Surgical treatment of severe chronic genital edema, refractory to medical management.

Severe chronic genital edema (scrotum and penis) is a debilitating condition physically, aesthetically, and psychologically. The etiology of genital edema is varied and is critical to determine prior to operative management. Our objective was to determine if surgical management would effectively improve the quality of life in patients with this disorder. Between August 2001 and March 2002, four patients with severe chronic genital edema were surgically treated at our institution. The ages of the patients ranged from 41 to 55 years and the duration of edema prior to presentation ranged from 3 months to 5 years. All patients underwent standard pre-operative evaluation and workup. The various etiologies in our patients were progression of a lower extremity edema present at birth, chronic cellulitis, and idiopathic in two. A testicular ultrasound or alternative radiological imaging study was used in all patients to rule out any underlying disorder. Surgical therapies included excision of penile edema in one and scrotal cytoreduction in three, with one patient requiring scrotal and abdominal advancement flaps. A literature review is also presented. The immediate outcome obtained by our four patients was significant improvement functionally, aesthetically, and psychologically. All patients were followed post-operatively and none have required additional surgery or developed further complications. Severe chronic genital edema is a debilitating condition. When conservative and medical management fail, surgical treatment can significantly improve the patient's quality of life.

Melissa M. Walls, Vince J. Flynn, Jr, and Wayne J.G. Hellstrom. Tulane University School of Medicine, Department of Urology, New Orleans, LA.