LYMPHEDEMA GENITAL
Genital Lymphedema
This page has been updated, please see the following pages:
Male Genital Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=male_genital_lymphedema
Female Genital Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=female_genital_lymphedema
Scrotal Lymphedema Charles ProcedureCharles Procedure
http://www.lymphedemapeople.com/wiki/doku.php?id=charles_procedure
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With
anyone male or female that has lymphedema of the lower limbs, genital
lymphedema
is a very real possibility. This is especially true of those whose
lymphedema
expresses itself early in childhood.
While this subject may embarrass some, there needs to be discussion and
enlightenment on it.
Related
terms: genital lymphedema, lymphedema of the scrotum, lymphedema of the
penis,
scrotal edema, scrotal lymphedema, labia swelling,
vulvar lymphangioma, genital oedema, lymph scrotum, male genital
lymphedema,
vulvar lymphedema, Chron's Disease, Buck's Fascia, lymphedema of the
externa
genitalia, genital lymphedema in children
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***
INTRODUCTION TO ARTICLE - FOR COMPLETE ARTICLE PLEASE CLICK ON WEBLINK
AT
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Genital Lymphoedema
By Melanie Lewis MCSP SRP, Macmillan Lymphoedema Clinical
Specialist Service
Co-ordinator
Lymphoedema
of the
genital region is relatively uncommon, but is extremely
uncomfortable and distressing for the patients who suffer with this
condition.
It can affect both men and women alike, but is seen more frequently in
males due
to the anatomical differences between the genders and effects of
gravity. Around
ten percent of people who develop leg oedema will have associated
genital
swelling, but some patients can have genital oedema alone.
In some circumstances, genital oedema can occur acutely due to trauma
or
cellulitis and may be able to resolve completely by itself. Far more
usual
however, is the chronic genital oedema, which is unfortunately
irreversible, but
can be controlled and reduced through appropriate lymphoedema
management. The
main cause of genital oedema is either due to primary or secondary
lymphoedema.
Primary lymphoedema
affecting
only the genitals is rare. It can be noticed from
birth or during the teens, and as the affected individual grows, the
involved
lymphatic system becomes ever more under pressure to drain the tissue
fluid and
the swelling becomes far more obvious. The main reasons for primary
genital
lymphoedema are that the lymph vessels are absent or reduced in number
or simply
don't work as well as they should i.e. functional failure. It has also
been
thought that primary lymphoedema patients who are obese, have an
increased risk
of genital swelling due to greater pressure on the groin from the
enlarged
abdomen.
Secondary lymphoedema
more
commonly affects the genital region than primary
lymphoedema. In Africa, India and other tropical countries, genital
swelling is
frequently seen due to infectious diseases like filariasis. This can
lead to
gross elephantiasis of the penis and scrotum. In the Western world, the
majority
of genital oedemas are from trauma or surgery to remove gynaecological,
urological, abdominal or prostatic cancers. It has been reported that
up to 70%
of patients treated for carcinoma to the vulva will have lower body
swelling.
Radiotherapy to the lymph nodes in the groin or abdominal region can
also cause
genital lymphoedema. The incidence also increases if there has been
surgery and
radiotherapy plus episodes of cellulitis.
Clinical
Features
Swelling
- Various
parts of the genital anatomy can become swollen. In males,
both the penis and scrotum, or each, can swell independently. Very few
patients
just have penile oedema, but it does happen, as can be seen from the
case study.
Sometimes, the scrotum becomes so swollen, that the patient has
difficulty in
walking. As the swelling increases, it can involve the area above the
base of
the penis (called the pubic area), thus causing the penis to retract
into the
scrotum. This clearly causes problems for micturition (urination)and
sexual
activity.
In females, the inner and outer lips of the vagina (labia) can become
so swollen
that they extend out of the vagina by up to 6 inches; again this
creates
problems for sexual activity and urination. In both genders, the pubic
area on
the lower abdomen alone can become oedematous, with associated skin
changes and
fibrosis.
Genital swelling can occur due to other causes. Palliative patients who
have
renal, cardiac or hypoproteinaemia (high output failure due to low
protein) and
patients who have had venous problems, could develop genital oedema. A
clear
diagnosis and medical investigations are needed, prior to lymphoedema
management.
Pain
is a
problem for some patients, who describe a dragging, heavy, bursting
sensation or an ache around the genital region. This is usually eased
when the
area is decongested or lifted by a jock straplike support or cycling
shorts.
Skin changes
are readily seen in genital oedema. Thickening and dry, flaking
skin (hyperkeratosis) or warty blisters (papillamatosis) do occur as
the
swelling progresses.
Acute Inflammatory Episodes (cellulitis)
are
commonly seen in oedematous skin,
which is the ideal medium for bacteria as it is generally warm, moist
and has
numerous crevices. The bacteria multiply in the protein rich oedema
fluid, and
infections can spread throughout the genital region, causing it to be
red, hot,
tender and swell even further. More often than not, an infection is
seen as the
precipitating factor in causing the swelling.
Fungal Infections do occur, due to the area being moist, warm and
having so many
crevices. Sweating also can trigger fungal infections.
Lymphorrhoea
occurs
when the tissue pressure increases and causes leakage of
fluid from the thin layer of skin. Lymphorrhoea can continue for a few
days or
weeks and carries a high risk of developing infections. It can be very
distressing for patients, as some have to wear incontinence/sanitary
pads to
absorb the copious fluid. Lymphoedema treatment is necessary to stop
this
leakage.
Sexual Dysfunction happens as the oedema increases. In males, impotence
or
painful erections impede sexual intercourse. Females find that the
presence of
oedema dampens sexual activity, due to decreased libido and pain.
http://www.lymphoedema.org/lsn/lsn140.htm#TOP
http://www.lymphoedema.org/lsn/
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Tips
for Female Genital Lymphedema
Very Special Thanks to
Cheri Hoskins and Cyndi Ortiz
for their response to questions posted on our discussion boards
Cheri L. Hoskins, CCT
President
Healthtronix Lymphedema Management, Inc.
Link no longer available
It is very difficult to answer
questions of this nature
without seeing someone or having a history (iteology, etc).
However, there are a few tricks that you can try biker shorts worn
daily with
compression in the crotch, Elvarex (a Jobst product) makes a wonderful
product,
just make sure when you are measured the therapist knows that you need
compression in the crotch.
When sitting, sit in a reclined position so as to relax the
inguinal nodes and prevent a crimp in that very important drainage area.
In addition, do deep breathing exercises several times a day to create
a vacuum
in your abdomen.
