Surgical Management of Massive Scrotal Lymphedema: A Case Report and Review of the Literature

Scrotal lymphedema, or scrotal elephantiasis, is a rare progressive condition caused by impaired lymphatic drainage and accumulation of protein-rich interstitial fluid, resulting in fibrosis and massive genital enlargement. This case report presents a 52-year-old man with massive idiopathic scrotal lymphedema, or scrotal elephantiasis, characterized by a 10-year history of progressive scrotal enlargement, recurrent infections, and loss of urinary and sexual function with a completely buried penis Diagnostic evaluation excluded infectious, neoplastic, and vascular causes, confirming non-filarial scrotal lymphedema. Management consisted of staged radical excision of fibrotic tissue with preservation of the testes, spermatic cords, and phallus, followed by reconstruction using a pedicled superficial circumflex iliac artery perforator groin flap. Adjunctive Z-plasty at the penile base and full-thickness thigh skin grafts restored contour and mobility. Postoperative recovery was uneventful, with complete flap survival and restoration of urinary function, hygiene, mobility, and quality of life. This case demonstrates that radical excision with SCIP flap reconstruction provides a reliable and durable solution for massive idiopathic scrotal lymphedema, including cases requiring tissue resection exceeding 30 kg. A focused review of the literature places this case in the context of previously reported cases of massive scrotal lymphedema.