Lymphovenous anastomosis (LVA) for treatment of isolated penile lymphedema: A case report.

Isolated penile lymphedema is a rare but severely disabling condition due to reduced lymphatic drainage. In this area treatment opportunities are poor being that conservative management is usually not effective and surgery limited to debulking lymphangiectomy, which is indicated only in very severe cases. Lymphovenous anastomosis (LVA) has a demonstrated efficacy in treatment of upper and lower limbs lymphedema but still has few applications in genital lymphedema and none when the swelling is confined in the penis. Here we present a case of an isolated penile lymphedema treated with super-microsurgical LVA. A 33-year-old patient presented swelling and pain immediately after a traumatic injury at the base of the penis. After 2 years of conservative praxis with manual lymphatic drainage of the penis and upper thigh bandage compression, no improvement of the symptoms was obtained. Indocyanine green lymphography was performed with dye injection in the glans confirming the diagnosis by showing lymphatic drainage stasis (dermal backflow). We consequently decided to undergo a surgical procedure performing lymphovenous anastomosis at the dorsum of the penis. Immediately following this intervention, both objective and subjective symptoms relief were noted with decrease of swelling and pain. The postoperative course was uneventful and at the 6 months follow up the patient reported no recurrence of the swelling even with the complete removal of compression therapy. We consider therefore that LVA may be a valid possibility for management of similar cases to provide a definitive clinical improvement.