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Elephancy of the external genitalia
Last reviewed: 23.04.2024
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Elephancy of the external genitalia is a rare, but severe somatic disease characterized by persistent chronic edema of the skin, subcutaneous fat and superficial fascia with impaired lymphatic and venous outflow.
The cause and mechanism of its development, despite the experience accumulated by doctors for many years, has not been sufficiently studied.
What causes elephantiasis of the external genitalia?
To congenital elephantias carry a "family" hereditary form (Milroy's disease), which is rare, in members of the same family.
The appearance of elephantiasis of the penis is possible after circumcision of the prepuce. Of all the causes of inflammatory nature, the first place is occupied by erysipelas, which often occurs in the lower parts of the abdomen, perineum, external genital organs, and also on the lower limbs. A specific significance in the development of the elephantia of the external genital organs is nonspecific infection.
Symptoms of the elephantia of the external genitalia
Elephancy is slowly a current inflammatory-dystrophic process in the skin, subcutaneous fat layer, superficial fascia, with densification, thickening and cicatricial changes in them accompanied by insufficiency of lymphatic vessels. At the heart of the pathogenesis of elephantiasis are disorders of lymph circulation at various levels of the lymphatic system, followed by the accumulation of proteinaceous fluid (up to 5%) in interstitial tissue, which leads to disruption of protein and water-salt metabolism in tissues, causing their dystrophic changes followed by hyalinosis and sclerosis.
With the elephantiasis of the external genital organs, the pathological process, as a rule, does not involve deep lymphatic vessels, cavernous bodies, urethra, testicles and appendages.
Symptoms of elephantiasis of the external genital organs - an increase in the external genitalia, sometimes they can reach huge sizes, in which the pathologically changed scrotum weighs several tens of kilograms.
Diagnosis of elephantia of external genital organs
Diagnosis of the elephantia of the external genitalia includes examination, palpation of pathologically altered soft tissues, finger examination of the prostate and regional lymph nodes, as well as special techniques (circumference, volume of genitalia, skin thermometry, Aldrich's bladder test, study of skin microflora and subcutaneous fat layer , radiography of bones and soft tissues, lymphography, in some cases venography).
On "soft" radiographs of the pelvic area and lumbar spine, bone tissue changes in patients with congenital and acquired elephantiasis are not detected.
A little more information in the study of lymphatic vessels is obtained with direct lymphography - the method of direct injection of contrast medium into previously colored lymphatic vessels.
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Treatment of elephantiasis of external genital organs
Conservative treatment of elephantiasis of external genital organs
Conservative treatment is used in the initial stages of the disease, it is aimed at eliminating both the underlying disease and its complications that arise in patients in advanced stages of the disease. Painful elephantis creates peace, locally apply warm and cold compresses, skin covers with various ointments with animal fats to reduce swelling in the otologically altered tissues.
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Operative treatment of elephantiasis of external genital organs
From the existing numerous methods of surgical treatment of elephantiasis of the external genital organs, the most radical right now is the radical removal of pathologically altered tissues of the external genital organs followed by skin plasty. Before the operation, the patients are carefully trained.
Indications for surgical treatment of elephantiasis of external genitalia:
- congenital malformation of lymphatic circulation of external genitalia:
- persistent progressive edema;
- a sharp increase in the size and deformation of the external genital organs with chronic lymphatic impairment and multiple recurrences of erysipelas.
Contraindications to surgical treatment: hypochromic anemia, cancers and active form of pulmonary tuberculosis. The operation must meet the following requirements:
- physiology and simplicity;
- radical removal of pathologically altered tissues as prevention of a possible recurrence of the disease;
- achievement of the most favorable functional and cosmetic results.
Principles of operative treatment of elephantiasis of external genital organs:
- individual approach to surgical treatment;
- the desire to perform a one-stage operation on the penis and scrotum in patients at a young age with a good general condition of the body;
- in the remaining cases, especially in patients in old age, the operation is performed in two stages (the first stage is the radical removal of the scrotum, the second stage is the removal of the pathologically changed soft tissues of the penis with subsequent cutaneous autoplasty);
- carrying out of all operations under anesthesia.
A solution of the brilliant green is marked on the scrotum by the line of the proposed skin incision. Starting from the front surface of the base, the scrotum produces a gradual excision of the fibro-altered skin and the subcutaneous fat layer to the full depth to its own testicles. Then, for the testicles, a bed is formed at the outer orifices of the inguinal canals, where the testicles are fixed with two or three silk sutures. This method of immersing the testicles in the outer inguinal ring was developed by Professor N.I. Krakowski in 1962. Then a thorough hemostasis is produced. Gradual excision of pathologically altered soft tissues with simultaneous rapid application of hemostatic clamps and subsequent stitching prevents hemorrhage. On average, blood loss is 100-150 ml.
Creation of the scrotum is carried out by the mobilization of the skin with a subcutaneous fat layer, taken in the form of counter semilunar flaps of unchanged skin at the base of the scrotum and perineum.
The wound is sutured tightly with the introduction through the contour of one or two active drains to drain the exudate. After 3-4 weeks after the first operation, the second stage of the operation is performed - radical excision of pathologically altered tissues of the penis with subsequent autoplasty by a split skin flap. To this end, the operation begins with the excision of fibro-altered skin, the subcutaneous fat layer, the superficial fascia, the foreskin of the penis circularly from the root to the head, where an internal leaf of the foreskin with a width not exceeding 3 mm is left. Split free skin flap 0.3-0.5 mm thick, taken with the help of dermatome from the front surface of a healthy thigh, is temporarily placed in sterile physiological solution.
Two split free skin flaps in the longitudinal direction are laid on the anterior and posterior surface of the penis. Skin flaps are sewn to the skin of the pubic region, to the remainder of the inner leaf of the foreskin and sewed together by individual silk sutures. Skin flaps are incised for outflow of exudate.
Further, dynamic monitoring is carried out. It is possible to conduct a sanatorium-and-spa treatment.
Modern methods of diagnosis and treatment of elephantiasis of external genital organs show that adequately carried out diagnostics and treatment are the guarantee of obtaining good near and far results.