An excellent resource on genital lymphedema is Gunther
Klose's video you can contact him at 866-621-7888
Website: http://klosetraining.com/
or Steve Norton 866-445-9674
Website: http://www.nortonschool.com/managementtraining.html
these two gentlemen are the most knowledgeable in the US on
genital lymphedema and who I go to for consultations. I hope this helps.
------------------
Here is the url for the
Jobst/Elvarex garment
http://www.jobst-usa.com/en/products/lymphedema/customelvarex/page.html
and JoviPak has some excellant
compression garments as
well
http://www.jovipak.com/
I saw Cheri Hoskins gave a few tips on treatment of genital edema. My tips would be pretty much the same. I have seen genital lymphedema respond really well to manual lymph drainage, and some good compression. For daytime compression, bike shorts work really well. For nighttime compression Solaris Tribute garments work well. Solaris has a website at http://www.solarismed.com/
If you need
insurance approval for that, as they are
custom and rather expensive, ask for coverage on code E1399 which is a
miscellaneous code for compression. Your doctor will probably need to
write a
letter of medical necessity. Make sure he reviews the cost of
complications that
commonly occur with untreated lymphedema such as infections. I have had
several
patients apply this treatment and it has been effective. Make
sure you
locate a therapist for MLD who is certified and who has had at least
135 hour of
training. There are some people who say they are lymphedema therapist
who have
maybe been to an afternoon class and are not helpful due to their lack
of
knowledge.
Hope things go well. Keep us posted.
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Treatment for
Genital Lymphedema
Our Deepest appreciation to Denise from
St. Ann's Hospice Lymphoedema
Clinic
and to Silkie for obtaining this for us!
Trunk massage and exercise
routine (TMER)
for patients with Genital Lymphoedema.
Choose a time each day to carry out this massage and exercise programme
when you
can lie on the bed and relax while you are doing it. You will also need
to
remove and or loosen any clothing which would get in the way of the
massage.
Your skin should not look red or pink at the end of the massage- if it
is you
must be pressing too hard- go lighter.
1. Lie with your knees bent up, feet on the bed. Place both hands on
your
stomach just below your ribcage. Breathe in as deeply as you can
through your
nose so that the air pushes your stomach up under your hands. Then
breathe out
through your mouth, pulling your stomach muscles in at the same time to
squeeze
all the air out. Repeat 5 times
2. Place one arm above your head, place your other hand just below your
arm pit
and gently and slowly move the skin round in as big a circle as
possible with
your hand. After approximately one minute change and repeat the same
routine
under the other arm. For approx. 1 minute on each side.
3. Using both hands stroke gently and very slowly from your groins on
both sides
up towards your armpits. Then stroke from the centre- just above your
genital
area, up and out towards your arm pits You can do both sides at the
same time,
or just one side at a time which ever is easier. When massaging try to
make sure
that your hands are relaxed and the whole hand is in contact with the
skin.
Try also to massage your back from the central crease between your
buttocks up
over your waist-line or ideally get somebody else to help you with this.
Massage for at least 2-3 minutes on each side.
4. Place your hands in your groins and as you did in ‘2’, slowly move
the
skin round in as big a circle as you can. For approx. 1 minute
5. With your knees bent up, squeeze your buttocks together as firmly as
possible
hold this while you tighten the muscles of your pelvic floor between
your legs
and then pull in your stomach muscles as hard as you can- hold them
tight all
together- and then relax. Imagine you are trying to zip up a really
tight pair
of jeans and having to pull everything in to get the zip to close. As
you
tighten everything up, breathe out- as you relax, breathe in. Repeat
5 times.
6. Hip and knee exercise. Bend your knee up towards you. Clasp your
hands round
your thigh and gently pull your knee towards your chest hold it there
for a
count of 2 then release the pressure by straightening your elbows repeat
this
slowly a further 4 times. Change legs and go through the same
routine on the
other side.
7. Finish off with an ankle exercise. Pump each foot up and down at the
ankle,
slowly and deliberately, 20 times.
This combination of exercise and massage will generally improve the
lymphatic
drainage from your lower body. Movement and exercise always helps to
stimulate
lymph drainage. Try not to sit for long periods without movement, keep
exercising the muscles of your pelvic floor it will help. You may need
advice
from a physiotherapist about this.
CARE OF THE SKIN of your lower body and genital area
is just as important
as of the legs.
Moisturise with a very bland cream such as Aqueous Cream, gently
massaging any
very firm areas of swelling to soften them. This is best done after the
massage
and exercise routine above, so that you have cleared the way ahead for
lymph to
drain. .
Use Aqueous Cream to wash the genital area instead of soap, it is less
drying
and will reduce irritation.
Always dry very carefully in skin creases and folds and don’t let cream
accumulate in them. Too much moisture in the creases encourages fungal
infections. If the skin in the creases looks red and irritated, consult
your
doctor, you might need an anti-fungal cream.
Any infection can make the lymphoedema worse and needs prompt
attention-
particularly cellulitis.
SUPPORT for the genital area to reduce swelling can be helpful. Some of
the
hosiery companies do make garments rather like cycling shorts to
provide
compression in this area. But sometimes buying lycra firm support
panties with
legs in and placing a pad inside to put additional pressure on the
genital area
gives further support. Obviously it is important that they don’t
constrict the
lymph drainage from the legs.
Manual Lymphatic Drainage Massage (MLD) can be helpful with genital
oedema. Find
out if this is available from your nearest Lymphoedema Clinic. It is
available
privately in some areas- lists of practitioners are available from MLD
UK
(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People. All links associated with this article must be listed as well.
. . . . . . . . . . .
