GIANT PENOSCROTAL LYMPHEDEMA: PLANNING AND SURGICAL TECHNIQUE TO TREAT A RARE DEBILITATING DISEASE
AbstractBackground: Giant penoscrotal lymphedema is a rare condition and is treated by surgical debulking and reconstruction with remaining skin and skin grafts. The described techniques may result in a staged surgery, multiple blood transfusions, orchidectomy and early debulking of the scrotal skin. We present a case series describing our technique to address all the concerns, discuss management to decrease progression and transmission in secondary cases and present a novel questionnaire to assess of quality of life of these patients. Methods: This descriptive case series was done from July 2016 to October 2019. Patients with Campisi grade 5 disease were included. Clinical assessment and relevant investigations were done to identify the cause and confirm the extent of the disease. Procedural detail, post-op haemoglobin levels (Hb), need for transfusion and weight of excised specimen were recorded. Wound healing, recurrence and body mass index were noted on follow up. Scrotal lymphedema quality questionnaire was developed and was filled on follow-up visit. Results: Twelve patients were operated on. The mean history was 3.0±0.5 years. 4 tested positive for microfilariae, while 4 out of 8 who tested negative had taken the anthelmintic drug. The mean weight excised was 15.8±2.3 kg, mean pre-operative score on quality-of-life assessment questionnaire was 83.3±2.6 versus 9.3±0.8 post operatively. Mean follow up time was 1.4±0.6 years. 1 patient had a minor recurrence necessitating re excision. Mean Hb was 13.5 ± 0.5 mg/dl preoperatively compared to 11.8±0.5 mg/dl post operatively, with none requiring transfusion. Conclusion: Single staged excision with split thickness skin grafting is an effective and safe way to treat patients with giant scrotal lymphedema. It’s the single best way to address the quality of life of patients.
Brown WL, Woods JE. Lymphedema of the penis. Plast Reconstr Surg 1977;59(1):68–71.
Gupta S, Ajith C, Kanwar AJ, Sehgal VN, Kumar B, Mete U. Genital elephantiasis and sexually transmitted infections - revisited. Int J STD AIDS 2006;17(3):157–65.
McDougal WS. Lymphedema of the external genitalia. J Urol 2003;170(3):711–6.
Tammer ME, Plogmeier K, Schneider W. Surgical therapy of scrotal edema in elephantiasis congenital hereditaria (Meige type). Urologe A 2002;41(5):493–5.
Nelson RA, Alberts GL. Penile and scrotal elephantiasis caused by indolent chlamydia trachomatis infection. Urology 2003;61(1):224.
Kalanzi EW, Ssentongo R, Zeeman R. Giant peno-scrotal lymphoedema: surgical considerations and management. East Cent Afr J Surg 2008;13(1):110–6.
Doscher ME, Herman S, Garfein ES. Surgical management of inoperable lymphedema: the re-emergence of abandoned techniques. J Am Coll Surg 2012;215(2):278–83.
Vives F, García-Perdomo HA, Ocampo-Flórez GM. Giant lymphedema of the penis and scrotum: a case report. Autops Case Rep 2016;6(1):57–61.
Campisi C, Davini D, Bellini C, Taddei G, Villa G, Fulcheri E, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 2006;26(1):65–9.
Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: scoping review. SAGE Open Med 2016;4:2050312116671725.
Mooney A. Quality of life: questionnaires and questions. J Health Commun 2006;11(3):327–41.
Hardt J. A new questionnaire for measuring quality of life - the Stark QoL. Health Qual Life Outcomes 2015;13:174.
O'Farrell N, Hoosen AA, Coetzee KD, van den Ende J. Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. Genitourin Med 1994;70(1):7–11.
Tillyashaykhov MN, Boyko Ye V, Aloev BB, Abdusamatov NT, Khasanov Sh T, Tillyashaykhova RM, et al. Giant scrotal lymphedema: a presentation of rare urogenital disease – a case report. Ann Clin Lab Res 2019;7(1):292.
Thejeswi P, Prabhu S, Augustine AJ, Ram S. Giant scrotal lymphoedema - a case report. Int J Surg Case Rep 2012;3(7):269–71.
Singh V, Sinha RJ, Sankhwar SN, Kumar V. Reconstructive surgery for penoscrotal filarial lymphedema: a decade of experience and follow-up. Urology 2011;77(5):1228–31.
Beg MA, Naqvi A, Zaman V, Hussain R. Tropical pulmonary eosinophilia and filariasis in Pakistan. Southeast Asian J Trop Med Public Health 2001;32(1):73–5.
Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J. Nematode infections: filariases. Infect Dis Clin North Am 2012;26(2):359–81.
Dembele B, Coulibaly YI, Dolo H, Konate S, Coulibaly SY, Sanogo D, et al. Use of high-dose, twice-yearly albendazole and ivermectin to suppress Wuchereria bancrofti microfilarial levels. Clin Infect Dis 2010;51(11):1229–35.
Mand S, Debrah AY, Klarmann U, Batsa L, Marfo-Debrekyei Y, Kwarteng A, et al. Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial. Clin Infect Dis 2012;55(5):621–30.
Rahman GA, Adigun IA, Yusuf IF, Aderibigbe AB, Etonyeaku AC. Giant scrotal lymphedema of unclear etiology: a case report. J Med Case Reports 2009;3:7295.
Ravari H, Johari HG, Rajabnejad A, Khooei A. Giant Scrotal Lymphoedema. J Cutan Aesthet Surg 2015;8(1):67–8.
Atawurah H, Orish VN. Giant scrotal lymphatic filariasis. J Med Trop 2017;19:136–8.
Modolin M, Mitre AI, Silva JCF, Cintra W, Quagliano AP, Arap S, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics 2006;61(4):289–94.
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