Surgical reconstruction of primary genital lymphedema-long term therapeutic efficacy

Ziyou Yu; Lingling Sheng; Weigang Cao; Shengli Li; Wei Lu; Weiqing Gao; Zhaohua Jiang

doi:10.21037/gs.2020.03.19

Surgical reconstruction of primary genital lymphedema-long term therapeutic efficacy

Gland Surg. 2020 Apr;9(2):575-581. doi: 10.21037/gs.2020.03.19.

Authors

Ziyou Yu¹, Lingling Sheng¹, Weigang Cao¹, Shengli Li¹, Wei Lu¹, Weiqing Gao², Zhaohua Jiang¹

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.
² Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.

Abstract

Background: Primary genital lymphedema is caused by congenital lymphatic dysplasia, which is often accompanied by lymphedema of the lower extremities. A lack of effective diagnostics and treatments are available in clinical practice. The purpose of this study is to present the experience of surgical treatment of genital lymphedema and follow-up magnetic resonance lymphangiography (MRL) examinations.

Methods: The clinical records of 40 patients diagnosed with primary genital lymphedema between 2010 and 2019 were retrospectively reviewed. The surgical management of all patients consisted of complete excision of the edematous subcutaneous tissue and plastic reconstruction of the penis or scrotum. This involved excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. All patients were examined by MRL to assess the extent of lymphedema pre- and postoperatively. The cosmetic results, recovery of sexual function, patient satisfaction, and complications are discussed.

Results: A total of 40 patients underwent surgical treatment. Scrotal hematoma (2.5%) and poor wound healing (5%) were encountered postoperatively. During follow-up period, no recurrence of edema occurred. The appearance of the scrotum and penis, as well as the sexual function was improved. MRL confirmed tissue edema and lymphatic malformation in the enlarged penis and scrotum preoperatively. In follow-up MRL, new formation or reopen of lymphatic drainage can be detect in 25 (62.5%) patients. All patients showed decreased area of dermal backflow.

Conclusions: Surgical treatment is necessary for genital lymphedema when swelling develops. The use of a retained scrotal septum and subcutaneous lymphatic tissue flaps can achieve improved morphology and function. MRL is a safe and accurate diagnostic imaging method for pre- and postoperative evaluation of lymphedema in patients undergoing lymphatic surgery.

Keywords: Genital lymphedema; magnetic resonance lymphangiography (MRL); surgical reconstruction.