Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Surgical management of male genital lymphedema: A systematic review

  • Aulia, Indri (External Genitalia Section, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia) ;
  • Yessica, Eva Chintia (External Genitalia Section, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia)
  • Received : 2019.08.26
  • Accepted : 2019.12.27
  • Published : 2020.01.15
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Abstract

Genital lymphedema (GL) is an uncommon and disabling disease that manifests as enlargement of the genital region resulting from the disturbance of lymphatic drainage. Although conservative treatment such as decompression is typically the first-line approach, surgical intervention has been shown to be effective in certain cases. This study aimed to systematically review studies evaluating available surgical alternatives for the treatment of male GL. A systematic search strategy using keyword and subject headings was applied to PubMed, Scopus, EMBASE, and Cochrane Library in May 2019. Studies investigating various surgical techniques to treat penile and scrotal lymphedema were included. The potential risk of bias of included trials was evaluated using the methodological index for non-randomized studies (MINORS). In total, 13 studies met the inclusion criteria, nine of which were determined to be high-quality. The average MINORS score was 12.45 for studies involving excision and 14 for studies involving lymphovenous anastomosis (LVA). The most common reason for a low score was a failure to describe the inclusion criteria. Recurrence of lymphedema during follow-up was reported in four studies involving excision and in no studies involving LVA. In general, the quality of the included literature was considered to be fair. Although surgical intervention might not always prevent the recurrence of lymphedema, all of the studies reported improved quality of life after the procedure. This study could be used as the basis for evidence-based guidelines to be applied in clinical practice for managing male GL.

Keywords

References

  1. Warren AG, Brorson H, Borud LJ, et al. Lymphedema: a comprehensive review. Ann Plast Surg 2007;59:464-72. https://doi.org/10.1097/01.sap.0000257149.42922.7e
  2. Namir SA, Trattner A. Transient idiopathic primary penoscrotal edema. Indian J Dermatol 2013;58:408.
  3. Chiu TW. Management of secondary lymphoedema. Hong Kong Med J 2014;20:519-28.
  4. Huang GK, Hu RQ, Liu ZZ, et al. Microlymphaticovenous anastomosis for treating scrotal elephantiasis. Microsurgery 1985;6:36-9. https://doi.org/10.1002/micr.1920060107
  5. Campisi C, Bellini C, Campisi C, et al. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 2010;30:256-60. https://doi.org/10.1002/micr.20737
  6. Kung TA, Champaneria MC, Maki JH, et al. Current concepts in the surgical management of lymphedema. Plast Reconstr Surg 2017;139:1003e-1013e. https://doi.org/10.1097/PRS.0000000000003218
  7. Kobayashi MR, Miller TA. Lymphedema. Clin Plast Surg 1987;14:303-13. https://doi.org/10.1016/S0094-1298(20)30602-7
  8. Mavili ME, Naldoken S, Safak T. Modified Charles operation for primary fibrosclerotic lymphedema. Lymphology 1994;27:14-20.
  9. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003;73:712-6. https://doi.org/10.1046/j.1445-2197.2003.02748.x
  10. Scaglioni MF, Uyulmaz S. Lymphovenous anastomosis and debulking procedure for treatment of combined severe lower extremity and genital lymphedema: a case report. Microsurgery 2018;38:907-11. https://doi.org/10.1002/micr.30331
  11. Vives F, Garcia-Perdomo HA, Ocampo-Florez GM. Giant lymphedema of the penis and scrotum: a case report. Autops Case Rep 2016;6:57-61.
  12. Pastor C, Granick MS. Scrotal lymphedema. Eplasty 2011; 11:ic15.
  13. Garaffa G, Christopher N, Ralph DJ. The management of genital lymphoedema. BJU Int 2008;102:480-4. https://doi.org/10.1111/j.1464-410X.2008.07559.x
  14. Halperin TJ, Slavin SA, Olumi AF, et al. Surgical management of scrotal lymphedema using local flaps. Ann Plast Surg 2007;59:67-72. https://doi.org/10.1097/01.sap.0000258448.17867.20
  15. Machol JA 4th, Langenstroer P, Sanger JR. Surgical reduction of scrotal massive localized lymphedema (MLL) in obesity. J Plast Reconstr Aesthet Surg 2014;67:1719-25. https://doi.org/10.1016/j.bjps.2014.07.031
  16. Thejeswi P, Prabhu S, Augustine AJ, et al. Giant scrotal lymphoedema: a case report. Int J Surg Case Rep 2012;3: 269-71. https://doi.org/10.1016/j.ijscr.2012.03.005
  17. Elkiran YM, Elshafei AM, Abdelgawwad MS, et al. Surgical management of giant scrotal lymphedema in morbidly obese patient with trisomy 21. J Vasc Surg Cases Innov Tech 2019; 5:71-4. https://doi.org/10.1016/j.jvscit.2019.02.002
  18. Torio-Padron N, Stark GB, Foldi E, et al. Treatment of male genital lymphedema: an integrated concept. J Plast Reconstr Aesthet Surg 2015;6:262-8. https://doi.org/10.1016/j.bjps.2014.10.003
  19. Modolin M, Mitre AI, da Silva JC, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo) 2006;61:289-94. https://doi.org/10.1590/S1807-59322006000400003
  20. Salako AA, Olabanji JK, Oladele AO, et al. Surgical reconstruction of giant penoscrotal lymphedema in sub-Saharan Africa. Urology 2018;112:181-5. https://doi.org/10.1016/j.urology.2016.09.064
  21. Mukenge S, Pulitano C, Colombo R, et al. Secondary scrotal lymphedema: a novel microsurgical approach. Microsurgery 2007;27:655-6. https://doi.org/10.1002/micr.20426
  22. Mukenge SM, Catena M, Negrini D, et al. Assessment and follow-up of patency after lymphovenous microsurgery for treatment of secondary lymphedema in external male genital organs. Eur Urol 2011;60:1114-9. https://doi.org/10.1016/j.eururo.2010.11.020

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