Giant scrotal elephantiasis

Genital elephantiasis in men

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.

Giant Scrotal Lymphoedema: A Case Series

Giant scrotal lymphoedema is a rare condition caused by obstruction, aplasia, or hypoplasia of lymphatic vessels draining the external genitalia. While this condition can be congenital or acquired, the most common acquired cause of such lymphatic obstruction worldwide is lymphatic filariasis (LF). We present a case series analysis of three patients of giant scrotal lymphoedema who were successfully treated for the condition in the Department of General Surgery, King George's Medical University (KGMU), Lucknow, with satisfactory post-operative recovery and minimal recurrence. The first patient was a 45-year-old who had been living with the condition for 10 years, and the resected scrotal tissue weighed 35 kg. The second patient was a 45-year-old who was diagnosed with filariasis five years back before the condition set in, and the resected scrotal tissue weighed 32 kg. The third patient was a 22-year-old young man who had been diagnosed with the condition 10 years back, and the resected scrotal tissue weighed 25 kg. Proper pre-operative evaluation was conducted in all three patients to establish the diagnosis of scrotal lymphoedema. The urethral catheterisation was conducted, which additionally helped to identify penile tissue intraoperatively. Careful exploration of scrotal tissue was conducted along with delineation of the penis from scrotal oedema. The surgical approach involved debulking scrotal lymphoedema with the reconstruction of scrotal skin while preserving penile tissue. Patients with giant scrotal lymphoedema face the social stigma that creates physical disability. Hence, they end up seeking medical help from tertiary care centres after the disease has reached advanced stages and fibrosis has set in. However, single-stage debulking, along with reconstructive surgery (referred to as reduction scrotoplasty), yields promising results even in cases of very bulky scrotal lymphoedema, weighing up to 35 kg, as per our study.

Infectious etiologies of genital elephantiasis outside of filariasis endemic regions: a case report

Background

Isolated genital elephantiasis outside filariasis endemic tropical and subtropical regions is rare and presents a diagnostic and therapeutic challenge. Serologic and radiographic investigation must be undertaken to exclude reversible causes of genital elephantiasis.

Case presentation

Authors report herein the case of a 58-year-old patient with chronic penile and scrotal elephantiasis. He had a history of untreated urethritis and an endoscopic urethrotomy for urethra stricture three years ago. Serological test for chlamydiosis was positive. Retrograde urethrocystography demonstrated a bulbar urethra stricture. The patient spectacularly and completely improved after endoscopic urethrotomy and long-term doxycycline.

Conclusions

Early treatment of sexual transmitted infections such as chlamydiosis is important to prevent the evolution of penoscrotal elephantiasis and to avoid surgical procedures.

Giant scrotal swelling in association with a congenital giant melanocytic nevus: A case report

Introduction

Scrotal lymphedema is a rare condition, with significant psychological and functional disability. To date, association with giant congenital melanocytic nevus has not been reported.

Case report

We report a case of a 15-year-old male with a giant congenital nevus associated with giant scrotal lymphedema. Surgical debulking with penoscrotoplasty achieved satisfactory functional and esthetic results.

Conclusions

Early diagnosis and surgical intervention should be advocated for congenital causes of large scrotal swelling.

[Surgical treatment of scrotal lymphedema]

L’éléphantiasis scrotal se définit comme étant une augmentation du volume scrotal qui peut atteindre une taille très importante; il s’agit du patient O.H âgé de 70 ans, marié et père de 4 enfants, originaire et résident à Agadir (sud du Maroc), agriculteur de profession. Le début de la symptomatologie remonte à 7 ans par l’installation de l’œdème scrotal puis des deux pieds et jambes augmentant progressivement de volume. L’examen local mettait en évidence un éléphantiasis scrotal de 80cm de circonférence et des deux jambes et pieds. Une imagerie à résonnance magnétique (IRM) pelvienne a été demandée dans le cadre du bilan d’exploration locorégionale. Le patient a été programmé pour un geste d’exérèse scrotale en mono- bloc sous rachis anesthésie avec libération des deux testicules couvertes directement par la peau restante et de la verge qui a été couverte par greffe de peau mince. Le but du traitement est assurer la fonction et prendre en charge les préjudices esthétiques. Le traitement conservateur consistant à la dérivation lymphatique vers le réseau veineux ou à la dilatation des vaisseaux lymphatiques a été abandonné. On se base pour la prise en charge sur la chirurgie qui peut être abstenu en cas de contre indication absolue au geste chirurgical.

