in the appearance of localized tumor masses 2,5,10 . Within this context, in all our patients the predisposing factor was obesity and the described etiopathogenic mechanism was triggering by infection, due to favorable local conditions.…”