title: Surgical treatment of lymphedema of the penis and scrotum.
abstract: 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.
authors.affiliation: Plastic Surgery/Urology Faculty of Medicine, University of São Paulo. miguelmodolin@uol.com.br
authors.forename: Miguel
authors.initials: M
authors.lastname: Modolin
authors.forename: Anuar Ibrahim
authors.initials: AI
authors.lastname: Mitre
authors.forename: José Carlos Faes
authors.initials: JC
authors.lastname: da Silva
authors.forename: Wilson
authors.initials: W
authors.lastname: Cintra
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Quagliano
authors.forename: Sami
authors.initials: S
authors.lastname: Arap
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: 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