Genital lymphoedema: Pathology, reconstruction and outcomes

Background: Penile and scrotal lymphoedema is a debilitating complication following lymph node dissection, radiation, or in the setting of obesity. Treatment is aimed at improving cosmesis and reducing urologic complications. Aims: To describe our experience with the surgical correction of peno-scrotal lymphoedema. Methods: A retrospective review of all patients who underwent surgical treatment for penoscrotal lymphoedema was performed. Comorbidities, technical approaches and functional outcomes were evaluated. Results: Twelve patients were included with an average age of 55.9 (16.6 - 74.4, standard deviation 19.4) years. Presenting symptoms included penile and scrotal oedema (seven patients), scrotal oedema (three), penile oedema (one), and suprapubic and scrotal oedema (one). Causes included obesity (four), radiation therapy (three), pelvic lymph node dissection (two) and unknown (two). Surgical procedures performed included penoplasty and scrotoplasty (eight), scrotoplasty (three), and penoplasty (one). Immediate complications developed in four patients and long-term complications in seven patients. Lymphoedema recurrence rate was seen in four (33.3%) patients out of 12, while three (25%) patients required reoperation. Conclusion: Our series describes a surgical technique with repeatedly favourable outcomes and highlights the necessity for multidisciplinary care to improve treatment outcomes.