What Is a Lymphedema?
A lymphedema happens when there is infection or blockage of the normal drainage of lymphatic channels from an affected portion of the body. Patients develop swelling of the effected area that is painful and can lead to chronic infection of the tissue. Some common causes of lymphedema are:
- radiation, or
- surgical treatment of cancer.
In other cases the lymphedema can arise without and known cause—this is referred to as idiopathic.
What Happens When the Scrotum Is Involved in Lymphedema?
Like involvement of a leg or arm, the scrotum swells, and in some cases the scrotum can reach an enormous size. The skin of the scrotum is doughy and filled with fluid and becomes thickened and chronically infected. This makes life very difficult for affected patients. Patients often become homebound and have chronic pain associated with the condition.
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Surgical Options
What Can Be Done for This Problem?
Surgical management of this problem can work well to return a patients quality of life and restore urination and possibly sexual function. Surgery is done to remove all of the effected tissue and reconstruct the scrotum. In most cases there is enough normal tissue surrounding the scrotum that a scrotal type of appearance can be created.
In severe cases of lymphedema of the scrotum, the foreskin of the penis is inverted and the penis is buried in the tissue of the scrotum. Sometimes the tissue of the penis has not been affected by the lymphedema, and it can be preserved. In other cases the penile skin is also effected and scarred and needs to be removed.
When the penile skin needs to be removed, one option is a skin graft applied to the penis. This will allow the full length of the penis to be brought out so that the problem with a buried penis is less likely to recur.
What about management of my abdominal fat?
It is not totally clear why lymphedema occurs, but it is often in patients with a large belly. Sometimes there is a pannus (a roll of fat) that hangs over the penis and will tend to cause recurrence of the problem with engulfment or burying of the penis.
Abdominoplasty or Pannicluectomy: Tummy Tuck
It is best to remove this fat along with the surgery to correct the lymphedema if it is a problem. This surgery is called an abdominoplasty or a pannicluectomy (many patients refer to this as a tummy tuck). It is done through a long horizontal incision between the belly button and the penis.
What are some of the complications associated with the surgery?
The surgeon has to be very careful about not damaging the penis or the testicles during surgery to remove the scrotum. The penis and testicles are buried in the abnormal tissue and it is easy for a surgeon to seriously damage them during the surgery. A reconstructive urologist can make sure the penis and testicles are carefully preserved.
At University of Utah Health, we have not seen any complications like loss of a testicle or damage to the penis with lymphedema surgery.
What is the post-op recovery from the surgery?
If a skin graft is needed, then patients remain in the hospital for five to seven days on bed rest to allow the skin graft to fully heal. Otherwise patients may be in the hospital just overnight or for a few days. Patients need to avoid any strenuous physical activity until they are fully healed. We generally recommend they do not lift greater than 15 pounds for a month after the surgery.
Follow-Up
It is important to have close follow up of the wound to make sure the surgery is healing well. We will generally follow-up with patients every one to two weeks after their discharge until the surgery has completely healed. This follow-up can be done with an outside urologist in consultation with us anywhere in the country.
I need to have surgery, but I live very far away. Can I get care at University of Utah Health?
Many of the conditions we treat are very rare, and patients come from all over the west and the country to Utah for treatment. When a patient has a condition like scrotal lymphedema, we make every effort to arrange for appointments and surgery within several days of the planned visit. Our reconstructive urologists will often talk with patients on the phone beforehand and come up with a plan for their care. We can also arrange for follow up with a local urologist that can communicate about any problems that arise after surgery.
Do not hesitate to contact us if you want to arrange for reconstructive surgery at U of U Health.