Penoscrotal elephantiasis can lead to hudge enlargement of the scrotal sac and the penis. It is as a result of lymphatic obstruction and subsequent infiltration of the subcutaneous tissue of the external genitalia with lymph [1]. The causes are multiple. It cripple both psychological and physical well-being of the patient. It tends to become an exotic entity even in countries south of the Sahara [2, 3]. The main stay of treatment is surgery.
We aim to report a case of penoscrotal elephantiasis which was managed at the Department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou (Burkina Faso).
Observation
A 52 year old cultivator, presented to the department of Urology, Yalgado Ouedraogo Teaching Hospital with history of gradual enlargement scrotal sac over twelve years. The swelling was painless and itchy. No history of a lower urinary tract symptoms, pelvic surgery or venereal disease. Physical examination revealed a hudge scrotal sac extending down to the upper third of the legs (Figure 1). The scrotal skin show many scratch marks and hypopigmented areas. The penile sharp is buried within the scrotal mass. This made it difficult to examine the penis. Urine comes out through a tunnel leading to the glans penis. Testicles could not be palpated due to hudge nature of the scrotal mass. The rest of the physical exam was normal.
Looking at the epidemiological and clinical findings, we made a diagnosis of penoscrotal elephantiasis. The patient had taken a dose of anti filarial drugs (albendazol and ivermectin). He washed the scrotal mass twice per day for three days with a polividon solution. Preoperative testing was performed before surgical procedure. He underwent surgical excision of the subcutaneous tissues and reconstruction of his penis and his scrotum. The procedure was performed as follows:
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Two oblique incisions were made toward the groin starting from cranial end of the previous incision, to find and dissect the spermatid cords and testicles.
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Excision of subcutaneous tissue with careful haemostasis.
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Resection of all abnormal tissue covering the penis.
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Fixation of the testicles to the bottom of the skin flaps to be used for scrotal reconstruction.
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Excision of excess skin.Drainage of both hemi-scrotum which were closed separately using absorbable sutures (Figure 3).
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Bladder was drained with size 20 F foley’s urethral catheter.
The excised scrotal mass contained gelatinous liquid. The subcutaneous tissue was very thick and whitish. All resected tissue weighed 12 kg.