Other sources of advice and support are:
Lymphoedema Support Network LSN - www.lymphoedema.org/lsn
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The Risk of
Genital Edema After External Pump Compression for Lower Limb
Lymphedema
http://www.lymphedema-therapy.com/98paper.html
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List of
available articles from Pub Med
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Link&db=PubMed&dbFrom=PubMed&from_uid=12913680
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Lymphedema
Treatments Are Poorly Utilized
Posted 10/29/2003
Ob/Gyn Practice Today
http://www.medscape.com/viewarticle/463235
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Lymphedema
Bulletin Board
http://www.lymphedemamanagement.com/bulletin/_article/0000002d.htm
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When Compression Is Not Appropriate
Scrotal Edema
Dr. Reid's Corner
I have seen several patients over the last months
that highlight the risk of
inappropriate use of compression. One patient had scrotal edema. He had
non-Hodgkin's lymphoma and developed edema of the lower extremities and
as this
became worse, he developed edema of the scrotum. The edema was
initially treated
with diuretics, which temporarily resulted in decreased lower extremity
edema
but had very little effect on the edema of the scrotum. Unfortunately,
the
patient applied a compressive wrap. The scrotal skin is very thin and
delicate
and the edema further stretched the skin. The compressive garment did
not help
and caused area of skin breakdown leading to a severe infection. The
proper
treatment for this patient was to treat the cancer causing the problem,
not
applying compression of the swollen scrotum. The infection complicated
the
management of this patient since the infection had to be treated before
the
chemotherapy could be started. Fortunately, non-Hodgkin's lymphoma is a
very
treatable cancer and once the patient received the proper treatment
with
chemotherapy, the cancer decreased significantly in size and the
scrotal edema
resolved. For additional information on scrotal edema see Dr. Reid's
Corner here
http://www.lymphedema.com/wcina.htm
Acknowledgment
Peninsula
Medical, Dr. Reid's Corner
http://www.lymphedema.com/
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Scrotal Edema
Dr. Reid's Corner
I have received a number of questions about scrotal
edema over the last few
months. These questions have asked about using compression for treating
edema of
the scrotum. In short, I do not think this is a good general practice,
let me
explain why. Scrotal edema is generally divided into acute or chronic
causes.
Acute cases are generally a surgical issue and require evaluation by
ultrasound.
Torsion or twisting of the spermatic cord is the most common etiology
of acute
scrotum in children. Children with torsion usually present with acute
scrotal
pain, nausea and vomiting. Surgical treatment, within 6 hours of the
onset of
symptoms, may ensure the preservation of the testis. For that reason
any acute
scrotal pain with edema requires urgent and specialized evaluation.
Chronic edema of the scrotum can be caused by a number of conditions
such as
heart failure, liver failure, venous obstruction, lymphatic obstruction
or prior
surgery or trauma. For example, patients who have kidney failure and as
a result
have peritoneal dialysis catheters put in place can develop edema of
the scrotum
due to drainage from the peritoneal cavity through the inguinal canal
and into
the scrotum. The proper treatment in this case is surgical evaluation
and
treatment.
In the case of congestive heart failure or liver failure, the problem
is that
blood flow to the heart or through the liver is impaired. This results
in back
flow and accumulation of edema in the legs and often in the scrotum.
The proper
treatment in these cases is the management of the congestive heart
failure or
the liver failure. For example, in the case of congestive heart
failure, scrotal
edema will often improve when some of the stress on the heart is
removed by
medications. These medications reduce the work of the heart in pumping
blood.
Other medications cause excess fluid to be eliminated by urination. In
liver
failure, diuretics are used to remove excess fluid and help reduce the
edema.
Edema of the scrotum can also occur due to compression of the veins in
the
pelvis or abdomen. For example, cancers such as prostate cancer or
lymphoma can
grow and put pressure on the veins or lymphatics and cause edema. In
this case,
the proper treatment is control of the cancer so that the pressure
exerted on
the veins and lymphatics is relieved. I have had many cases of severe
edema of
the scrotum that have resolved after effective treatment of the cancer
that was
putting pressure on the veins or lymphatics.
In some cases prostate cancer or non-cancerous enlargement of the
prostate can
make urination difficult, resulting in the retention of urine in the
bladder. If
the bladder gets large enough, it can cause compression of the pelvic
veins
resulting in bilateral lower extremity and scrotal edema. These
patients improve
dramatically when the excess urine in the bladder is removed and the
enlarged
prostate is treated by surgical reduction.
Since edema of the scrotum often occurs due to a blockage at the level
of either
the heart or the liver or the draining lymphatics or veins, application
of
compression of the scrotum will not fix the underlying problem and may
result in
worse edema. The scrotum has a limited blood supply and compression of
the
scrotum could further diminish that blood supply. This could
potentially worsen
the condition or even result in serious tissue breakdown. There are
support
devices to help support and cushion an enlarged scrotum. However, I do
not know
of any approved devices for compression of the scrotum to treat scrotal
edema. I
am including a figure of the anatomy of the blood flow to the testicles
to make
my point. The figure shows the arteries in red and the veins in blue.
Please
note the limited blood supply to the scrotum. Compression of an
edematous
scrotum may further diminish venous outflow potentially worsening the
condition.
In addition, the skin of the scrotum is very thin and compression could
lead to
skin breakdown. This could lead to further serious complications
including
infection and tissue necrosis.
Acknowledgment
Peninsula Medical, Dr. Reid's Corner
http://www.lymphedema.com/
http://www.lymphedema.com/scrotal.htm
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From
The Yale School of Medicine
The treatment of scrotal lymphedema.
Answer:
Worldwide, most cases of scrotal lymphedema result from inflammation as
a
sequela of filarial infection, usually in tropical regions where the
filariasis
is endemic. In the U.S., the cause is usually surgery, irradiation,
and/or
cancer. The mainstay of therapy is surgical with medical therapy such
as
diuretics and scrotal elevation of little value except for very mild
cases. Any
underlying medical or infectious cause for the lymphedema, however,
should be
treated prior to attempting surgical therapy.
Surgical therapy can be categorized as either bypassing
(lymphangioplasty) or
excisional (lymphangiectomy). While numerous lymphangioplasty
procedures have
been conceived using autogenous material (skin bridges, omental
transposition),
prosthetic conduits (nonabsorbable suture threads), and microsurgical
techniques
(lymphaticovenous shunts), none have found to be consistently
satisfactory in
long-term results. It is generally agreed that excisional therapy,
which was
first described by Delpech in 1820, still provides the most expeditious
and
reproducible results.
Numerous variations of lymphangiectomy exist but they all have in
common the
excision of superficial lymphatics, subcutaneous tissue, and skin at
the level
of Buck’s fascia on the penis with dissection of the spermatic cord and
testicles from the edematous scrotal mass. Scrotal reconstruction and
coverage
varies. If there is not enough scrotal skin left then split-thickness
skin
grafts and/or fasciocutaneous thigh flaps may be necessary.
Courtesy Yale Surgery, Yale.edu
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Congenital
lymphedema of the penis: a method of
reconstruction.
Tapper D, Eraklis AJ, Colodny AH, Schwartz M.
Congenital lymphedema of the genitalia has profound physical and
psychological
consequences for the growing child. Extensive resection of this tissue
and
reconstruction by skin grafting offers a less than satisfactory
cosmetic result.
