Lymphœdèmes pénoscrotaux : étude rétrospective de 33 cas

Genital Lymphedema after Cancer Treatment: A Narrative Review

Genital lymphedema may affect males and females after cancer treatment (gynecological, such as cervical, uterine or ovarian, melanoma, prostate, anus…). It is frequently associated with lower limb lymphedema, and is responsible for discomfort, cosmetic disfigurement and functional disturbances. Impacts on body image, sexual function and quality of life are major, and difficult to explore because cancer treatment itself and lymphedema are so closely interwoven. Local complications, e.g., papillomatosis, warty growth, lymph vesicles with embarrassing lymph oozing and cellulitis, may occur. Usual lymphedema therapies, like bandaging and elastic compression, are poorly adapted to these sites. Surgery, essentially based on cutaneous resection techniques, is the primary symptomatic treatment; it achieves good efficacy, in adults and children, with possible recurrence requiring reintervention.

Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: A case report

Combined secondary scrotal and lower extremity lymphedema is an infrequent complication of radical excision of urogenital cancers associated with pelvic lymphadenectomy. Scrotal lymphedema is usually psychologically distressing, and difficult to treat. We report a case of a 41-years old male who presented with scrotal and left lower extremity lymphedema after radical prostatectomy and pelvic lymphadenectomy successfully treated with pedicled superficial inguinal lymph node (SILN) transfer and lymphaticovenous anastomosis (LVA) restoring the lymphatic drainage. The flap consisted of subscarpal adipofascial tissue between the level of the inguinal ligament and the groin crease measuring 11 × 7 cm. The flap composed of afferent lymphatics from the lower abdomen, lymph nodes, and fatty tissue without skin, the right-sided flap was transposed to the root of scrotum while the left one to the proximal left thigh, then two-level LVA were performed in the left extremity. The surgery went uneventful with no postoperative complications. At a 9 month follow-up, there was a significant reduction of the scrotal volume with a reduction of excess volume of the lower extremity from 49.6 to 9.4% compared with the healthy side. No cellulitis was reported during the follow-up period with improvement in the patient's clinical symptoms and quality of life. We believe that pedicled superficial inguinal lymph node flap together with LVA is a reliable and safe treatment option for either scrotal or lower extremity lymphedema following pelvic cancer treatment.

Penile lymphoedema: approach to investigation and management

BACKGROUND

Penile lymphoedema (with and without cellulitis) is a rare, often chronic, clinically heterogeneous entity with an uncertain pathogenesis and an important differential diagnosis. It creates significant physical and psychosexual morbidity, and presents considerable therapeutic challenges. The existing literature is limited.

AIM

To describe and share our updated cumulative experience of a cohort of patients with penile lymphoedema.

METHODS

This was a retrospective review of the case records of patients with chronic penile lymphoedema seen in two dedicated male genital dermatology clinics between January 2011 and July 2016.

RESULTS

In total, 41 cases were identified. Over a third had Crohn disease (CD) (which was occult in one-third of these), and over a third had serological evidence of streptococcal infection. All patients responded to systemic antibiotics and specialized urological surgery circumcision and excision).

CONCLUSIONS

Penile lymphoedema should be investigated to exclude underlying pathology especially CD and streptococcal infection. Treatment with antibiotics should be considered early and long term to try to preserve the foreskin: most patients are uncircumcised. Some patients may benefit from a course or courses of oral steroids. The development of gross dysfunction of the prepuce usually dictates circumcision and excision of lymphoedematous tissue once the situation is medically stabilized.

[Dermato-urology: Male genital lesions urologist should know]

This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion.

METHOD

This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites".

RESULTS

It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses.

CONCLUSION

Any suspicious, fixed, must lead to a skin biopsy.

Surgical resection of vulva lymphoedema circumscriptum

BACKGROUND

Lymphangioma circumscriptum, a rare, benign disease that can be either congenital or acquired, involves the deep dermis and subcutaneous lymphatics.

OBJECTIVE

This study aims to analyse the efficacy of surgical resection of vulva lymphangioma circumscriptum (VLC).

MATERIALS AND METHODS

Between January 2000 and December 2008, eight consecutive women referred to our centre and treated surgically for VLC were included in the study. VLC was responsible for recurrent lymph oozing in seven cases. All women were treated by the same plastic surgeon specialising in lymphatic diseases.

RESULTS

The first surgery was performed after a median interval of 5.4 years since VLC onset. The first cutaneous resection included the labia majora of all women and labia minora of five and clitoral hood of four. Five women experienced rapidly recurrent vesicles associated with lymph oozing and underwent resection again (once: two women, twice: three women). The second resection was performed 4-6 months after the first, whereas the third took place 1-6 years after the second. Five women had moderate and transitory post-surgical lymph oozing. After a median follow-up of 53 months after the last surgery, seven of the eight women were free from symptom.

CONCLUSION

Surgical resection is an effective and well-tolerated therapy for VLC in most women. Lesion recurrence is frequent but resection can be repeated several times with no adverse effects.

