Penoscrotal elephantiasis after treatment of prostate cancer: A case report

Penoscrotal elephantiasis (EPS) is a terminal state of lymphoedema defined by a progressive histopathological state characterized by chronic inflammatory fibromatosis of the subdermal and dermal connective tissue caused by lymphatic and venous stasis. Its clinical appearance is typical of an increase, sometimes considerable, in the volume of the external genital organs, which can lead to an unaesthetic appearance, a sexual impact, and psychological distress. The etiology can be primary or secondary to a parasitic disease (filariasis) or intrinsic or extrinsic lymphatic obstruction. Genital lymphedema may affect after cancer treatment and prostate cancer ranks as the second most prevalent cancer in men, making it crucial to consider any complications that may occur following its treatment.
We present a case of one patient, a 74-year-old man from Morocco, who underwent surgery two years ago for radical prostatectomy supplemented by radiotherapy and hormone therapy. The evolution was marked by an increase in scrotal size, with sexual and psychic prejudice. The Clinical examination revealed penoscrotal elephantiasis respecting the glans penis and both lower limbs. The diagnostic is clinical and etiological research requires specific complementary examinations, depending on the circumstances. Probably for this case, the penoscrotal elephantiasis was secondary to radical prostatectomy and/or post-radiotherapy.The patient was scheduled for surgical treatment involving en bloc resection of the elephantiasis scrotum, and immediate reconstruction after completely freeing the two testicles. The affected penile skin was also resected and replaced with a skin graft. The aesthetic and functional outcome was good with a follow-up of 7 months.