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 embarrassment
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
