Giant peno-scrotal lymphoedema: surgical considerations and management

Abstract

Chronic lymphoedema can affect any parts of the body, including the scrotum and penis. Massive scrotal lymphoedema with gross genital deformation is called penoscrotal elephantiasis¹. Penoscrotal elephantiasis can be a functionally and emotionally incapacitating dilemma to the patients. Usually patients suffer from pain, chronic irritation, repeated infections, ambulatory problems, sexual dysfunction and social dejection. Congenital (primary) lymphoedema is due to malformation of the lymphatic vessels and are rare conditions for example the congenital hereditary elephantiasis of the Meige type². Acquired (secondary) genital lymphoedema can be caused by genital infection such as lymphogranuloma venereum (LGV), filarial infestation like Wuchereria bancrofti, recurrent inflammation, tumors, lymph node dissection, trauma and radiotherapy³. With severe penoscrotal lymphoedema, the mainstay of treatment involves surgical excision, followed by reconstruction using local flaps or skin grafts. We present 3 cases of giant penoscrotal elephantiasis treated by excision and reconstruction with anterior and posterior flaps as a successful treatment of this difficult problem.