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Page 2 of 14 Guiotto et al. Plast Aesthet Res 2023;10:26 https://dx.doi.org/10.20517/2347-9264.2023.15

Results: 16 patients with GL were included: 50% underwent debulking surgery, 18.8% microsurgery, and 31.2%
debulking + microsurgery. We recorded a significant regression of the GL stage: 62.5% shifted from stage II/III to
postoperative stage I. Similarly, we found an infection recurrency resolution in 50%, a scrotal oedema reduction in
62.5%, and a scrotal oedema resolution in 37.5% of the patients treated. While almost half of the patients (53.3%)
with associated penile oedema described persistent postoperative penile oedema, only two patients complained of
persistent lymphorrhea.

Conclusion: According to our clinical experience, preoperative and postoperative physical functional therapy is
always recommended. For stages I and IIA, after the failure of the conservative treatment, lymph-venous shunts
and lymph node transplantation surgery are proposed at the early time. When GL is already diagnosed at stages IIB
and III, the debulking surgery, together with functional procedures, represents our first approach.

Keywords: Genital lymphoedema, debulking surgery, functional surgery, microsurgery, lymphatic venous
anastomosis, multi lymphatic-venous anastomoses, lymph node transplantation

INTRODUCTION
[1]
Genital lymphoedema (GL) localisation represents 0.6% of all lymphoedema cases on a global scale .
Genital lymphoedema is a chronic and evolutive disease caused by pathological fluid retention in scrotal,
[2]
penis, and pubic (or vulvar) interstitial tissue as a result of imbalanced lymphatic drainage . The lymph
drainage reduction determines an accumulation of protein-rich interstitial fluid, which leads to further fluid
retention, inducing a vicious circle of progressive fibrosis .
[3]
GL can be classified by aetiology as primary or secondary. Primary (also named congenital) is often
idiopathic or rarely related to genetic autosomal mutations . Secondary lymphoedema is commonly related
[4]
to surgical or radiotherapy cancer treatment, followed by infection causes (this aetiology is predominant in
developing countries) .
[3]

The diagnosis relies on the patient’s history and physical examination, supported by radiological imaging,
such as computed tomography, magnetic resonance imaging, and duplex ultrasonography.

Currently, the standard assessment to quantitatively evaluate the residual lymphatic function is mainly
[5]
based on nuclear medicine techniques, particularly lymphoscintigraphy .
From a clinical perspective, patients mainly reported pain, heaviness, skin tightness, and frequent infections
in the genital area with compromised urinary and sexual functions in advanced stages, with an overall
degraded quality of life .
[6]
Nowadays, no specific and definitive treatment exists for GL. Early diagnosis and precocious therapy are
highly recommended, particularly considering the impact on the patient quality of life and the chronic/
[7]
recurrent evolution of the disease .

The gold standard care for lymphoedema is a multidisciplinary approach, which always starts with
conservative treatments (complete decongestive therapy (CDT), compression bandaging, and exercises,
manual lymph drainage, skin care, and treatment of the underlying conditions) followed by surgical
interventions .
[8]