Surgery Is the Last Resort for Huge Scrotal Lymphedema: A Series of Challenging Cases.

We aim to provide our surgical techniques, and outcomes of functional scrotal reduction procedures with complete preservation of the genitourinary original anatomy in a simple way without using complicated skin grafting or skin advancement flaps in Patients with huge and long-standing scrotal lymphedema 18 patients ages ranged from 14-65 with a median of 30 years. Functional scrotal and penoscrotal reduction was attained in all cases, without distortion of the genitourinary anatomy and without the need for advancement, rotational or free flaps, maximal scrotal diameter was reduced from median of 61[48-92] cms to a median of 25[21-29] cms ( P <0.0001) and remained almost unchanged at the end of the follow up period 26[22-34] cms ( P <0.0001). Sexual performance and voiding capacity were improved in all patients, testicular vascularity was unaffected and the Glasgow Benefit Inventory (GBI) for the quality of life showed marked enhancement in the total 55.5[50-72], general 55.5[50-72], social 100[50-100] and physical 16.6[16-33] points subscales. According to our experience, surgery remains the gold standard treatment for management of huge scrotal lymphedema, successful preservation of the genitourinary functions can be attained despite the size in most cases with excellent cosmoses.

Surgical Management of Cirsoid Aneurysms of the Scalp: Ten Years' Experience.

OBJECTIVE: Cirsoid aneurysms are rare arteriovenous malformations of the scalp that present with disfigured pulsatile masses and may be associated with headache, bleeding, or tinnitus. These lesions are difficult to manage because of their complex vascular anatomy, high shunt flow, and cosmetic disfigurement; many options have been described to treat such lesions. We evaluate 10 years' experience in the surgical management of cirsoid aneurysms of the scalp. METHODS: This study included 15 patients with cirsoid aneurysm of the scalp, all of whom were treated with surgical excision only over 10 years. They were 8 females and 7 males, with a median age of 23 years. History of trauma was present in 5 patients. Frontal and parietal regions were the commonly affected sites. Superficial temporal, supraorbital, and occipital arteries were the most frequent feeding arteries. RESULTS: Excision of the lesion was performed in all patients using our modified surgical technique. All patients had good cosmetic results and there were no recurrences during an average follow-up of 25 months. CONCLUSIONS: Despite great progress in endovascular therapy, surgical excision of cirsoid aneurysms of the scalp seems to be the most effective treatment, with good results and patient satisfaction.

Giant scrotal swelling in association with a congenital giant melanocytic nevus: A case report.

INTRODUCTION: Scrotal lymphedema is a rare condition, with significant psychological and functional disability. To date, association with giant congenital melanocytic nevus has not been reported. CASE REPORT: We report a case of a 15-year-old male with a giant congenital nevus associated with giant scrotal lymphedema. Surgical debulking with penoscrotoplasty achieved satisfactory functional and esthetic results. CONCLUSIONS: Early diagnosis and surgical intervention should be advocated for congenital causes of large scrotal swelling.

Surgical management of giant scrotal lymphedema in morbidly obese patient with trisomy 21.

Huge scrotal lymphedema is a rare problem that affects the patient's lifestyle and leads to physical and emotional disability. It also carries potential challenges for the treating surgeon, especially if the patient is noncompliant or morbidly obese. A 21-year-old morbidly obese trisomy 21 man with huge scrotal lymphedema and buried penis that developed within 2 years presented for excision scrotoplasty with reconstruction of the penis using the original invaginated penile skin. Giant scrotal lymphedema with buried penis can be treated successfully by excision scrotoplasty with preservation of the invaginated healthy penile skin to reconstruct the penis.