Over the past year we have employed a method of total excision of the
lymphedematous tissue of the penile shaft with cosmetic reconstruction
without
skin grafting. A circumferential incision was made 5-10 mm from the
coronal
sulcus and deepened to the level of Buck's fascia. The skin and
subcutaneous
tissue were then completely dissected away from the penis. The skin was
everted
and all of the abnormal lymphedematous tissue excised up to the dermal
skin
margin. The skin was then tailored to the size of the penile shaft and
reapproximated. This method has been employed in two patients with the
advantages of (1) shorter hospitalization, (2) lack of morbidity
associated with
the skin donor site, and (3) satisfactory cosmetic results.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7411361&itool=iconabstr
------------------------------------------------------------------
There is also an extended list of articles at this site from
PubMed (government site).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=pubmed_pubmed&from_uid=3993854
-----------------------------------------------------------------
SCROTAL LYMPHEDEMA
Buck's Fascia Surgery
For scrotal lymphedema, the
safest and most effective
surgery is called Buck's Fascia. In this surgery, the subcutaneous
tissues
(layer of swelling/fluid collection) of the scrotum is removed, the
skin is then
resected with the excess being removed.
You may find additional information under our section on genital
lymphedema. The
two surgical procedures described here are the safest and most
effective
techniques used. However, both also may require skin grafts.
For his leg lymphedema, he should be referred to a certified therapist
to have
decongestive therapy. Once the leg edema is brought under control,
there are
wraps and garments available that
will hold that swelling in check.
-------------------------------------------------------------------
Labial
swelling, clear discharge? Suspect genital lymphedema.(After Pelvic,
Gyn.
Surgery)
OB/GYN News, August 1, 2003, by Kate Johnson
MONTREAL -- Unusual gynecologic complaints of labial swelling or clear
labial/vaginal discharge could be symptoms of genital lymphedema,
especially if
the patient has had previous pelvic or gynecologic surgery or radiation
affecting lymph nodes or vessels.
Awareness of this phenomenon is slowly growing among gynecologic
oncologists,
but until recently "there was [little recognition] that gynecologic
lymphedema could complicate their treatments," Dr. Andrea Cheville,
director of the University of Pennsylvania Cancer Center's Lymphedema
Program,
said at a meeting sponsored by the World Federation for Ultrasound in
Medicine
and Biology.
"I have found limited receptivity regarding lymphedema on the part of
gynecologic oncologists. This reflects the general emphasis in cancer
care on
disease and worrying about recurrence. Historically, there hasn't been
emphasis
on addressing the non-life-threatening sequelae," she said in an
interview.
Lymphedema can occur
after treatment of gynecologic malignancies such as
ovarian, endometrial, or cervical cancer, because of the extensive use
of pelvic
lymph node dissection and radiation therapies. In addition, treatments
for
bladder, colon, and renal cancer also have potential to compromise the
deep
lymphatic structures, increasing the risk of gynecologic lymphedema,
she said.
The incidence of genital lymphedema is not known, largely because it
often goes
undiagnosed, but it has been estimated to occur following 10%-20% of
all
gynecologic oncology surgery and radiation therapy. Like other forms of
lymphedema, it most commonly occurs in the first 3-4 years after cancer
treatment, but can occur up to 30 years later.
"For patients with this history, if they have any genital swelling;
changes
in the skin texture; changes in hair growth; thickening of the labia;
the
presence of papillomas or discreet warty growths; or lymphorrhea, which
is
leakage of serous fluid through compromised or intact skin, think
lymphedema,"
she said.
Lymphorrhea may be
difficult to recognize, especially if it is occurring
intravaginally, but physicians can distinguish it from normal vaginal
discharge
or vaginal infections in a number of ways. "Many times vaginal
discharge is
whitish or curdish, thick, and opaque, but this is not. Lymphorrhea
tends to be
clear or a little bit yellow colored. If you culture it, it will be
negative.
But patients may sometimes complain that it is malodorous. Lymph has no
odor,
but it is very proteinaceous, which makes it a good culture medium for
bacteria," she said.
Genital lymphedema is a devastating condition, but unlike breast
cancer, it is
not a topic of polite conversation, Dr. Cheville said. She urged
physicians to
ask patients about these symptoms.
Treatment for the condition, as with general lymphedema, involves
combined
decongestive therapy consisting of compressive bandaging and manual
lymph
drainage, but this treatment approach can prove very problematic in
gynecologic
lymphedema.
"Bandaging is very difficult, because it's tricky to adequately
compress
the vulvar region," she noted, adding that she uses a specially
designed
bandage with Velcro straps and odor control pads.
She recommended that unless physicians have training in lymphedema
management,
they should refer the patient, but she acknowledged the difficulty in
finding
well-trained therapists.
"There are very few therapists who have comfort and experience treating
genital lymphedema. Predominantly these would be physical therapists,
but some
nurses and some occupational therapists do it as well."
http://www.findarticles.com/cf_dls/m0CYD/15_38/107275640/p2/article.jhtml?term=
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The
Medical Alogorithms Project - Chapter 16
16.28 Male
Genital Complications of Chronic Lymphatic Obstruction (Hydrocele
Lymphedema Elephantiasis Lymph Scrotum)
Overview:
Obstruction of lymphatic drainage from the male genitals can result in
retention
of interstitial fluid or chyle in the scrotum and/or penis. The
duration and
extent of the obstruction as well as development of complications
determine the
eventual outcome for the patient.
Causes of chronic lymphatic obstruction affecting the penis and/or
scrotum:
(1) filariasis
(2) sexually transmitted infections
(3) leprosy tuberculosis or deep fungal infection
(4) malignancy
(5) idiopathic
(6) after surgery or lymph node dissection
(7) scarring and fibrosis from other causes
Manifestations:
(1) hydrocele – fluid
accumulation in the scrotal sac without skin changes
(2) lymphedema - (elephantiasis when extreme) affects the scrotum
and/or penis
with changes in size and the skin quality
(3) lymph scrotum – vesicles filled with chylous fluid that easily
break and
leak
Distinction between hydrocele and lymphedema:
(1) A hydrocele may be
unilateral while scrotal lymphedema is bilateral.
(2) A hydrocele does not
affect the penis.
(3) In lymphedema the skin is abnormal while in hydrocele it is normal
and soft.
(4) It may be hard to exclude hydrocele if lympedema is present.
Features of elephantiasis:
(1) marked deformity or enlargement of the external genitalia
(2) skin hard and thick
(3) presence of knobs or bumps
Complications:
(1) cellulitis
(2) recurrent trauma
(3) infertility
(4) psychological distress or embarassment
Preventive measures:
(1) drainage of hydrocele
(2) frequent cleansing with soap and water
(3) monitoring for breaks in the skin with prompt therapy of cellulitis
(4) proper wrapping to minimize trauma and to collect any exudate or
lymph
drainage
References:
Dreyer G Addiss D et al. Basic Lymphoedema Management. Treatment and
Prevention
of Problems Associated with Lymphatic Filariasis. Hollis Publishing
Company.
