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Elephantiasis of the external genitalia
Medical expert of the article
Last reviewed: 12.07.2025
Elephantiasis of the external genitalia is a very rare but severe somatic disease characterized by persistent chronic edema of the skin, subcutaneous fat layer and superficial fascia with impaired lymphatic and venous outflow.
The cause of its occurrence and the mechanism of its development, despite the experience accumulated by doctors over many years, have not yet been sufficiently studied.
What causes elephantiasis of the external genitalia?
Congenital elephantiasis includes a "familial" hereditary form (Milroy's disease), which is rare and occurs in members of the same family.
The occurrence of elephantiasis of the penis is possible after circumcision of the foreskin. Of all the causes of an inflammatory nature, the first place is occupied by erysipelas, which often occurs in the lower abdomen, perineum, external genitalia, and also on the lower extremities. A certain significance in the development of elephantiasis of the external genitalia is played by non-specific infection.
Symptoms of elephantiasis of the external genitalia
Elephantiasis is a slowly progressing inflammatory-dystrophic process in the skin, subcutaneous fat layer, superficial fascia, with compaction, thickening and cicatricial changes in them accompanied by insufficiency of lymphatic vessels. The pathogenesis of elephantiasis is based on disturbances of lymph circulation at various levels of the lymphatic system with subsequent accumulation of protein fluid (up to 5%) in the interstitial tissue, which leads to disruption of protein and water-salt metabolism in tissues, causing their dystrophic changes with subsequent hyalinosis and sclerosis.
In case of elephantiasis of the external genitalia, the deep lymphatic vessels, cavernous bodies, urethra, testicles with appendages are usually not involved in the pathological process.
Symptoms of elephantiasis of the external genitalia include enlargement of the external genitalia, which can sometimes reach enormous sizes, with the pathologically altered scrotum weighing several tens of kilograms.
Diagnosis of elephantiasis of the external genitalia
Diagnosis of elephantiasis of the external genitalia includes examination, palpation of pathologically altered soft tissues, digital examination of the prostate and regional lymph nodes, as well as special techniques (determination of the circumference and volume of the genitals, thermometry of the skin, Aldrich blister test, study of the microflora of the skin and subcutaneous fat layer, radiography of bones and soft tissues, lymphography, and in some cases venography).
On “soft” radiographs of the pelvic region and lumbar spine, changes in bone tissue in patients with congenital and acquired elephantiasis are not detected.
Somewhat more information in the study of lymphatic vessels is obtained with direct lymphography - a method of directly introducing a contrast agent into pre-stained lymphatic vessels.
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Treatment of elephantiasis of the external genitalia
Conservative treatment of elephantiasis of the external genitalia
Conservative treatment is used in the initial stages of the disease, it is aimed at eliminating both the underlying disease and its complications that occur in patients in advanced stages of the disease. Patients with elephantiasis are given rest, warm and cold compresses are applied locally, the skin is lubricated with various ointments with animal fats to reduce swelling in otologically altered tissues.
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Surgical treatment of elephantiasis of the external genitalia
Of the numerous existing methods of surgical treatment of elephantiasis of the external genitalia, the most correct is currently recognized as radical removal of pathologically altered tissues of the external genitalia with subsequent skin grafting. Before the operation, patients are carefully prepared.
Indications for surgical treatment of elephantiasis of the external genitalia:
- congenital disorder of lymph circulation of the external genitalia:
- persistent progressive edema;
- a sharp increase in the size and deformation of the external genitalia with chronic disruption of lymph circulation and multiple relapses of erysipelas.
Contraindications to surgical treatment: hypochromic anemia, cancer and active form of pulmonary tuberculosis. The operation must meet the following requirements:
- physiological and simple;
- radical removal of pathologically altered tissue as a prevention of possible relapse of the disease;
- achieving the most favorable functional and cosmetic results.
Principles of surgical treatment of elephantiasis of the external genitalia:
- individual approach to surgical treatment;
- the desire to perform a single-stage operation on the penis and scrotum in young patients with good general health;
- in other cases, especially in elderly patients, the operation is performed in two stages (the first stage is radical removal of the scrotum, the second stage is removal of pathologically altered soft tissues of the penis with subsequent skin autografting);
- all operations are performed under anesthesia.
The line of the proposed skin incision is marked on the scrotum with a brilliant green solution. Starting from the anterior surface of the scrotum base, gradual excision of the fibrously altered skin and subcutaneous fat layer is performed to the full depth of the proper testicular membranes. Then, a bed is formed for the testicles at the external openings of the inguinal canals, where the testicles are fixed with two or three silk sutures. This technique of immersion of the testicles at the external inguinal ring was developed by Professor N. I. Krakovsky in 1962. Then careful hemostasis is performed. Gradual excision of pathologically altered soft tissues with simultaneous rapid application of hemostatic clamps and their subsequent suturing prevents blood loss. On average, blood loss is 100-150 ml.
The scrotum is created by mobilizing the skin with the 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 of one or two active drains through counter-openings for the outflow of exudate. Three to four 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 with a split skin flap. For this purpose, the operation begins with excision of the fibrously altered skin, subcutaneous fat layer, superficial fascia, foreskin of the penis circularly from the root to the head, where the inner leaf of the foreskin no more than 3 mm wide is left. A split free skin flap 0.3-0.5 mm thick, taken with a dermatome from the anterior surface of the healthy thigh, is temporarily placed in a sterile saline solution.
Two split free skin flaps are placed longitudinally on the anterior and posterior surfaces of the penis. The skin flaps are sutured to the skin of the pubic area, to the remainder of the inner layer of the foreskin and stitched together with separate silk sutures. Notches are made on the skin flaps to allow exudate to drain.
Dynamic observation is carried out in the future. Sanatorium and resort treatment is possible.
Modern methods of diagnosis and treatment of elephantiasis of the external genitalia show that adequate diagnosis and treatment are the key to obtaining good immediate and long-term results.