Scrotal swelling and enlargement can be caused by a variety of disorders. One of the more common causes of an enlarged scrotum is a hernia. Another common cause is fluid accumulation between the testicle and the skin. This is called a hydrocele. Generally, the swelling is unilateral – only on one side. A less common but more serious and debilitating scrotal condition that can lead to massive scrotal swelling is scrotal lymphedema. With this condition, the entire scrotum becomes extremely large as lymph fluid and tissue accumulates. Eventually, the skin of the scrotum becomes very bumpy and irregular and the penis becomes buried within the tissue. This condition is also referred to as scrotal elephantiasis, but our preference it to use the term scrotal lymphedema, especially when describing a condition limited to the scrotum, generally in obese men. Patients referred with this condition have massive scrotums so large that the sheer size interferes with walking. In many cases, our patients report that they were previously seen by a number of doctors, advised to lose weight (patients with this condition are often obese) and scheduled for various X-Ray tests, but not offered treatment. Unfortunately, this is a disorder that is best treated with surgery to remove the mass of tissue. In some cases, skin grafting may be required.

Scrotal Lymphedema – Patient Standing

Scrotal Lymphedema – Patient Supine

The following is an example of a patient who recently underwent scrotal lymphedema treatment (2011). He was referred after being denied surgery due to his obesity. However, although there are many benefits to weight loss, and morbid obesity can be associated with a higher risk of certain complications from surgery, the reality is that patients with this problem can not effectively lose weight when disabled with this mass to the point of not being able to effectively walk. Moreover, it does not appear that weight loss can lead to the resolution of this problem. Therefore, our approach is to proceed with scrotal lymphedema surgery without delay in most cases, assuming the patient is medically cleared for anesthesia. The testicles were both preserved, and there was no damage to the penis or urethra.

Scrotal Lymphedema before treatment with surgery

Picture taken at after removal of the mass

Scrotal Lymphedema before surgery, another view

Picture taken 2 months after scrotal lymphedema surgery

This surgery is performed at the Center for Reconstructive Urology at UC, Irvine Medical Center in Orange County, California. Recent news reports suggest that scrotal lymphedema surgery can be associated with a high risk of mortality, penile loss, or castration. Although surgery involving the genitalia can be associated with risks, to date, we have never had the complication of death, penile injury, urethral injury, or loss of a testicle.