Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment

<i>Background and Objectives</i>: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinat...

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Autores principales:	Juste Kaciulyte, Leonardo Garutti, Davide Spadoni, Jonathan Velazquez-Mujica, Luigi Losco, Pedro Ciudad, Marco Marcasciano, Federico Lo Torto, Donato Casella, Diego Ribuffo, Hung-Chi Chen
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	genital lymphedema rare lymphedema debulking surgery physiologic surgery multimodal approach targeted therapy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/82390fcecada47dea0c6cab13b351026
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spelling	oai:doaj.org-article:82390fcecada47dea0c6cab13b3510262021-11-25T18:18:19ZGenital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment10.3390/medicina571111751648-91441010-660Xhttps://doaj.org/article/82390fcecada47dea0c6cab13b3510262021-10-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1175https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objectives</i>: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema—GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. <i>Materials and Methods</i>: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors’ department were selected. Only patients that were treated in the authors’ institution and presented a minimum follow-up of 3 months were admitted to the current study. <i>Results</i>: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months—11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. <i>Conclusions</i>: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients’ quality of life.Juste KaciulyteLeonardo GaruttiDavide SpadoniJonathan Velazquez-MujicaLuigi LoscoPedro CiudadMarco MarcascianoFederico Lo TortoDonato CasellaDiego RibuffoHung-Chi ChenMDPI AGarticlegenital lymphedemarare lymphedemadebulking surgeryphysiologic surgerymultimodal approachtargeted therapyMedicine (General)R5-920ENMedicina, Vol 57, Iss 1175, p 1175 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	genital lymphedema rare lymphedema debulking surgery physiologic surgery multimodal approach targeted therapy Medicine (General) R5-920
spellingShingle	genital lymphedema rare lymphedema debulking surgery physiologic surgery multimodal approach targeted therapy Medicine (General) R5-920 Juste Kaciulyte Leonardo Garutti Davide Spadoni Jonathan Velazquez-Mujica Luigi Losco Pedro Ciudad Marco Marcasciano Federico Lo Torto Donato Casella Diego Ribuffo Hung-Chi Chen Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
description	<i>Background and Objectives</i>: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema—GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. <i>Materials and Methods</i>: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors’ department were selected. Only patients that were treated in the authors’ institution and presented a minimum follow-up of 3 months were admitted to the current study. <i>Results</i>: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months—11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. <i>Conclusions</i>: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients’ quality of life.
format	article
author	Juste Kaciulyte Leonardo Garutti Davide Spadoni Jonathan Velazquez-Mujica Luigi Losco Pedro Ciudad Marco Marcasciano Federico Lo Torto Donato Casella Diego Ribuffo Hung-Chi Chen
author_facet	Juste Kaciulyte Leonardo Garutti Davide Spadoni Jonathan Velazquez-Mujica Luigi Losco Pedro Ciudad Marco Marcasciano Federico Lo Torto Donato Casella Diego Ribuffo Hung-Chi Chen
author_sort	Juste Kaciulyte
title	Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
title_short	Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
title_full	Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
title_fullStr	Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
title_full_unstemmed	Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment
title_sort	genital lymphedema and how to deal with it: pearls and pitfalls from over 38 years of experience with unusual lymphatic system impairment
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/82390fcecada47dea0c6cab13b351026
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Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment

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