Innovative microsurgical treatment of male external genitals lymphedema

Abstract

Secondary lymphedema of male external genital organs, characterized by increase in genital organs volume, tissue fibrosis, erysipelas, and objective difficulties in the normal use of lower limbs and the penis, is a very common and impairing consequence of invasive surgery, radical lymphadenectomy and radiotherapy of the pelvic-inguinal area. Standard surgical approach to lymphedema are either very invasive and/or at high risk of lymphedema recurrence and do not guarantee an efficient long-term treatment. Alternatively, we developed a microsurgical technique to perform direct anastomoses between the lymphatic collectors of the spermatic funiculum afferent to the external iliac chains and the vessels tributary to the spermatic vein. This innovative approach, although surgically demanding, provided a long term successful treatment of external genitals with no clinical complications, low invasivity, rapid post-surgical recovery, minor tissue demolition and satisfactory post-surgical functional and esthetic results. In addition, lympho-venous microsurgery seems to trigger the local development of new lymphatic vessels that not only canalize along new collecting channels, but also form complex meshes in proximity to the anastomosis area, thus improving lymphedema also in adjacent tissues like lower limbs, supplied by lymphatics emptying into common developed lymphatic shunt.

Keywords: Microsurgery; Lymphatic meshes; Secondary lymphedema; Lympho-venous anastomosis; Lymphangiogenesis

Core tip: Treatment of secondary lymphedema of male external genital organs through invasive standard surgical techniques may be complicated by impairing consequences for the patient and often do not guarantee an efficient long-term outcome. Alternatively, microsurgical suture of lympho-venous anastomoses between lymphatic collectors of the spermatic funiculum efferent to the external iliac chains and the pampiniform plexus tributary to the spermatic vein provides a successful long term treatment of genitals lymphedema and triggers the development of new lymphatic meshes in proximity to the anastomosis area, thus improving lymphedema also in tissues, like lower limbs, supplied by lymphatics emptying into common developed shunts.