A salvage surgical solution for recurrent lymphangioma of the prepuce

Penile Chylorrhea as a Rare Presentation of Penile Lymphangioma Circumscriptum Reconstructed with Deep External Pudendal Artery Perforator Flap

Chylorrhea, a chylous (white viscid) discharge from the external urethral penile opening, is unrelated to urination and is a rare presentation of lymphangioma circumscriptum in the penis that can significantly impair a patient’s quality of life and psychological well-being. Herein, we present a case of recurrent chylorrhea that was detected using diagnostic tools and treated using the deep external pudendal artery perforator flap in the inner thigh, which is extremely rich in lymphatic vessels and lymph nodes.

Penile Lymphangioma: review of the literature with a case presentation

Background

Penile lymphangiomas are rare manifestations of lymphangiomas or lymphatic malformations which are more commonly found in the head or neck region of the body. Lymphangiomas are further categorized as lymphangioma circumscriptum, cavernous lymphangioma, cystic hygroma, or acquired lymphangiomas (also known as lymphangiectasia), based on their depth and etiology.

Results

A literature review revealed only 30 cases of penile lymphangioma between 1947 and March 30, 2018. Several causes were attributed to the acquired penile lymphangiomas, including trauma, phimosis, and infection. While penile lymphangiomas can be initially mistaken for an infection, a thorough history and physical examination is sufficient to clinically diagnose a lymphangioma of the penis. Historically, surgical excision has been the gold standard of treatment for this condition. When asymptomatic, patients may opt for conservative management with avoidance of mechanical trauma alone. Other physicians have revealed novel treatment plans to rid patients of their penile lymphangioma such as a staged laser procedure.

Conclusion

In this article, we elucidate the causes, symptoms, treatments, and outcomes associated with penile lymphangiomas found in the literature while also presenting the case of a 30-year-old African-American man diagnosed with acquired penile lymphangioma.

Surgical Approach to Concealed Penis: Technical Refinements and Outcome

OBJECTIVES

A concealed penis is defined as a phallus of normal size buried in prepubic tissue (buried penis), enclosed in scrotal tissue (webbed penis), or trapped by scar tissue after penile surgery (trapped penis). We report our results using a standardized surgical approach that was highly effective in both functional and cosmetic terms.

METHODS

From January 2002 to December 2005, 56 patients (median age 7 years) underwent surgery for a buried penis, 11 (median age 5 years) for a webbed penis, and 20 (median age 8 years) for a trapped penis. All 20 patients with a trapped penis had previously undergone circumcision for phimosis, except for 3 (1 for multioperated lymphangioma, 1 for repaired hypospadias, and 1 for corrected glanular epispadia). All webbed penises were phimotic, requiring circumcision. The surgical technique consisted of complete exteriorization of the shaft and reconstruction of the penopubic and penoscrotal angles. These maneuvers, however, proved extremely straightforward, with the addition of an incision along the scrotal raphe without any incision of the penile skin.

RESULTS

All the patients were observed for at least 1 year after repair. Recurrence was observed in 3 boys with a buried penis (5.3%); all 3 boys were obese. Two cases of a trapped penis (10.0%) recurred, but no case of a webbed penis recurred. Regarding complications, 2 patients with a buried penis presented with mild lymphatic stasis of distal shaft that spontaneously subsided within a few months.

CONCLUSIONS

The scrotal approach we have described has simplified the complete exteriorization of the penile shaft, with easy bleeding control, avoiding the use of flaps, grafts, and additional ventral Z-plasty often described in published reports. In addition, the cosmetic results were judged to be good by the parents.

CO2 Laser Ablation of Lymphangioma Circumscriptum of the Scrotum

Lymphangioma circumscriptum (LC) is an uncommon skin condition characterized by large muscular-coated lymphatic cisterns that lie deep with in the subcutaneous tissue and communicate with dilated dermal lymphatics. Patients suffer from edema and lymphatic leakage. Surgical excision and reconstruction is the gold standard for therapy. However, this can be mutilating. The authors present a patient who suffered widespread disease of his scrotum who had excellent symptomatic relief by treatment with the CO(2) laser.