Secondary scrotal lymphedema: A novel microsurgical approach

Secondary scrotal lymphedema: A novel microsurgical approach
Sylvain Mukenge, M.D. 1 *, Carlo Pulitanò, M.D. 1, Renzo Colombo, M.D. 2, Daniela Negrini, B.D. 3, Gianfranco Ferla, M.D. 1
1Department of Surgery, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy2Department of Urology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy3Department of Experimental and Clinical Biomedical Sciences, University of Insubria, Varese, Italy
email: Sylvain Mukenge (mukenge.mvunde@hsr.it)

*Correspondence to Sylvain Mukenge, Department of Surgery, Scientific Instistute H San Raffaele, Via Olgettina 60, 20132 Milan, Italy
setDOI("ADOI=10.1002/micr.20426")

Abstract

Secondary scrotal lymphedema is an infrequent complication of radical cystectomy assiociated with pelvic lymphadenectomy. We report a case of secondary lymphedema of male genitalia presenting more than 4 years after a radical cystectomy with extended pelvic lymphadenectomy for adenocarcinoma of the bladder. Microsurgical lymphovenous anastomoses are usually performed using only the scrotal lymphatics excluding the testicular lymphatics drainage. We have experimented a new microsurgical technique based on lymphovenous anastomosis between the collectors of the spermatic funiculus and the veins of the pampiniform plexus, allowing the testicular lymphatic drainage.

Wiley InterScience

Microsurgery for treatment of peripheral lymphedema: Long-term outcome and future perspectives.

Microsurgery for treatment of peripheral lymphedema: Long-term outcome and future perspectives.

Microsurgery. 2007 May 3

Campisi C,
Eretta C,
Pertile D,
Da Rin E,
Campisi C,
Maccio A,
Campisi M,
Accogli S,
Bellini C,
Bonioli E,
Boccardo F.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Genoa, Italy.

Authors report over 30 years of their own clinical experience in the treatment of chronic peripheral lymphedemas by microsurgical techniques performed at the Center of Lymphatic Surgery of the University of Genoa, Italy. Over 1,500 lymphedema patients were treated with microsurgical techniques. Derivative lymphatic-venous techniques were most often used. For those cases where a venous disease was associated to lymphedema, reconstructive lymphatic microsurgery techniques were performed (lymphatic-venous-lymphatic-plasty).

Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Volume changes showed a significant improvement in over 83%, with an average follow-up of more than 10 years. There was an 87% reduction in the incidence of cellulitic attacks after microsurgery.

Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonoperative treatment. Improved results can be expected with operations performed at earlier lymphedema stages. (c) 2007 Wiley-Liss, Inc. Microsurgery 2007.

PMID: 17477420 [PubMed - as supplied by publisher]