Circumcision as a treatment of idiopathic penis lympedema - description of a clinical case

Genital lymphedema is an uncommon disease caused by an obstruction or dysfunction of the lymphatic system. The etiology is not identified in 20% of cases. This disease causes significant physical and psychosexual morbidity and treatment involves the complete removal of the tissue involved. Describe the role of circumcision as a possible treatment for idiopathic penile lymphedema (IPL). Description of a clinical case of a patient with IPL observed at our institution. A 42-year-old Caucasian male, with no relevant personal history, went to an Urology consultation due to a painless increase in the foreskin affecting the distal end of the penis lasting for to 2 years. This affected his quality of life causing sexual and aesthetic issues. No history of episodes of urinary tract infections, local infections such as balanitis and cellulitis, recent surgeries, recent travel, and local trauma were reported. His sex partner was healthy. Physical examination revealed a painless, swollen foreskin without erythema or cellulitis involving the distal 1/3 of the penis. Analytical and imaging study were normal. He underwent circumcision with excision of the entire lymphedematous tissue. Histologically, was observed the presence of marked edema, with enlarged vessels and moderate lympho-plasmocytic inflammatory infiltrate in perivascular location of the dermis and subcutaneous cellular tissue. No cytoarchitectural alterations due to HPV infection or p16 were identified. The presence of IPL was confirmed. Until today, the patient is asymptomatic, satisfied with the aesthetic result and with improved sexual activity. IPL affects quality of life and cause significant physical and psychological morbidity. Excluding the presence of secondary causes such as sexually transmitted diseases or lymphatic obstructions of neoplastic etiology is mandatory. Circumcision can be a possible treatment with goods results. –