Lymphedema is a condition in which fluid collects in the fatty tissue just under the skin.
The affected part of the body can swell to many times its normal size, and the tissue can become doughy, painful, and chronically infected. Although lymphedema most often affects the arms, hands, and legs, it can also affect the scrotum.
- In some cases, the scrotum can become so large that the patient can no longer walk and is in chronic pain.
- In severe cases, the foreskin of the penis may be inverted and the penis buried in the scrotal tissue.
Causes of Lymphedema
Lymphedema can occur when infection, damage, or a blockage prevents the lymphatic channels from draining normally. This can occur after radiation therapy or surgery to treat cancer, but there are cases that arise for no apparent reason. Although many men suffering from the condition are obese, simply losing weight does not typically resolve the issue. In some cases, patients are so disabled by the massive size of the scrotum that physical activity and weight loss is virtually impossible.
Treatments for Scrotal Lymphedema
The most effective treatment for scrotal lymphedema is surgery to remove the mass, along with reconstruction of the scrotum and penis if necessary. Because of the delicate nature of the surgery, the procedure is typically performed by a team that includes both a urologist and a plastic surgeon.
The procedure is performed under general anesthesia and begins with a catheter being inserted into the urethra to protect the urethra and stabilize the penis. The surgeon then separates the shaft of the penis from the surrounding tissue and removes any scarred or infected tissue. Surgery may also involve detaching the ligament that runs from the base of the penis to the pubic bone. Skin from the thigh may be grafted onto the penile shaft where it was separated from the surrounding tissue.
Because scrotal lymphedema is often associated with obesity, additional procedures may be performed to remove the excess fat and tissue.
Suction lipectomy, also known as liposuction, involves the suctioning of fat through catheters inserted through small incisions.
- Excess fat and tissue hanging down over the thighs and genitals may be removed through a procedure known as a panniculectomy.
- The fat situated above the pubic area may be removed using a procedure known as an escutheonectomy.
Recovery and Outlook Following Scrotal Lymphedema Surgery
Most patients remain in the hospital for three to five days. Antibiotics may be prescribed to prevent postoperative infection, and a catheter is normally worn for approximately a week. A follow-up appointment to check the skin graft and remove the catheter is scheduled a week following surgery. A second follow-up is scheduled for four to six weeks following surgery, and further follow-ups are scheduled as needed for the first year.
Most patients do not experience a recurrence of the condition and have normal sensation and function following surgery; however, all surgeries have potential risks. Possible complications resulting from scrotal lymphedema surgery include:
- Decreased sensitivity in the genital area
- Poorly healed skin grafts
- Swelling of the penis
- Painful erections