Genital Lymphedema

Anatomy

  • external genitalia lymph vessels
    • superficial lymphatic capillary plexuses
      • lined with endothelium
      • thin
      • valveless
    • deeper lymphatic plexuses
      • connect to superficial plexuses
      • have few valves
  • Vessels all drain to superficial and deep regional lymph nodes
    • inguinal nodes –> pelvic nodes –> cysterna chyli –> thoracic duct –> subclavian

Etiology/Differential Diagnosis

  • Neoplasia (i.e. metastatic prostate, penis, bladder CA)
  • Infection (i.e. filariasis, Brugia malayi, Wuchereria bancrofti, Streptococcus sp, syphilis, TB, chancroid, leprosy)
  • Reactive (i.e. trauma, burns, DVT, radiation)
  • Granuloma (i.e. sarcoidosis, rheumatoid arhtritis, Crohn’s)
  • Fluid Balance disorder (i.e. CHF/ESRD anasarca)
  • Idiopathic
  • Congenital (Meigs’ dz)

Complications (if chronic and unreated):

  • Infection, cellulitis
  • lymphangiosarcoma
  • hidradenitis suppurativa

Treatment:

  • Fluid overload (anasarca) –> diurese
  • Sarcoidosis –> topical steroid
  • Infection like strep –> abx
  • metastatic disease –> chemo?
  • Surgery: improve lymph flow (success rate < 50%) OR excision
  • Surgical excision preferred with STSG reconstruction/wound coverage

Reference: McDougal WS.  Genital Lymphedema.  Textbook of Reconstructive Urologic Surgery

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