L’éléphantiasis pénoscrotal, diagnostic et prise en charge: à propos de trois cas

L’éléphantiasis pénoscrotal est une pathologie rare en dehors des pays d’endémie filarienne. C’est une pathologie bénigne, mais qui peut devenir handicapante en gênant le rapport sexuel et parfois même la miction. Nous rapportons trois cas d’éléphantiasis pénoscrotal primitif, traités par une résection chirurgicale complète du tissu pathologique et une reconstruction pénoscrotale, avec un bon résultat fonctionnel et esthétique. Nous mettons le point, à travers notre expérience et une revue de la littérature, sur les aspects diagnostiques et la prise en charge thérapeutique de l’éléphantiasis pénoscrotal.

Pelvic lymphedema: truth or fiction?

Pelvis is a functional shell-like unit consisting of the pelvic floor and perineum. The patients, who underwent a radical operation of the pelvis due to an oncological disease, often develop pelvic disorders. These disorders do not depend on the type of surgery or any presence of postoperative treatment (radio- and chemotherapy). The reason for this is still mostly unknown. These disorders without an appropriate treatment of rehabilitation always result in the following symptoms: fatty tissue hypertrophy and fibrosis as well as functional chronic disorders. Lymphedema is described as a progressive pathological condition with retention of protein-rich liquid in the interstitial space, fatty tissue hypertrophy and fibrosis. It is possible to assume that lymphadenectomy related to pelvic surgery results in a localized lymphedema in the pelvis developing disorders of perineum and pelvic floor: a pelvic lymphedema, or rather a blind lymphedema, i.e. with symptoms but with no signs. The clinical evidence shows that the lymphatic vessels play a relevant role in the pathology of the pelvic floor and perineum. The study of pelvic lymphedema could be the key when choosing the therapies for pelvic disorders resulting from surgery.

Secondary scrotal lymphedema: a novel microsurgical approach

Secondary scrotal lymphedema is an infrequent complication of radical cystectomy assiociated with pelvic lymphadenectomy. We report a case of secondary lymphedema of male genitalia presenting more than 4 years after a radical cystectomy with extended pelvic lymphadenectomy for adenocarcinoma of the bladder. Microsurgical lymphovenous anastomoses are usually performed using only the scrotal lymphatics excluding the testicular lymphatics drainage. We have experimented a new microsurgical technique based on lymphovenous anastomosis between the collectors of the spermatic funiculus and the veins of the pampiniform plexus, allowing the testicular lymphatic drainage.

Lymphœdème compliquant une hidradénite suppurée : trois observations

BACKGROUND

We report three patients (respectively 36, 52 and 52 years old) with a long history of hidradenitis suppurativa associated with pubic lymph oedema.

CASE REPORT

Dramatic pubic oedema was noted, with "rugby-ball and bag-like" tumefaction associated with nodules and fistula. There was no evidence of lymph node involvement or abdominal lymphatic blockade. One patient underwent surgical excision combined with split-thickness graft and complete healing ensued. Pathological examination of the excised tissue showed telangiectasia and fibrosis.

DISCUSSION

Chronic lymphedema affects patients with severe and long-lasting disease. The complication is caused by chronic and recurrent inflammation due to HS with subsequent blockade or destruction of local lymph drainage routes. Once this complication appears, no medical treatment is effective.

[A case of iatrogenic scrotal elephantiasis: reconstruction of the scrotal purse and the cutaneous sleeve of the penis with local skin flaps]

Scrotal elephantiasis is a pathology of often unknown etiology. Symptomatology is characterized by an oedematius infiltration of skin and subcutaneous tissue, hard-bound aspect and purplished color. The scrotum, the penis and the perineal area are gradually affected. This pathology is very invalidating for the patient, on functional, sexual and aesthetic aspects. The authors present the case of a 58-year-old man with an enormous scrotal mass invading the penis and drowning the testicular elements, which were impossible to palpate. The aetiology was determined by exclusion and an iatrogenic origin following the cure of bilateral inguinal hernia was retained. Resection of the scrotal mass was performed. The reconstruction of the scrotal purse and the cutaneous sleeve of the penis were carried out using local flaps of the remaining healthy skin.

Linfedema como presentación inusual de cáncer de próstata

The most common etiology of lymphedema in our environment is tumoral and, generally, it is due to treatment of the cancer itself. However, the initial presentation of prostate carcinoma as lymphedema is very rare. In fact, there aren't very few documented cases in literature. We described the case of a patient who was admitted into the hospital to be examined for lymphedema in his genitals and legs. Our patient was diagnosed of prostate carcinoma with retroperitoneal adenopathies. The best treatment in this case is block-hormonal therapy. Prognosis is very bad and the survival rate is poor within five years of diagnosis.

Intérêt de la résection cutanée après réduction volumétrique par physiothérapie décongestive des lymphœdèmes primitifs volumineux des membres inférieurs

Treatment of lymphedema is based upon decongestive physiotherapy including low stretch bandages. We reported 3 cases of huge primary lymphedema of lower limb treated with cutaneous resection after decongestive physiotherapy. Two men and a woman (47, 48, 48 years old) had unilateral right lymphedema which appeared at the age of 38, 38 and 37 years. Patients were hospitalized and treated during 3 to 5 weeks with decongestive physiotherapy and then followed by one (n=2) or two cutaneous (n=1) resections. Lymphedema volume calculated with the method of truncated cones decreased of 32, 38 and 59%. Largest differences between the two calves were 54, 38 and 57 cm before treatment and 17, 9 and 12 cm after treatment. Cutaneous resections on external side of the calf were longitudinal without complications. Lymphedema volume remained stable after 24, 6 and 12 months with two superposed elastic stockings and regular self bandaging.