Penile Lymphedema Due to Penile Strangulation

SavageGlow · #1 ● 06-18-2024, 04:12 PM

A 65-year-old single Japanese man was referred to our hospital with tremendous enlargement of the penis. There was no particular psychiatric or family history, and the patient had never travelled to a tropical region. Approximately 4 years prior to admission, he began to roll a commercially available rubber band (4.5 cm in diameter) around the penile root and foreskin, and used it throughout the day and evening to prevent urinary incontinence. Two years after beginning such rubber band use, the patient noticed gradual swelling and deformity of the penis, but continued to use the rubber band, resulting in progressive enlargement.

A physical examination revealed brown colored hypertrophic skin that was very large (44 cm in length, maximum circumference 50 cm) though painless and completely covering the penis, with only the penile orifice barely observable (Figure 1(a)). A normal scrotum and testes could be identified after lifting the mass (Figure 1(b)). The thickened skin had no ulceration or infection, though loss of sensation for urination and erection were noted. Magnetic resonance imaging of the genital area showed an intact penis covered with edematous soft tissue. Most laboratory findings including filarial worm egg inspection were within normal limits, though urinalysis confirmed pyuria. Based on these findings, we diagnosed secondary giant penile lymphedema due to long-term chronic penile strangulation from use of a rubber band.

A histopathological examination revealed that most of the excised mass consisted of proliferated collagen fibers, as well as enlarged lymphatic and capillary vessels with lymphocyte infiltration. Two months after surgery, wound healing along with acceptable cosmetic results and improvement of QoL was noted, though the patient required continuous use of a Foley urethral catheter because of loss of sensation to urinate.