Genital elephantiasis in men.

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.

Genital elephantiasis: Surgical treatment and reconstruction.

Genital elephantiasis is a severe form of lymphedema of the groin. It is characterized by progressive enlargement and distortion of the genitals, presenting significant physical, psychological, and social challenges to the affected individuals. Although pharmacological treatment of filariasis is well-established in the medical field, the surgical management of genital elephantiasis can be varied and confusing. This review article provides an in-depth analysis of the etiology, classification, severity grading, and various effective surgical treatment and reconstructive modalities commonly employed by surgeons since the early twentieth century. We also discuss how a combination approach of ablation, soft tissue coverage, and lymphatic reconstruction is viable for treating genital elephantiasis. By examining the literature, we hope to provide insights into how surgery plays a role in the holistic management of genital elephantiasis.

Radical reduction and reconstruction for male genital elephantiasis: Superficial circumflex iliac artery perforator (SCIP) lymphatic flap transfer after elephantiasis tissue resection.

BACKGROUND: Treatment of elephantiasis, the most severe lymphedema, is challenging. Management of male genital elephantiasis (MGE) is even more challenging than extremity elephantiasis due to its complicated shape and high risk of lymphorrhea and cellulitis. Complete resection of fibrous tissue and lymphatic reconstruction is considered to be ideal for the treatment of MGE. The aim of this study was to evaluate the feasibility of radical reduction and reconstruction (3R) for isolated MGE. METHODS: Medical charts of patients who underwent 3R were reviewed. The 3R operation consisted of genital fibrous tissue resection and reconstruction of soft tissue and lymphatic structure using superficial circumflex iliac artery perforator (SCIP) lymphatic flap transfer (LFT). No compression was applied postoperatively. Patient and flap characteristics, intraoperative findings, and postoperative results were evaluated. RESULTS: Seven patients were included. MGE included isolated scrotal elephantiasis in 4 cases, and scrotal and penile elephantiasis in 3 cases. Resected tissue volume ranged from 609 to 2304 grams (average, 1511.0 grams). SCIP-LFT was performed in all cases; pedicled full-thickness SCIP-LFT for scrotal reconstruction in all cases, and SCIP pure-skin-perforator flap transfer for penile reconstruction in 3 cases. There was no postoperative genital complication or evidence of genital lymphedema recurrence in the mean follow-up period of 22.7 months. Genital lymphedema scores significantly improved postoperatively (6.7 ± 1.8 vs. 0.3 ± 0.5, P <0.001). CONCLUSIONS: 3R operation allowed one-stage curative treatment for MGE. LFT has the potential to play an essential role in the prevention of postoperative wound complications and lymphedema recurrence after radical resection of fibrotic tissue.

Giant scrotal elephantiasis in a migrant from Niger.

We hereby describe the case of a giant scrotal elephantiasis due to infection by Wuchereria bancrofti, imported in Belgium. We briefly discuss diagnostic methods, their subtlety, and therapeutic possibilities.

Resection and reconstruction of idiopathic scrotal elephantiasis: surgical approach and quality of life assessment.

Scrotal elephantiasis (SE) is a condition considered rare in western industrialised countries but common in filaria prone regions. If no apparent causes are found for SE, it is called idiopathic SE. Medical and conservative therapies are ineffective against idiopathic SE, and surgical intervention is mandatory to treat this disabling condition. Nevertheless, it remains unclear whether surgical intervention improves quality of life among patients with idiopathic SE. Herein, we report a case of a 41-year-old man who underwent acute scrotal resection and reconstruction, secondary to haemorrhage from his idiopathic SE. The aim of this study was to describe the operative approach and assess patient satisfaction after surgical treatment. The patient had no recurrence of SE after surgical treatment at 6 months follow-up and had considerable improvements assessed by general and disease-specific quality of life questionnaires.

Surgical debulking of podoconiosis nodules and its impact on quality of life in Ethiopia.

BACKGROUND: In Ethiopia, severe lymphedema and acute dermato-lymphangio-adenitis (ADLA) of the legs as a consequence of podoconiosis affects approximately 1.5 million people. In some this condition may lead to woody-hard fibrotic nodules, which are resistant to conventional treatment. We present a series of patients who underwent surgical nodulectomy in a resource-limited setting and their outcome. METHODS: In two teaching hospitals, we offered surgical nodulectomies under local anaesthesia to patients with persisting significant fibrotic nodules due to podoconiosis. Excisions after nodulectomy were left to heal by secondary intention with compression bandaging. As outcome, we recorded time to re-epithelialization after surgery, change in number of ADLA episodes, change in quality of life measured with the Dermatology Quality of Live Index (DQLI) questionnaire, and recurrence rate one year after surgery. RESULTS: 37nodulectomy operations were performed on 21 patients. All wounds re-reepithelialised within 21 days (range 17-42). 4 patients developed clinically relevant wound infections. The DLQI values were significantly better six months after surgery than before surgery (P<0.0001). Also the number of ADLA episodes per three months was significantly lower six months after surgery than before surgery (P<0.0001). CONCLUSION: Nodulectomy in podoconiosis patients leads to a significant improvement in the quality of life with no serious complications, and we recommend this to be a standard procedure in resource-poor settings.