2002. pages 53-62.
-------------------------------------------------------
Acquired
vulvar lymphangioma mimicking genital warts. A case report and review
of the
literature
Abstract
Mu XC, Tran TA, Dupree M, Carlson JA.
Department of Pathology and Laboratory Medicine, Albany Medical Center
Hospital,
New York, USA
http://www.ncbi.nlm.nih.gov/pubmed?term=Acquired%20vulvar%20lymphangioma%20mimicking%20genital%20warts.%20A%20case%20report%20and%2
------------------------------------------------------
Vulvar lymphedema: unusual manifestation of metastatic Crohn's disease
Servicio de Dermatologia.
Hospital Universitari Vall
dHebron. Barcelona.
Cutaneous-mucosal lesions constitute one of the most frequent
extraintestinal
manifestations of Crohn's disease and in some cases may be the first
symptom of
intestinal disease. We describe the case of a 45-year-old female
patient who
sought medical help for genital tumefaction of 20 years' evolution. For
the
previous 15 years, she had been experiencing digestive symptomatology
attributed
to irritable bowel syndrome. Two months before the consultation, and
coinciding
with aggravation of the condition, the patient had been diagnosed with
colonic
Crohn's disease. Skin biopsy of the labia minora revealed sarcoid
granulomas.
The results of microbiological studies (staining for microorganisms and
cultures) were negative. A diagnosis of metastatic vulvar Crohn's
disease was
made and, treatment with metronidazole was started, which improved the
genital
edema after 2 months. Genital lymphedema is an exceptionally rare
manifestation
of metastatic Crohn's disease that may appear several years before
intestinal
symptomatology develops. Treatment with metronidazole seems to be a
good
therapeutic option.
Pub Med
-------------------------------------------------------------------
Male
Genital Lymphedema - Filarial infection
Tropical Medicine Central Resource
http://tmcr.usuhs.mil/tmcr/chapter26/clinical1.htm
---------------------------------------------------------
Lymphedema
of the external
genitalia.
McDougal WS.
Department of Urology, Massachusetts General Hospital, 55 Fruit Street,
Boston,
MA 02114, USA.
PURPOSE: This article presents a simple classification of lymphedema of
the
external genitalia, which is useful for selecting the appropriate
therapy, and
evaluates our experience with the various therapeutic options used to
treat this
disorder. MATERIALS AND METHODS: The literature was reviewed and the
records of
patients treated for the disorder were analyzed. RESULTS: A convenient
classification of the disorder divides cases into congenital and
acquired.
Therapy is primarily dependent on whether the disease is self-limited
and
whether there has been any pathological change in the skin, lymphatics
and
subcutaneous tissue. For self-limited diseases in which no permanent
pathological sequelae occur conservative therapy is appropriate. For
most
chronic conditions a surgical procedure is required. Excisional
techniques are
most effective for severe forms of the disease. In select cases
subcutaneous
tissue excision with preservation of the overlying skin is appropriate.
However,
for most patients excision of the skin and subcutaneous tissue with
split-thickness grafting is most effective. CONCLUSIONS: When patients
with
lymphedema of the external genitalia require surgery and are properly
selected
for the appropriate procedure, the functional and cosmetic results are
excellent
and patient rehabilitation is likely.
Pub Med
-------------------------------------------------------------------
Primary
lymphedema of the genitalia
in children and adolescents.
Ross JH, Kay R, Yetman RJ, Angermeier K.
Department of Plastic Surgery, Cleveland Clinic Foundation, Ohio, USA.
PURPOSE: Congenital lymphedema is a rare disorder that may result in
disfiguring
edema of the male genitalia. We reviewed our experience with 5 cases to
advance
our understanding of this challenging problem. MATERIALS AND METHODS:
Four boys
with significant lymphedema underwent excision of the involved
subcutaneous
genital tissue and coverage with local skin flaps. Two boys in whom
this
approach failed later underwent complete excision of the involved
subcutaneous
tissue and skin, and coverage with split thickness skin grafts. The boy
with
minimal edema was observed. RESULTS: Two of the 4 boys who underwent
subcutaneous genital tissue resection and coverage with local skin
flaps are
markedly improved, although 1 requires further revision. In the other 2
boys
treatment failed, necessitating repeat genital tissue excision and
grafting.
While there have been no recurrences in the grafted areas, each patient
has
required additional operations to manage recurrent edema in adjacent
tissues of
the perineum and inguinal region, and in 1 significant contraction of
the
grafted skin developed. Mild genital lymphedema in the remaining
patient has
remained stable during 10 years of followup. CONCLUSIONS: Congenital
lymphedema
of the genitalia is a challenging problem. Recurrences requiring
multiple
operations are common. We recommend expectant management of mild cases.
In more
severe cases excision without grafting should be attempted. While skin
grafting
may be the most definitive solution, it does not prevent recurrence in
adjacent
regions, and it carries the risk of skin contraction. Skin grafts
should only be
used when other techniques have failed.
MedLine
-------------------------------------------------------------------
Surgical
management of congenital
lymphedema in infants and children.
Fonkalsrud EW.
Of 67 children and infants with lymphedema, 28 had the congenital type.
Congenital lymphedema appears during the first few weeks of life,
frequently
involves more than one extremity, and enlarges at a slower rate than
general
body growth. The swelling usually becomes less pronounced with age, and
no
specific therapy is required in two thirds of the patients. Seven of
the 28
children had swelling of the upper extremities and a generalized
lymphangiopathy
syndrome. Subcutaneous lymphangiectomy was performed on ten of 28
patients who
had moderate to severe swelling. Those with hand and arm involvement
were
particularly benefited; however, operations on the dorsum of the foot
produced
hypertrophic scars in one third of the cases. The operation is deferred
until
after age 2 years to permit optimal technical repair and to identify
those
patients whose conditions will improve spontaneously.
Pub Med
-------------------------------------------------------------------
A
new surgical approach in genital
lymphedema.
Yormuk E, Sevin K, Emiroglu M, Turker M.
Department of Plastic and Reconstructive Surgery, University of Ankara,
Turkey.
A new surgical approach has been used in a case of genital lymphedema.