Penoscrotal edema: a case report and literature review

BACKGROUND

Penoscrotal edema is typically caused by lymphatic obstruction, which can have both primary and secondary causes. Studies describing congenital penoscrotal edema are rare. Surgery can be divided into two types: The first approach involves extensive removal of diseased tissue and tissue reconstruction. The second approach is removal of the lesions and creating additional lymphatic vascular anastomoses.

CASE PRESENTATION

We present a case report of a 15-year-old patient with recurrent penoscrotal edema and swelling of both lower extremities. The literature were also reviewed to provide additional information. Physical examination revealed slow lymphatic reflux of the lower extremities and no obvious abnormalities in testicular morphology, bilaterally, or blood supply. Surgery was performed by excising the affected skin and subcutaneous tissue and the flaps was cut in the middle in Y shape to cover the penis and scrotum. Postoperative follow-up revealed wound integrity and patient satisfaction with the outcome.

CONCLUSION

Excision and reconstructive surgery are the primary treatments for penoscrotal edema. The majority of reported patients undergoing excision and reconstruction achieved satisfactory reshaping and improved their life quality.

Giant Penile Lymphedema Caused by Chronic Penile Strangulation with Rubber Band: A Case Report and Review of the Literature

We treated a 65-year-old Japanese man with a giant penile lymphedema due to chronic penile strangulation with a rubber band. He was referred to our hospital with progressive penile swelling that had developed over a period of 2 years from chronic use of a rubber band placed around the penile base for prevention of urinary incontinence. Under a diagnosis of giant penile lymphedema, we performed resection of abnormal penile skin weighing 4.8 kg, followed by a penile plasty procedure. To the best of our knowledge, this is only the seventh report of such a case worldwide, with the present giant penile lymphedema the most reported.

Surgical Reconstruction of Giant Penoscrotal Lymphedema in Sub-Saharan Africa

OBJECTIVE

To present management challenges, surgical technique, and outcome associated with penoscrotal reconstruction in patients with giant scrotal lymphedema in sub-Saharan Africa.

METHODS

A prospective study of all patients who had penoscrotal reconstruction for giant scrotal lymphedema at our university teaching hospital between January 2003 and December 2012 was carried out. Patients' preoperative clinical evaluation findings, operative technique, and postoperative course were reviewed after obtaining ethical approval and informed consent from the patients.

RESULTS

Nineteen patients with giant scrotal lymphedema presented to us during the period of study; out of which, 11 had surgical excision and were studied. Their mean age and median duration of symptoms were 48.5 years and 11.5 years respectively. They all had surgical reconstruction using modified Charles procedure by the same combined team of urologists and plastic surgeons. Scrotal hematoma (27.3%) and superficial surgical site infection (18.2%) were complications encountered postoperatively. One patient (9.1%) had recurrence within 24 months, requiring repeat excision.

CONCLUSION

Giant scrotal lymphedema poses severe physical challenge to the sufferer. Surgery remains the only hope to reduce penoscrotal size. Combined effort of urologic and plastic surgeons is essential for reconstruction.

Management of pediatric pyocele using percutaneous imaging-guided aspiration

INTRODUCTION

Pyocele of the scrotum is a rare clinical entity not well-described in the pediatric literature. With the exception of those patients who cannot undergo surgery, all published cases have been treated definitely with surgical drainage with severe cases leading to orchiectomy.

PRESENTATION OF CASE

A 12 day-old full-term boy with no significant medical history presented to the emergency department with a two-day history of fever, right hemiscrotal redness, swelling and discomfort. Scrotal ultrasound revealed findings consistent with an acute pyocele of the tunica vaginalis also known as an infected hydrocele. The infection was successfully managed with ultrasound-guided transcutaneous aspiration under local anesthesia.

DISCUSSION

To the best of our knowledge, this is the first description of percutaneous aspiration of infant pyocele Pediatric patients diagnosed with acute pyocele require immediate urologic evaluation, with a consideration for surgical exploration and drainage. Unfortunately, orchiectomy may be required at the time of surgical exploration in severe cases. Percutaneous drainage is a non-operative, minimally invasive treatment modality that avoids orchiectomy and the risks of general anesthesia.

