Reconstructive surgery for penoscrotal filarial lymphedema: a decade of experience and follow-up.

OBJECTIVES: To present our experience of reconstructive surgery in patients with penoscrotal filarial lymphedema.

METHODS: From January 2000 to December 2009, we treated 48 patients with penile and penoscrotal filarial lymphedema using reconstructive surgery. Isolated penile involvement was seen in 14 patients, and 34 patients had penoscrotal involvement. All the patients had taken multiple courses of antifilarial drug before surgery. For isolated penile involvement, the diseased penile skin was excised and covered with a split-thickness skin graft. In some patients, the inner prepucial skin was preserved and used to cover the penile shaft. For those with penoscrotal involvement, scrotoplasty was performed, after excising the diseased scrotal skin and underlying soft tissue, while sparing the testes and spermatic cords.

RESULTS: The mean patient age was 38 years (range 25-52), and the median follow-up time was 48 months (range 10-120). All 48 patients reported a satisfactory cosmetic appearance after the procedure and noted improvement in their ability to void while standing. Also, all of them could ambulate better and resumed sexual activity. Local groin infection was present in 12 patients; all were cured after proper management.

CONCLUSIONS: In filarial lymphedema of penis and/or scrotum, excision of the diseased tissue and covering with a split-thickness skin graft provided good results. If the inner prepucial skin is healthy, it should be used to cover the distal penile shaft. If the scrotum is involved, scrotoplasty with lateral and posterior mobilized flaps provides satisfactory results.