After
resection of the lymphedematous mass, U-shaped flaps were made from the
suprapubic region anteriorly and the posterior scrotal skin
posteriorly. The
denuded penis was transposed to its original place by passing it
through a
buttonhole incision made on the anterior flap. The testicles were
placed and
fixed in pouches prepared between the anterior and posterior flaps. The
patient
had an acceptable postoperative outcome both in testicular function and
habitual
sexual activities.
PubMed
-------------------------------------------------------------------
Microlymphaticovenous anastomosis for treating scrotal elephantiasis.PMID: 3990547 [PubMed - indexed for MEDLINE]
-------------------------------------------------------------------
Scrotal
reconstruction using thigh pedicle
flaps: long-term follow-up of 12 cases.
Kochakarn W, Hotrapawanond
P.
Department of Surgery, Faculty of
Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand.
INTRODUCTION: Genital skin loss in
men may be caused by
avulsion injuries of the penis and scrotum or by gangrene of the male
genitalia.
Reconstruction of the scrotum after complete loss of the overlying skin
is a
challenging problem. We report our experience on the management of this
problem.
MATERIAL AND METHOD: Medical records of all male patients with massive
scrotal
skin loss and exposed testes treated at Ramathibodi Hospital and
Noparat
Rajthanee Hospital from 1990 to 1999 were reviewed. The etiologies of
scrotal
skin loss, technique of treatment, post-operative consequence as well
as
complications were noted. RESULTS: Twelve patients were described in
this study.
Nine patients had avulsion injuries of the penile and scrotal skin
secondary to
agricultural machinery accidents. Three patients were after extensive
debridement of Fournierris gangrene. The exposed testes had been placed
in thigh
pouches and scrotal reconstruction using thigh pedicle flaps was done
4-6 weeks
later. No immediate and delayed complications were detected in all of
the
patients. They recovered without any sequelae and had a satisfactory
cosmetic
result. CONCLUSION: Extensive scrotal skin loss should be immediately
treated
surgically. Implantation of the exposed testes in the upper thigh pouch
and
delayed reconstruction of the scrotum using thigh pedicle flaps can
provide
excellent results
PMID: 11999821 [PubMed - indexed for
MEDLINE]
-------------------------------------------------------------------
Genital Lymphoedema
By Melanie Lewis MCSP SRP, Macmillan Lymphoedema
Clinical Specialist Service Co-ordinator
Lymphoedema of the genital region is relatively uncommon, but
is extremely
uncomfortable and distressing for the patients who suffer with this
condition.
It can affect both men and women alike, but is seen more frequently in
males due
to the anatomical differences between the genders and effects of
gravity. Around
ten percent of people who develop leg oedema will have associated
genital
swelling, but some patients can have genital oedema alone.
In some circumstances, genital oedema can occur acutely due to trauma
or
cellulitis and may be able to resolve completely by itself. Far more
usual
however, is the chronic genital oedema, which is unfortunately
irreversible, but
can be controlled and reduced through appropriate lymphoedema
management. The
main cause of genital oedema is either due to primary or secondary
lymphoedema.
Primary lymphoedema affecting only the genitals is rare. It can be noticed from birth or during the teens, and as the affected individual grows, the involved lymphatic system becomes ever more under pressure to drain the tissue fluid and the swelling becomes far more obvious. The main reasons for primary genital lymphoedema are that the lymph vessels are absent or reduced in number or simply don't work as well as they should i.e. functional failure. It has also been thought that primary lymphoedema patients who are obese, have an increased risk of genital swelling due to greater pressure on the groin from the enlarged abdomen.
Secondary lymphoedema more commonly affects the genital region than primary lymphoedema. In Africa, India and other tropical countries, genital swelling is frequently seen due to infectious diseases like filariasis. This can lead to gross elephantiasis of the penis and scrotum. In the Western world, the majority of genital oedemas are from trauma or surgery to remove gynaecological, urological, abdominal or prostatic cancers. It has been reported that up to 70% of patients treated for carcinoma to the vulva will have lower body swelling. Radiotherapy to the lymph nodes in the groin or abdominal region can also cause genital lymphoedema. The incidence also increases if there has been surgery and radiotherapy plus episodes of cellulitis.
Clinical Features
Swelling - Various parts of the genital anatomy can become swollen. In males, both the penis and scrotum, or each, can swell independently. Very few patients just have penile oedema, but it does happen, as can be seen from the case study. Sometimes, the scrotum becomes so swollen, that the patient has difficulty in walking. As the swelling increases, it can involve the area above the base of the penis (called the pubic area), thus causing the penis to retract into the scrotum. This clearly causes problems for micturition (urination)and sexual activity.
In females, the inner and outer lips of the vagina (labia) can become so swollen that they extend out of the vagina by up to 6 inches; again this creates problems for sexual activity and urination. In both genders, the pubic area on the lower abdomen alone can become oedematous, with associated skin changes and fibrosis.
Genital swelling can occur due to other causes. Palliative patients who have renal, cardiac or hypoproteinaemia (high output failure due to low protein) and patients who have had venous problems, could develop genital oedema. A clear diagnosis and medical investigations are needed, prior to lymphoedema management.
Pain is a problem for some patients, who describe a dragging, heavy, bursting sensation or an ache around the genital region. This is usually eased when the area is decongested or lifted by a jock straplike support or cycling shorts.
Skin changes are readily seen in genital oedema. Thickening and dry, flaking skin (hyperkeratosis) or warty blisters (papillamatosis) do occur as the swelling progresses.
Acute Inflammatory Episodes (cellulitis) are commonly seen in oedematous skin, which is the ideal medium for bacteria as it is generally warm, moist and has numerous crevices. The bacteria multiply in the protein rich oedema fluid, and infections can spread throughout the genital region, causing it to be red, hot, tender and swell even further. More often than not, an infection is seen as the precipitating factor in causing the swelling.
Fungal Infections do occur, due to the area being moist, warm and having so many crevices. Sweating also can trigger fungal infections.
Lymphorrhoea occurs when the tissue pressure increases and causes leakage of fluid from the thin layer of skin. Lymphorrhoea can continue for a few days or weeks and carries a high risk of developing infections. It can be very distressing for patients, as some have to wear incontinence/sanitary pads to absorb the copious fluid. Lymphoedema treatment is necessary to stop this leakage.
Sexual Dysfunction happens as the oedema increases. In males, impotence or painful erections impede sexual intercourse. Females find that the presence of oedema dampens sexual activity, due to decreased libido and pain.
Lymphoedema Treatment and Management
The four cornerstones of lymphoedema care can be modified to treat genital oedema.