[Surgical treatment of scrotal lymphedema]. / Traitement chirurgical d'un lymphœdème scrotal.

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.

Scrotal elephantiasis associated with follicular occlusion triad: A case report and literature review.

RATIONALE: Follicular occlusion triad (FOT) is an autosomal recessive inherited disease and no more than 3 variants of the triad have been reported. We give a report in which scrotal elephantiasis is a variant of FOT and further perform a literature review. PATIENT CONCERNS: A 41-year-old man came to us because of a large scrotal cyst and generalized skin lesions that had occurred over the past 10 years. The generalized skin lesions consisted of hidradenitis suppurativa on the perineum and back, acne conglobata in the armpit, and dissecting cellulitis of the scalp. He took antibiotics for a long time but achieved poor effect. Furthermore, he told his father and elder brother also manifested such skin lesions. DIAGNOSES: Magnetic resonance showed a mass in the left scrotum with clear boundaries. A routine blood test showed a high leukocyte level of 12 × 10/L and a hemoglobin content of 78 g/L. C-reactive-protein increased. Series of autoimmune antibody tests were negative. The postoperative pathologic findings showed that the mass was an epidermoid cyst, and hematoxylin and eosin staining showed hyperkeratosis of the skin as well as inflammatory and edematous changes. A diagnosis of a variant of FOT was made. INTERVENTIONS: We removed skin abscesses and lesioned the inner part with hydrogen peroxide. Then we performed an excision of the scrotal lesion. OUTCOME: The patient recovered well and had no evidence of recurrence at a 16-month follow-up. LESSONS: We reported a case in which scrotal elephantiasis was a variant of FOT and surgical intervention played an important role in secondary urologic diseases.

Elefantiasis escrotal. Presentación de un caso en Gambia / Elefantíase escrotal. Apresentação de caso na Gâmbia / Scrotal elephantiasis. Case presentation in the Gambia

Se presentó un paciente masculino con 25 años de edad, procedencia rural. Refirió en la cara lateral del hemiescroto derecho secreciones de color amarillo. En los genitales externos presentó una masa de 38 cm de largo y 35 cm de ancho, bordes irregulares, piel circundante edematosa, seca, acartonada, ulcera de 10 x 5 cm, no dolorosa y secreciones blanquecinas y serohemática escasa, pérdida de la anatomía del pene y disuria. Se confirmó el diagnóstico de elefantiasis escrotal secundaria a filariasis. Se aplicó tratamiento con dietilcarbamazina y quirúrgico. El tratamiento posibilitó la curación y la reincorpación social y sexual del paciente(AU)

A 25-year-old male patient was presented, of rural origin to the Urology office of the Royal Victoria National Hospital in the Republic of Gambia. He reported on the lateral side of the right hemiescrot yellow secretions. In the external genitalia it presented a mass of 38 cm long and 35 cm wide, irregular edges, surrounding edematous, dry, cracked skin, ulcer of 10x5 cm, non-painful and whitish secretions and serohematic scarce, loss of penile anatomy and dysuria The diagnosis of scrotal elephantiasis secondary to filariasis was confirmed. Diethylcarbamazine treatment and surgical intervention were applied. The treatment allowed the healing and social and sexual reincorpation of the patient(AU)

Um paciente do sexo masculino, 25 anos, foi apresentado, de origem rural, ao consultório de Urologia do Royal Victoria National Hospital, na República da Gâmbia. Ele relatou no lado lateral das secreções amarelas hemiescrot à direita. Na genitália externa, apresentava massa de 38 cm de comprimento e 35 cm de largura, bordas irregulares, circundando pele edematosa, seca e quebradiça, úlcera de 10x5 cm, secreções não dolorosas e esbranquiçadas e escassez seroemática, perda de anatomia peniana e disúria O diagnóstico de elefantíase escrotal secundária à filariose foi confirmado. Tratamento com dietilcarbamazina e intervenção cirúrgica foram aplicados. O tratamento permitiu a cura e a reincorpação social e sexual do paciente(AU)

Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

The Successful Treatment of Elephantiasis Nostras Verrucosa With Ablative Carbon Dioxide Laser.

