Surgical treatment of lymphedema of the penis and scrotum.
OBJECTIVE
Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region.


METHODS
Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface.


RESULTS
Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema.


CONCLUSIONS
The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.
Modolin
Miguel
M
Plastic Surgery/Urology Faculty of Medicine, University of São Paulo. miguelmodolin@uol.com.br
Mitre
Anuar Ibrahim
AI
da Silva
José Carlos Faes
JC
Cintra
Wilson
W
Quagliano
Ana Paula
AP
Arap
Sami
S
Ferreira
Marcus Castro
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D005832:Genital Diseases, Male / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008209:Lymphedema / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000473:pathology / Q000601:surgery*; D012611:Scrotum / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome