What is the treatment for lymphedema of the penis?

Treatment of Penile Lymphedema

The most effective treatment for penile lymphedema is surgical excision of affected tissues followed by reconstruction, which provides the best outcomes for morbidity, mortality, and quality of life improvement. 1

Surgical Management Options

• Modified Charles procedure is the primary surgical approach, consisting of excision of affected skin followed by reconstruction of the penoscrotal region 1

• The procedure involves:

  • Removal of affected lymphedematous tissue 1
  • Scrotoplasty with midline suture to simulate the scrotal raphe 1
  • Coverage of the penis with split-thickness skin graft using a zigzag suture on the ventral surface 1

• Local flap reconstruction techniques can be used after lymphangiectomy to preserve function and improve cosmetic outcomes 2

• Posteriorly based perineal flaps may help preserve perirectal lymphatics that provide collateral lymphatic drainage 2

Combined Approach for Severe Cases

• For giant or advanced lymphedema, a combination of conservative and surgical methods yields the best results 3
• Pre-surgical and post-surgical complex decongestive physical therapy (CDPT/CDT) according to the Földi method should be implemented alongside surgical intervention 3
• This combined approach has demonstrated significant reduction in affected tissue size and improved functional outcomes 3

Surgical Outcomes and Benefits

• Surgical treatment provides:
  • Better local hygiene 1
  • Easier ambulation 1
  • Ability to void in standing position 1
  • Resumption of sexual function 1
  • Improved cosmetic results 1
  • Remarkable enhancement in quality of life 1

Special Considerations

• Multiple surgical interventions may be necessary for extensive cases to achieve satisfactory results 4
• Patients with history of lymphadenectomy and radiation therapy may experience recurrent lymphedema after surgical treatment 1
• Proper selection and usage of compression hosiery post-surgery helps preserve and improve treatment outcomes 3

Pitfalls to Avoid

• Isolated use of either surgical or conservative treatment alone typically does not provide sufficient improvement in quality of life 3
• Fasciocutaneous thigh flaps, while used for coverage after scrotal lymphedema resection, may alter testicular thermoregulation and potentially cause infertility 2
• Delaying treatment can lead to complications including chronic irritation, repeated infections, drainage, and sexual dysfunction 2