Skin Care and meticulous hygiene of the genitals is imperative. Daily bathing with an antibacterial soap and drying the area afterwards is very important to reduce the likelihood of infections. Regular moisturising with an aqueous cream will deter any areas of dry, flaky skin and keep the area soft.
As this area is prone to fungal infections and cellulitis, regular inspection will enable the patient to detect any early signs of inflammation. If an infection occurs, prompt anti- fungal or antibiotic treatment is required. If a patient suffers from recurring cellulitis episodes, then longterm prophylactic antibiotics may be required.
Compression
Garments or Multi- Layered Bandaging
techniques are needed to give the genital area support and
compression.
The penis, scrotum and labia areas will continue to swell until a firm
outer
casing prevents them from doing so. This outer casing works by
providing the
muscles with a base to press against, thereby, reducing the swelling.
The best form of compression garment comes in the form of custom-made
tights or
shorts. Spandex or padded cycling shorts and sports jock straps are
also very
useful to provide more comfort to the oedematous areas. Under garments
must be
firm and supportive, not loose. In some instances, two pairs, or an
under
garment plus swimming trunks, have been found to be effective.
Foam inserts also can increase the amount of compression to the penis,
scrotum
or female genital area. Ladies may find that the addition of a sanitary
towel
underneath garments is also helpful. For male patients with significant
penile
and scrotum swelling, a regime of multi-layered bandaging may be
appropriate.
This will consist of washable or disposable bandages and padding/foam
being
applied to the scrotum and penis separately. Your lymphoedema
specialist will
need to have had additional training in managing lymphoedema of the
genitals, as
bandaging the genital area can be very awkward, particularly in getting
the
bandages to stay in place once the oedema has reduced. Occasionally,
bandaging
can cause an irritation at the base of the penis and the edge of the
scrotal
bandaging, thus care must be taken to ensure adequate padding is in
place.
Simple solutions that have helped, include creating a harness for the swollen scrotum, using a soft pliable material like splint foam or 'Velfoam' prior to padding and bandaging. The harness creates more uplift for the scrotum and patients find it more comfortable as the bandages don't tend to slip. The harness and the penile bandaging can be kept in place using Velcro strips, as it is much easier to apply and reapply and does, therefore, tend to stay in place better. The use of compression shorts, post bandaging, also draws the genitals close to the body and also keeps the bandages in place. All bandages can be easily removed for micturition or if soiled, and the patient taught how to apply/reapply them. The use of bandages can significantly reduce the oedema, which would be maintained by compression garments such as shorts or tights.
Exercise
in any form is important, as it
keeps all the joints and muscles working adequately. If there are no
areas of
broken skin, then an excellent form of exercise is swimming or walking
in the
water. The genital area will have some support from the swimming attire
and the
pressure from the water assists too. Other forms of aerobic exercise
that are
also useful are cycling and walking, but it is important that
compression
garments and padding are worn when cycling.
A specific form of exercise for female genital oedema is the pelvic
floor
exercise. Together with abdominal exercises and diaphragmatic
breathing, pelvic
floor exercises can help in reducing the oedema. Ask your lymphoedema
specialist
or physiotherapist for further advice.
Lymph Drainage is an important part of lymphoedema management. Manual Lymphatic Drainage (MLD) and Simple Lymphatic Drainage (SLD) are massage techniques designed to move fluid away from the swollen genital region, to parts that are not affected, to drain freely. The massage itself is very light and is not painful. It is also very useful in softening hard, fibrosed tissue. MLD is a technique that is carried out by trained therapists. SLD is a simplified form of MLD and can be taught to the patient or carer to do themselves.
Surgical
Management
In some cases where conservative treatment does not control the
swelling,
surgical intervention may be required. Surgery could involve reducing
the
scrotum, penis or labia with the aid of plastic surgery skin grafting.
Case
Study
Mr A is a 68-year-old gentleman who has suffered with genital oedema
since
November 2001.Whilst on holiday in 2001, Mr A developed a painful spot
on the
right buttock possibly from an insect bite. Unfortunately, this blemish
continued to increase in size and eventually became an abscess. He was
operated
on 3 times in a generalist hospital and due to infections and
gangrenous tissue,
some of his inguinal lymph nodes were removed. Mr A's genital swelling
started
soon after the surgery and was sited in the penis area alone. He
unluckily had
numerous cellulitis episodes, which in turn increased the penile
swelling. The
scrotum area was severely distorted due to the previous operations and
in
December 2002, Mr A underwent plastic surgery to graft and lower the
testicle
area, which although improved the cosmetic appearance of the testicles
increased
the penile swelling.
Mr A was referred to the lymphoedema service and assessed in June 2003.
On
examination, the genital area was red, inflamed and had a discharge
from the
shaft of the penis, which was grossly oedematous. The lymphorrhoea had
been
present for the last 6 months and Mr A had to pad the area to stop it
staining
his under garments. Severe skin changes were apparent with brown
discolouration
patches, hyperkeratosis and fibrosis all over the penis. The pubic area
was also
swollen and fibrosed.
Functionally, Mr A felt all forms of activity were limited, as well as
travelling and socialising. He suffered an extreme amount of discomfort
and
pain, which hindered his mobility, and psychologically he felt that the
oedema
had greatly affected his quality of life and the way in which he viewed
himself
as a man.
Treatment commenced immediately, with Mr A starting a 2-week course of antibiotics to manage the infection. Information regarding hygiene and daily moisturising with an aqueous cream was initiated to help the skin changes, and antibacterial talc was recommended to reduce friction in the groin region. A simple technique of bandaging was also taught to the patient to reduce penis size and stop the leaking fluid. MLD was started and SLD was taught, to improve the fibrosis and create collateral drainage.
Mr A was reassessed four weeks later and was delighted with the results. His penile swelling had reduced significantly, making it look far more normal. The skin condition was greatly improved with all areas of hyperkeratosis and leaking diminished. His mobility was normal due to the pain being relieved and he informed me that he had booked a holiday. He is continuing with his lymphoedema regime, consisting of SLD, multi-layered bandaging and daily use of his compression padded cycling shorts, which will keep him in control of his genital oedema.
For further information regarding genital oedema, ask your lymphoedema specialist or medical practitioner.
http://www.lymphoedema.org/lsn/lsn140.htm#TOP
-------------------------------------------------------------------
PMID: 6343640 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6343640&dopt=Abstract
-------------------------------------------------------------------
Lymphedema
of male external genitalia: a
retrospective study of 33 cases
[Article in French] 2005
Vignes
S, Trevidic
P.
Unite de Lymphologie, Hopital Cognacq-Jay, Site Broussais, Paris.
