Megson Matthew, Ralph Prof. David

(277) A CASE OF PENILE-SCROTAL RECONSTRUCTION DUE TO MALE GENITAL LYMPHOEDEMA

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives This is a case of scrotal lymphoedema in a 36 year old gentleman who had had 3 years of recurrent infections. Due to the extent of the disease he required an excision of the lymphoedematous tissue and a scrotoplasty to reconstruct his scrotum from unaffected skin. Methods This is a video demonstrating the steps of the excision of the lymphoedematous tissue and subsequent reconstructive. Steps of the procedure start with marking of the lymphoedematous tissue. The surgeon the dissects down the isolate the cords and delivers the testes. The penile shaft can then be isolated and all lymphoedematous tissue excised. With the important structures now isolated, the scrotal lymphoedematous tissue can be removed. Care must be taken to keep the unaffected skin on the lateral aspects of the wounds, as these have a different lymphatic drainage and are therefore not involved in the pathology. This creates an ideal tissue for reconstruction as this allows primary closure of the neo-scrotum. The lymphoedematous tissue tends to be extremely vascular with large feeding vessels, therefore care much be taken with haemostasis. Due to the lymphoedematous tissue extending into the patients perineum he was then placed into lithotomy to allow better access to this area. Care was taken to avoid injury to the anus and rectum. Prior to the close of the neo-scrotum an Orchidopexy was performed to stop testicular retraction. The lateral skin was then closed to create a neo-scrotum over drains. Results The video shows a typical operation for male genital lymphoedema and the usual end results. The patient is happy with his final result. The histology showed an anogenital granulomatosis lymphoedema. Conclusions A variety of treatment options for anogenital granulomatosis exist though if left to become severe then surgery is required before any of these medications would improve future outcomes. Conflicts of Interest No conflict of interest to declare.

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