Reconstructive surgery for giant penoscrotal elephantiasis: about one case
Identifieur interne : 000A36 ( Pmc/Corpus ); précédent : 000A35; suivant : 000A37Reconstructive surgery for giant penoscrotal elephantiasis: about one case
Auteurs : Brahima Kirakoya ; Barnabé Zango ; Abdoul Karim Paré ; Aristide Fasnéwendé Kaboré ; Clotaire YaméogoSource :
- Basic and Clinical Andrology [ 2051-4190 ] ; 2014.
Abstract
Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.
Url:
DOI: 10.1186/2051-4190-24-16
PubMed: 25780589
PubMed Central: 4349225
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Reconstructive surgery for giant penoscrotal elephantiasis: about one case</title><author><name sortKey="Kirakoya, Brahima" sort="Kirakoya, Brahima" uniqKey="Kirakoya B" first="Brahima" last="Kirakoya">Brahima Kirakoya</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Zango, Barnabe" sort="Zango, Barnabe" uniqKey="Zango B" first="Barnabé" last="Zango">Barnabé Zango</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Pare, Abdoul Karim" sort="Pare, Abdoul Karim" uniqKey="Pare A" first="Abdoul Karim" last="Paré">Abdoul Karim Paré</name><affiliation><nlm:aff id="Aff2">Department of Urology Andrology, Hubert koutoucou Maga Teaching Hospital, Cotonou, Bénin</nlm:aff></affiliation></author><author><name sortKey="Kabore, Aristide Fasnewende" sort="Kabore, Aristide Fasnewende" uniqKey="Kabore A" first="Aristide Fasnéwendé" last="Kaboré">Aristide Fasnéwendé Kaboré</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Yameogo, Clotaire" sort="Yameogo, Clotaire" uniqKey="Yameogo C" first="Clotaire" last="Yaméogo">Clotaire Yaméogo</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25780589</idno><idno type="pmc">4349225</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349225</idno><idno type="RBID">PMC:4349225</idno><idno type="doi">10.1186/2051-4190-24-16</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000A36</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A36</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Reconstructive surgery for giant penoscrotal elephantiasis: about one case</title><author><name sortKey="Kirakoya, Brahima" sort="Kirakoya, Brahima" uniqKey="Kirakoya B" first="Brahima" last="Kirakoya">Brahima Kirakoya</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Zango, Barnabe" sort="Zango, Barnabe" uniqKey="Zango B" first="Barnabé" last="Zango">Barnabé Zango</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Pare, Abdoul Karim" sort="Pare, Abdoul Karim" uniqKey="Pare A" first="Abdoul Karim" last="Paré">Abdoul Karim Paré</name><affiliation><nlm:aff id="Aff2">Department of Urology Andrology, Hubert koutoucou Maga Teaching Hospital, Cotonou, Bénin</nlm:aff></affiliation></author><author><name sortKey="Kabore, Aristide Fasnewende" sort="Kabore, Aristide Fasnewende" uniqKey="Kabore A" first="Aristide Fasnéwendé" last="Kaboré">Aristide Fasnéwendé Kaboré</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Yameogo, Clotaire" sort="Yameogo, Clotaire" uniqKey="Yameogo C" first="Clotaire" last="Yaméogo">Clotaire Yaméogo</name><affiliation><nlm:aff id="Aff1">Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author></analytic><series><title level="j">Basic and Clinical Andrology</title><idno type="eISSN">2051-4190</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Slama, A" uniqKey="Slama A">A Slama</name></author><author><name sortKey="Jaidane, M" uniqKey="Jaidane M">M Jaidane</name></author><author><name sortKey="Elleuch, A" uniqKey="Elleuch A">A Elleuch</name></author><author><name sortKey="Ben Sorba, N" uniqKey="Ben Sorba N">N Ben Sorba</name></author><author><name sortKey="Yacoubi, Mt" uniqKey="Yacoubi M">MT Yacoubi</name></author><author><name sortKey="Mosbah, Af" uniqKey="Mosbah A">AF Mosbah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gandaho, I" uniqKey="Gandaho I">I Gandaho</name></author><author><name sortKey="Avakoudjo, J" uniqKey="Avakoudjo J">J Avakoudjo</name></author><author><name sortKey="Hounnasso, Pp" uniqKey="Hounnasso P">PP Hounnasso</name></author><author><name sortKey="Hodonou, F" uniqKey="Hodonou