CONCLUSION

Percutaneous drainage avoids open surgical exploration, expedites recovery, and is performed in the absence of general anesthesia in select cases.

Reconstructive surgery for giant penoscrotal elephantiasis: about one case

Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.

Giant scrotal elephantiasis: an idiopathic case

Scrotal elephantiasis is very rare disease in industrialized countries, where it is mainly due to surgery, irradiation or malignancies. It can be defined as idiopathic only when the possible congenital, infectious and compressive causes are excluded. We report a case of massive scrotal lymphoedema in an adult Caucasian patient, in Italy. He presented an extremely voluminous scrotal mass measuring 50 x 47 x 13 cm (weight 18 kg), which extended below his knees, invalidating all his daily activities. The patient was hospitalized in order to undergo to surgical treatment. Although genetic causes were searched and the possible role of infectious agents and compressive factors was evaluated, no etiology was ascertained. Histopathologic examination showed non-specific chronic inflammation, confirming the diagnosis of idiopathic elephantiasis. One year after surgical treatment, the patient is healthy without recurrence signs.

Giant scrotal lymphedema of unclear etiology: a case report

Introduction

Scrotal lymphedema is common in the tropics and subtropics. The giant variants can cause a lot of physical disability and psychological disturbances.

Case presentation

We present a 25-year-old Nigerian male with giant scrotal lymphedema with severe debilitating symptoms, immobility and emotional disturbance. He benefited from a modified Charles' procedure and reconstruction of the penile shaft using a split-thickness skin graft.

Conclusion

Giant scrotal lymphedema related to poverty, ignorance and neglect, is amenable to surgery. Surgery provides a cosmetically acceptable and functionally satisfying outcome.

Surgical repair of idiopathic scrotal elephantiasis

Scrotal lymphedema (scrotal elephantiasis) is uncommon outside of filariasis endemic regions. We present a case of a 65-year-old with idiopathic lymphedema of the scrotum and functional impairment of the penis. The patient underwent surgical excision of the edematous subcutaneous tissues and plastic reconstruction of his penis and scrotum. Three years later, the patient showed no signs of local recurrence, had complete restoration of urinary and sexual function and was extremely satisfied with the result. Surgical management was an effective strategy in the management of scrotal lymphedema in this case.

[Penoscrotal elephantiasis: diagnostics and treatment options]

Penoscrotal elephantiasis is a symptom that can be caused by local but also by systemic disorders. When the changes are reversible, conservative measures such as physical and antiphlogistic approaches lead to success. In cases of irreversible penoscrotal elephantiasis, excision and amputation of the affected penoscrotal areas are recommended to eliminate the functional disturbances. In all manifestations it is important to prevent and treat those diseases known to cause elephantiasis.

Giant scrotal elephantiasis of inflammatory etiology: a case report

BACKGROUND

Scrotal lymphedema is rare outside endemic filariasis regions in Africa and Asia. It is of variable origin in the western world.

CASE PRESENTATION

We present a case of a 40-year-old European man with massive elephantiasis of the scrotum attributed to chronic inflammation of the lower urinary tract caused by urinary outlet obstruction and diabetes mellitus. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome.

CONCLUSION

In this report we discuss a rare case of scrotal elephantiasis in an European patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant scrotal elephantiasis.

[A case of iatrogenic scrotal elephantiasis: reconstruction of the scrotal purse and the cutaneous sleeve of the penis with local skin flaps]

Scrotal elephantiasis is a pathology of often unknown etiology. Symptomatology is characterized by an oedematius infiltration of skin and subcutaneous tissue, hard-bound aspect and purplished color. The scrotum, the penis and the perineal area are gradually affected. This pathology is very invalidating for the patient, on functional, sexual and aesthetic aspects. The authors present the case of a 58-year-old man with an enormous scrotal mass invading the penis and drowning the testicular elements, which were impossible to palpate. The aetiology was determined by exclusion and an iatrogenic origin following the cure of bilateral inguinal hernia was retained. Resection of the scrotal mass was performed. The reconstruction of the scrotal purse and the cutaneous sleeve of the penis were carried out using local flaps of the remaining healthy skin.