Franco Mora M C, Pichín Quesada A, Giraudy Simón G, León Estrada M, Candebat Montero L H, Tamayo Tamayo I
Servicio de Urología, Hospital Provincial Universitario Clínico Quirúrgico "Saturnino Lora Torres", Santiago de Cuba.
Arch Esp Urol. 2007 Jul-Aug;60(6):688-92. doi: 10.4321/s0004-06142007000600012.
Penile and scrotal lymphedema produces a monstrous deformity with psychological impact and occasionally extreme mental anguish. The penis is buried in the scrotal tissue, deformed, thickened, edematous, and curved. The scrotum changes to a great, very thick, hard skin mass, sometimes cracked, exudative, and fetid. Erection and sexual intercourse are very difficult or impossible, and the scrotal enlargement interferes with walking. To report a new case of male external genitalia lymphedema.
METHODS/RESULTS: We present a technical variation of the surgical treatment of penile-scrotal primary lymphedema in a 32-year-old patient suffering this disease for several years, which had underwent several medical and surgical treatments, such as lymphangioplasty and penile root fasciotomy. Observation consisted in the performance of two incisions in w-plasty, one at the root of the penis, the other one in the preserved preputial mucosa, and excision of all the lymphedematous tissue with reconstruction using the preputial mucosa and a small area of non infiltrated skin at the root of the penis. In the scrotum, two butterfly-wing shape skin flaps were performed; the testicles and the spermatic cord were isolated to ease the operation, minimize the surgical time and avoid complications; the lymphedematous tissue was resected with a great fragment of scrotum; finally reconstruction was performed from the adjacent healthy skin.
With this technique it was not necessary to perform a free or vascularized skin graft. The patient recovered his penile functional capacity improved aesthetically and his anguish disappear.
阴茎和阴囊淋巴水肿会造成严重畸形，产生心理影响，有时还会导致极度精神痛苦。阴茎被埋于阴囊组织中，变形、增厚、水肿且弯曲。阴囊变成一个巨大、非常厚实、坚硬的皮肤肿物，有时会出现皲裂、渗出且有恶臭。勃起和性交变得非常困难或无法进行，阴囊肿大还会妨碍行走。报告一例男性外生殖器淋巴水肿的新病例。
方法/结果：我们展示了一名32岁患有此病数年的患者阴茎 - 阴囊原发性淋巴水肿手术治疗的技术改进，该患者此前接受过多种医学和手术治疗，如淋巴管成形术和阴茎根部筋膜切开术。手术操作包括在阴茎根部和保留的包皮黏膜处做两个W形切口，切除所有淋巴水肿组织，并用包皮黏膜和阴茎根部一小片未受浸润的皮肤进行重建。在阴囊处，做两个蝶形皮瓣；分离睾丸和精索以方便手术、缩短手术时间并避免并发症；切除大量阴囊组织及淋巴水肿组织；最后用相邻的健康皮肤进行重建。
采用该技术无需进行游离或带血管蒂的皮肤移植。患者恢复了阴茎功能，外观得到改善，痛苦也消失了。