BACKGROUND AND OBJECTIVE: Elephantiasis nostras verrucosa (ENV) is a disfiguring skin condition that is difficult to treat. Existing treatment modalities serve to improve cosmesis or treat symptoms. Herein, we report a case of ENV with lymphocutaneous fistula successfully treated with ablative carbon dioxide laser. STUDY DESIGN/PATIENTS AND METHODS: A 57-year-old woman with biopsy-proven ENV with lymphocutaneous fistula was treated with ablative carbon dioxide laser to the symptomatic area of her right thigh in 3 treatment sessions over 6 months. RESULTS: The patient had resolution of lymphocutaneous drainage as well as 90% improvement in the appearance of ENV lesions at the 1-month follow-up visit. CONCLUSION: Ablative carbon dioxide laser may provide cosmetic, symptomatic, and medical benefit for patients with localized ENV.

Técnica de Charles en elefantiasis de extremidad inferior. Caso clínico / Charles procedure in lower limb elephantiasis. A case report

La primera opción terapéutica para el linfedema consiste en medidas conservadoras conocidas como terapia descongestiva compleja, de la que se benefician muchos pacientes. Sin embargo, los casos refractarios severos requieren abordaje quirúrgico. Existen numerosas técnicas disponibles con tasas de recurrencia variables. La técnica de Charles es una alternativa apropiada para los casos más severos. Presentamos nuestra experiencia en un caso en varón de 21 años de edad con elefantiasis masiva de la extremidad inferior izquierda secundaria a linfedema congénito sin respuesta al tratamiento conservador. Tras una valoración clínica y radiológica exhaustiva se propone cirugía ablativa según la técnica de Charles, que llevamos a cabo en 3 tiempos quirúrgicos en 8 meses con resultados globalmente favorables. De paso revisamos la práctica actualmente aceptada para el tratamiento del linfedema de la extremidad inferior y las opciones terapéuticas disponibles (AU)

The first therapeutic option of lymphedema consists on a series of conservative measures known as complex descongestive therapy. Many patients benefit from this program. However, refractory severe cases require surgical management. Many techniques are available with different rates of recurrence. The Charles procedure is an appropriate alternative for severe cases. We present our experience with a 21 years old man with left lower limb massive elephantiasis secondary to congenital lymphedema refractory to conservative treatment. After clinical and radiological assessment, ablative surgery was proposed according to the Charles procedure, performed on 3 surgical times over 8 months, with favorable outcomes. By the way, we review the accepted practice to treat lymphedema in lower limb and the available therapeutic options (AU)

Successful Surgical Treatment for Elephantiasis Nostras Verrucosa Using a New Designed Column Flap.

Elephantiasis nostras verrucosa is a chronic lymphedema that causes enlarged and disfigured extremities. There are plenty of treatment options. However, there is no complete treatment. Preventive or symptomatic therapy is the basis for treating elephantiasis. In this article, we report a case of elephantiasis nostras verrucosa treated successfully by surgical reconstruction using a newly designed column flap.

Excision of Elephantiasis Nostras Verrucosa Lesions in a Patient With Hereditary Lymphedema: Case Report and Review of the Literature.

Elephantiasis nostras verrucosa (ENV) is a rare cutaneous sequela of chronic lymphedema. Treatment of ENV remains poorly elucidated but has historically involved conservative management aimed at relieving the underlying lymphedema, with a few cases managed by surgical intervention. We report a case of a 27-year-old male with primary lymphedema complicated by large painful ENV lesions on his left foot that we excised surgically with good functional and cosmetic results as validated by the patient. To our knowledge, this is the first report of a case of ENV with a pedunculated morphology and the presence of a deep invasive stalk.

[Idiopathic scrotal elephantiasis. A case report]. / Elefantiasis escrotal idiopática. Reporte de un caso.

BACKGROUND: Penoscrotal lymphedema (scrotal elephantiasis) is a condition that has been described in areas in which filariasis is endemic. CASE REPORT: This paper presents a case of a 45-year-old man with idiopathic lymphedema isolated to the scrotum. After acquired causes of lymphedema were ruled out, the patient was treated with scrotectomy and penoscrotal reconstruction. Currently, the patient is receiving follow-up care without evidence of recurrence. CONCLUSIONS: Penoscrotal lymphedema may cause symptoms of weakness, immobility and emotional disturbance. Surgery procedure provides a satisfactory cosmetical and functional outcome.

Introducción: el linfedema penoescrotal (también conocido como elefantiasis penoescrotal) es una condición que históricamente se ha descrito en áreas en las que la filariasis es endémica. Caso clínico: presentamos el caso de un hombre de 45 años de edad con linfedema escrotal. Después de descartar las causas adquiridas de linfedema, el paciente fue sometido a escrotectomía, prepuciectomía y reconstrucción escrotal y peneana. Actualmente el paciente se encuentra en seguimiento, sin datos de recidiva. Conclusión: el linfedema penoescrotal puede causar síntomas de debilidad e inmovilidad, así como problemas psicológicos. La cirugía otorga resultados cosméticos y funcionales aceptables.