Patient: YSS age: 32 years Race: Black.
Personal history: He did not refer associated pathologies HEA: Patient who came to the consultation for presenting for two years progressive increase of the external genital organs, transudation of the lymph and sexual impotence.
Positive data on physical examination upon receipt:
External genitals: Tagged penis and scrotum edema with erythema and pain.
Inguinal non-painful adenopathies.
1.
Pathological studies were performed to demonstrate possible etiology: Complete blood count: Normal cells.
Serology: Non-reactive.
Mantoux hip test: total protein binding and fixed: Normal X-ray: Absence of bone lesion.
Abdominal U/S: Thickened right psoas 48 mm simple TAC of hypogastrium and pelvis: Necrosis of the head aseptic with hypertrophy of the psoas at this level.
Different surgical procedures were performed: - Right retroperitoneal exploration. - Right iliac and vena cava adenotomy. - Needle lymphangioplasty. - penile root fasciotomy.
This patient did not present any symptoms of urinary cheluria or lower limb edema, nor was varicocele or hydrocele detected.
With the clinical manifestations, as well as the findings found and ruling out another possible cause of lymphedema of the penis and scrotum in this patient is diagnosed as follows:
Primary inflammatory swelling of the penis and scrotum
Aseptic necrosis of the head
A multidisciplinary team consisting of urologists, angiologists and plastic surgeons was then evaluated.
It was decided to perform lymphangiectomy.
Pathway Anatomy
It is distorted by the condition, which prevents the normal evacuation of the lymph, due to the fundamental distortion and elastic attachment of the penis, lymphatic conjunctive fibers due to the increased fibrous tissue and reduction of the organs
The skin and dermis; give the tunica erectileis difficult to distinguish between the covered and the peripeneal muscle of Sappey, which contributes with its contraction to compress the dorsalis pedis artery fascia, respecting the dorsalis fascia
In the bags of the six coverings that make up the covering of the testicles: the scrotum, the muscular scrotum, the cellulose, the Cooper's fascia, the second muscular layer must also be removed.
