CC BY 4.0 · Arch Plast Surg 2023; 50(02): 182-187
DOI: 10.1055/s-0042-1757572
Extremity/Lymphedema
Idea and Innovation

Surgery Is the Last Resort for Huge Scrotal Lymphedema: A Series of Challenging Cases

Yasser M. ElKiran
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Amr M. Elshafei 
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Mohamed S. Abdelgawad
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Mohammed F. Kamel
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Hesham A. Sharaf-Eldeen
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Mohammed A. Abdelmaksoud
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abstract

We aim to provide our surgical techniques, and outcomes of functional scrotal reduction procedures with complete preservation of the genitourinary original anatomy in a simple way without using complicated skin grafting or skin advancement flaps in Patients with huge and long-standing scrotal lymphedema 18 patients ages ranged from 14-65 with a median of 30 years. Functional scrotal and penoscrotal reduction was attained in all cases, without distortion of the genitourinary anatomy and without the need for advancement, rotational or free flaps, maximal scrotal diameter was reduced from median of 61[48-92] cms to a median of 25[21–29] cms (P<0.0001) and remained almost unchanged at the end of the follow up period 26[22-34] cms (P<0.0001). Sexual performance and voiding capacity were improved in all patients, testicular vascularity was unaffected and the Glasgow Benefit Inventory (GBI) for the quality of life showed marked enhancement in the total 55.5[50–72], general 55.5[50–72], social 100[50–100] and physical 16.6[16–33] points subscales. According to our experience, surgery remains the gold standard treatment for management of huge scrotal lymphedema, successful preservation of the genitourinary functions can be attained despite the size in most cases with excellent cosmoses.

Keywords

lymphedema - genitalia - scrotal swelling

Author Contributions

Y.M.E. (Conceptualization, acquisition of data, revising the article), A.M.E. (analysis and interpretation of data, drafting the article), M.S.A. (acquisition of data, drafting the article), M.F.K. (acquisition of data, revising the article), H.A.S.-E. (analysis and interpretation of data, revising the article) M.A.A. (Conceptualization, drafting the article). All authors read and finally approved of the version to be published, all authors were accountable for all aspects of the work.


Ethical Approval

An approval was submitted in our ethics committee department under approval number R/18.12.373.


Patient Consent

Informed consent was obtained from all individual participants included in the study.


Supplementary Material



Publication History

Received: 24 February 2022

Accepted: 29 June 2022

Article published online:
10 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Cook G. Podoconiosis. Non-infectious geochemical elephantiasis. In: Cook G, Zumla A. eds. Manson's Tropical Disease. 2nd ed. London: WB Saunders; 1998: 1322-1338
    Search in Google Scholar
  • 2 de Godoy JM, Facio Jr FNJ, de Carvalho EC, Godoy MdeF. New compression mechanism in penile-scrotal lymphedema and sexual rehabilitation. Urol Ann 2014; 6 (01) 88-90
    CrossrefPubMedSearch in Google Scholar
  • 3 Singh V, Sinha RJ, Sankhwar SN, Kumar V. Reconstructive surgery for penoscrotal filarial lymphedema: a decade of experience and follow-up. Urology 2011; 77 (05) 1228-1231
    CrossrefPubMedSearch in Google Scholar
  • 4 Martínez RE, Couchell SH, Raffel B, Swartz WM. Primary lymphedema of the scrotum: surgical treatment and reconstruction. Ann Plast Surg 1988; 21 (04) 354-357
    CrossrefPubMedSearch in Google Scholar
  • 5 Vives F, García-Perdomo HA, Ocampo-Flórez GM. Giant lymphedema of the penis and scrotum: a case report. Autops Case Rep 2016; 6 (01) 57-61
    CrossrefPubMedSearch in Google Scholar
  • 6 Casley-Smith JR, Casley-Smith JR. Modern treatment of lymphoedema. I. Complex physical therapy: the first 200 Australian limbs. Australas J Dermatol 1992; 33 (02) 61-68
    CrossrefPubMedSearch in Google Scholar
  • 7 Földi E. The treatment of lymphedema. Cancer 1998; 83 (12, Suppl American): 2833-2834
    CrossrefPubMedSearch in Google Scholar
  • 8 Goel TC, Goel A. Treatment and prognosis. In: Goel TC, Goel A. eds. Lymphatic Filariasis. 1st ed. Singapore: Springer; 2016: 81-85
    Search in Google Scholar
  • 9 Gibson T. Delpech: his contributions to plastic surgery and the astonishing case of scrotal elephantiasis. Br J Plast Surg 1956; 9 (01) 4-10
    CrossrefPubMedSearch in Google Scholar
  • 10 Morey AF, Meng MV, McAninch JW. Skin graft reconstruction of chronic genital lymphedema. Urology 1997; 50 (03) 423-426
    CrossrefPubMedSearch in Google Scholar
  • 11 Ogunbiyi SO, Modarai B, Smith A, Burnand KG. London Lymphoedema Consortium. Quality of life after surgical reduction for severe primary lymphoedema of the limbs and genitalia. Br J Surg 2009; 96 (11) 1274-1279
    CrossrefPubMedSearch in Google Scholar
  • 12 Elkiran YM, Elshafei AM, Abdelgawwad MS, Abdelmaksoud MA. Surgical management of giant scrotal lymphedema in morbidly obese patient with trisomy 21. J Vasc Surg Cases Innov Tech 2019; 5 (01) 71-74
    CrossrefPubMedSearch in Google Scholar
  • 13 Elkiran YM, Abdelmaksoud MA, Abdelgawwad MS, Elsaadany NA, Elshafei AM. Giant scrotal swelling in association with a congenital giant melanocytic nevus: a case report. JPRAS Open 2020; 26: 80-85
    CrossrefPubMedSearch in Google Scholar
  • 14 Cimador M, Castagnetti M, De Grazia E. Management of hydrocele in adolescent patients. Nat Rev Urol 2010; 7 (07) 379-385
    CrossrefPubMedSearch in Google Scholar
  • 15 Torio-Padron N, Stark GB, Földi E, Simunovic F. Treatment of male genital lymphedema: an integrated concept. J Plast Reconstr Aesthet Surg 2015; 68 (02) 262-268
    CrossrefPubMedSearch in Google Scholar
  • 16 Dandapat MC, Mohapatro SK, Patro SK. Elephantiasis of the penis and scrotum. A review of 350 cases. Am J Surg 1985; 149 (05) 686-690
    CrossrefPubMedSearch in Google Scholar
  • 17 Wisenbaugh E, Moskowitz D, Gelman J. Reconstruction of massive localized lymphedema of the scrotum: results, complications, and quality of life improvements. Urology 2018; 112: 176-180
    CrossrefPubMedSearch in Google Scholar
  • 18 Apesos J, Anigian G. Reconstruction of penile and scrotal lymphedema. Ann Plast Surg 1991; 27 (06) 570-573
    CrossrefPubMedSearch in Google Scholar
  • 19 Salas Cabrera R, Moré Pérez F. Giant scrotal lymphedema [in Spanish]. Arch Esp Urol 2007; 60 (02) 195-198
    PubMedSearch in Google Scholar
  • 20 McKay HA, Meehan WL, Jackson AC, LeBlanc GA. Surgical treatment of male genital lymphedema. Urology 1977; 9 (03) 284-287
    CrossrefPubMedSearch in Google Scholar