INTRODUCTION: The aim of this retrospective study was to describe the main characteristics and treatment of male external genitalia lymphedema.
PATIENTS AND METHODS: From 1987 to 2003, all patients seen in a single hospital for lymphedema of male external genitalia were included. For each patient, the following characteristics were recorded: primary or secondary lymphedema, cause of secondary form, date of onset of lymphedema, associated lower limb lymphedema, clinical signs, and complications. In the primary forms, lower limb lymphoscintigraphy was performed. Specific surgery was proposed in all cases of symptomatic lymphedema (circumcision, scrotum and/or penile cutaneous excision).
RESULTS: Thirty-three patients with lymphedema of external genitalia (17 primary, 16 secondary) were recruited. Two primary lymphedema were congenital, one isolated. Mean age +/- SD of the onset of the 15 other primary genital lymphedema was 23.4 +/- 17.5 years, always after the appearance of lower limb lymphedema. Sixteen men had secondary lymphedema (bladder, prostate, or rectum cancer, Hodgkin or non-Hodgkin lymphoma, aorto-bifemoral bypass grafting, biopsy or curretage of inguinal nodes). Secondary genitalia lymphedema was not associated with lower limb lymphedema in two cases and, in the others it occurred 66 +/- 122 months after (n=11), at the same time (n=2) or before lower limb lymphedema (n=1). Clinically, we noted genitalia heaviness (n=31), lower limb lymphedema (n=30), vaginal hydrocele (n=13), impaired miction due to prepucial swelling (n=10), leakage of lymphatic fluid (n=10). Lower limb lymphedema was complicated by at least one erysipelas (n=20), spreading to the external genitalia (n=4). In primary forms, lymphoscintigraphy showed ipsilateral hypoplasia of inguinal nodes in lower limb lymphedema (n=14) and/or external genitalia backflow (n=7). Surgical treatment was performed in 17 cases (11 primary, 6 secondary) with good results after 21 months' median follow up (1 month-10 years). Two patients died of cancer. One secondary lymphedema improved spontaneously and one disappeared after withdrawal of lower limb pneumatic compression.
DISCUSSION: Lymphedema
of external
genitalia is responsible for discomfort and local complications.
Surgical
treatment is the main procedure of this disorder.
PMID: 15746602 [PubMed
- indexed for MEDLINE]
-------------------------------------------------------------------
Skin graft
reconstruction of chronic genital lymphedema.
Morey AF, Meng MV, McAninch JW.
Department of Urology, University of California, School of Medicine,
San
Francisco 94143-0738, USA.
OBJECTIVES: We present a simple, reliable method of scrotal and penile
reconstruction yielding satisfactory cosmetic and functional results
for
patients with disabling chronic genital lymphedema. METHODS: Nine
patients were
treated with wide excision of the affected genital skin and subsequent
coverage
of exposed areas with split-thickness skin grafts in a single-stage
procedure.
RESULTS: All patients have had excellent cosmetic results without
recurrence of
genital lymphedema or compromise of sexual function postoperatively.
CONCLUSIONS: Single-stage reconstruction for idiopathic genital
lymphedema by
radical skin excision and split-thickness skin grafting provides
gratifying
functional and cosmetic results.
PMID: 9301709 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9301709&dopt=Abstract
-------------------------------------------------------------------
Division of Plastic Surgery, Department of Trauma Surgery, Plastic and Reconstruction Surgery, University Hospital Goettingen, Germany. mikhail.zvonik@med.uni-goettingen.de
Genital lymphedema represents a severe disability for patients particularly when complicated by erysipelas, the most frequent complication. The objectives of this study were: to investigate the frequency of erysipelas in patients with genitallymphedema and genital lymphatic cysts who underwent evaluation for surgical treatment, to observe the influence of resection operations on the frequency of erysipelas, and to measure changes in the quality of life due to the resection. A total of 93 patients with genital lymphedema were studied. All patients underwent integrated care treatment in the Földi Clinic, Hinterzarten and the Department of Plastic and Hand Surgery of the University Hospital Freiburg during the period between 1997 and 2007. 44 of these patients underwent surgical treatment of genital lymphedema. The results indicate that lymphatic cysts were the most important risk-aggravating factor for recurrent erysipelas with lymphorrhea in the genital region (p < 0.001). Following the resection operation, however, the number of erysipelas incidents significantly decreased (p < 0.001). In addition, the antibiotic dose could be reduced after surgery (p = 0.039) and an improved quality of life was achieved (p < 0.001)
PubMed
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=======================================================
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
=======================================================
For information about Lymphedema
http://www.lymphedemapeople.com/thesite/all_about_lymphedema.htm
For Information about Lymphedema Complications
http://www.lymphedemapeople.com/thesite/lymphedema_complications.htm
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http://www.lymphedemapeople.com/forum/forum.asp?FORUM_ID=7
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=======================================================
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http://www.lymphedemapeople.com/forum/topic.asp?TOPIC_ID=247
===================================================
Lymphedema People
Support Groups
-----------------------------------------------
Children
with Lymphedema
The time has come for families, parents, caregivers to have a support
group of
their own. Support group for parents, families and caregivers of
chilren with
lymphedema. Sharing information on coping, diagnosis, treatment and
prognosis.
Sponsored by Lymphedema People.
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
......................
Lipedema
Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
totally
frustrating conditions out there. This will be a support group for
those
suffering with lipedema/lipodema. A place for information, sharing
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exploring treatment options and coping.
Come join, be a part of the family!
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......................
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved
one with lymphedema who you are trying to help and understand come join
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......................
All
About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
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......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
nothing out
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
perhaps,
it is time that one be offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
information
available through sister site Lymphedema People.
http://health.groups.yahoo.com/group/lymphaticdisorders/
Subscribe: lymphaticdisorders-subscribe@yahoogroups.com
At our home page we have 18 categories with 218 articles
on lymphedema, edema, and related conditions:
The Forums
Lymphedema Information
Lymphedema and Edema Related Conditions
Hereditary Conditions of the Lymphatics
Related Medical Conditions
Complications of Lymphedema
Lymphedema Treatment Options
Complete Listings of Therapists and Links
Cellulitis and Related Infections
Wound Information, Care, Treatment
Skin Care, Conditions and Complications
Exercise, Diets, Nutrition
Miscellaneous Interesting Articles section
Resources, Organizations, Support Groups
Government Resources
Advocacy and Lobbying Resources
Resources for the Medical Community
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Home page: Lymphedema People
http://www.lymphedemapeople.com/
Updated Dec. 29, 2011