Etiology, clinical appearance and therapy of penoscrotal lymphedema

Penoscrotal lymphedema has serious functional, cosmetic, psychological and potentially malignant consequences. In contrast to the relatively common oc currence of this disease in areas with endemic filariasis? the incidence in the rest of the world is almost exclusively due to therapeutic sequelae of other illnesses or as congenital entities. As conservative forms of treatm ent have proved to be inefficient, we discuss different surgical options ba sed on the treatment of 12 patients seen in our clinic. Only the complete e xcision of the edematous and fibrotic tissues, together with reconstructive methods using local flaps and skin grafts, can guarantee a definitive solu tion, irrespective of the etiology. A detailed anatomical knowledge of the regional lymphatic drainage pathways allows safe operative treatment. Despi te the rarity of this disease, a number of different surgical procedures ha ve been reported in the literature that are compared with the findings in o ur patients.