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Penile lymphoedema: approach to investigation and management
Author(s) -
Shim T. N.,
Doiron P. R.,
Francis N.,
Minhas S.,
Muneer A.,
Hawkins D.,
Dinneen M.,
Bunker C. B.
Publication year - 2019
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.13609
Subject(s) - medicine , lymphedema , foreskin , occult , surgery , glans , dermatology , cellulitis , fasciitis , penile cancer , etiology , retrospective cohort study , differential diagnosis , penis , cancer , pathology , alternative medicine , biology , breast cancer , genetics , cell culture
Summary Background Penile lymphoedema (with and without cellulitis) is a rare, often chronic, clinically heterogeneous entity with an uncertain pathogenesis and an important differential diagnosis. It creates significant physical and psychosexual morbidity, and presents considerable therapeutic challenges. The existing literature is limited. Aim To describe and share our updated cumulative experience of a cohort of patients with penile lymphoedema. Methods This was a retrospective review of the case records of patients with chronic penile lymphoedema seen in two dedicated male genital dermatology clinics between January 2011 and July 2016. Results In total, 41 cases were identified. Over a third had Crohn disease (CD) (which was occult in one‐third of these), and over a third had serological evidence of streptococcal infection. All patients responded to systemic antibiotics and specialized urological surgery circumcision and excision). Conclusions Penile lymphoedema should be investigated to exclude underlying pathology especially CD and streptococcal infection. Treatment with antibiotics should be considered early and long term to try to preserve the foreskin: most patients are uncircumcised. Some patients may benefit from a course or courses of oral steroids. The development of gross dysfunction of the prepuce usually dictates circumcision and excision of lymphoedematous tissue once the situation is medically stabilized.