Reconstruction of penile and scrotal lymphedema

Acquired genital chronic lymphedema and elephantiasis are not common problems in the United States. Most noncongenital cases are due to lymph node dissection, injury, or irradiation. Genital lymphedema is a functionally disabling and emotionally incapacitating entity, especially in the elderly population. Methods of reconstruction reported in the literature involve either lymphangioplasty or direct excision of the involved tissue with local tissue reconstruction. We report a case of acquired genital elephantiasis in an elderly man following radical cystectomy and pelvic irradiation for transitional cell bladder cancer. Our technique of reconstruction consisted of (1) excision of all involved lymphedematous skin of the penis and scrotum, and (2) use of posterior scrotal flaps, superiorly based flap of the pubic area for testicular coverage, and split-skin graft to the penis. Genital lymphedema presents a formidable challenge for reconstructive surgeons. The low morbidity and successful outcome observed in this case, however, indicate that the procedure described herein can and should be offered to elderly patients to improve function and quality of life.