F">F Hodonou</name></author><author><name sortKey="Akpo, C" uniqKey="Akpo C">C Akpo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ouattara, K" uniqKey="Ouattara K">K Ouattara</name></author><author><name sortKey="Dafe, Si" uniqKey="Dafe S">SI Dafe</name></author><author><name sortKey="Yarkwe, Y" uniqKey="Yarkwe Y">Y Yarkwe</name></author><author><name sortKey="Cisse, C" uniqKey="Cisse C">C Cissé</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ndoye, A" uniqKey="Ndoye A">A Ndoye</name></author><author><name sortKey="Diao, B" uniqKey="Diao B">B Diao</name></author><author><name sortKey="Fall, Pa" uniqKey="Fall P">PA Fall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kossoko, H" uniqKey="Kossoko H">H Kossoko</name></author><author><name sortKey="Allah, Ck" uniqKey="Allah C">CK Allah</name></author><author><name sortKey="Kadio, Mr" uniqKey="Kadio M">MR Kadio</name></author><author><name sortKey="Yeo, S" uniqKey="Yeo S">S Yeo</name></author><author><name sortKey="Dje, Va" uniqKey="Dje V">VA Dje</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Denzinger, S" uniqKey="Denzinger S">S Denzinger</name></author><author><name sortKey="Watzlawek, E" uniqKey="Watzlawek E">E Watzlawek</name></author><author><name sortKey="Burger, M" uniqKey="Burger M">M Burger</name></author><author><name sortKey="Wieland, Wf" uniqKey="Wieland W">WF Wieland</name></author><author><name sortKey="Otto, W" uniqKey="Otto W">W Otto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuepper, D" uniqKey="Kuepper D">D Kuepper</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Masia, Dr" uniqKey="Masia D">DR Masia</name></author><author><name sortKey="Castus, P" uniqKey="Castus P">P Castus</name></author><author><name sortKey="Delia, G" uniqKey="Delia G">G Delia</name></author><author><name sortKey="Casoli, V" uniqKey="Casoli V">V Casoli</name></author><author><name sortKey="Martine, D" uniqKey="Martine D">D Martine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcdougal, Ws" uniqKey="Mcdougal W">WS McDougal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stamatiou, Kn" uniqKey="Stamatiou K">KN Stamatiou</name></author><author><name sortKey="Karakos, C" uniqKey="Karakos C">C Karakos</name></author><author><name sortKey="Karanasiou, V" uniqKey="Karanasiou V">V Karanasiou</name></author><author><name sortKey="Papadimitriou, V" uniqKey="Papadimitriou V">V Papadimitriou</name></author><author><name sortKey="Sofras, F" uniqKey="Sofras F">F Sofras</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thejeswi, P" uniqKey="Thejeswi P">P Thejeswi</name></author><author><name sortKey="Prabhu, S" uniqKey="Prabhu S">S Prabhu</name></author><author><name sortKey="Augustine, Aj" uniqKey="Augustine A">AJ Augustine</name></author><author><name sortKey="Ram, S" uniqKey="Ram S">S Ram</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ouzilleau, J" uniqKey="Ouzilleau J">J Ouzilleau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, V" uniqKey="Singh V">V Singh</name></author><author><name sortKey="Sinha, Rj" uniqKey="Sinha R">RJ Sinha</name></author><author><name sortKey="Sankhwar, Sn" uniqKey="Sankhwar S">SN Sankhwar</name></author><author><name sortKey="Kumar, V" uniqKey="Kumar V">V Kumar</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Basic Clin Androl</journal-id><journal-id journal-id-type="iso-abbrev">Basic Clin Androl</journal-id><journal-title-group><journal-title>Basic and Clinical Andrology</journal-title></journal-title-group><issn pub-type="epub">2051-4190</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25780589</article-id><article-id pub-id-type="pmc">4349225</article-id><article-id pub-id-type="publisher-id">29</article-id><article-id pub-id-type="doi">10.1186/2051-4190-24-16</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Reconstructive surgery for giant penoscrotal elephantiasis: about one case</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Kirakoya</surname><given-names>Brahima</given-names></name><address><email>kobrahi@yahoo.fr</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Zango</surname><given-names>Barnabé</given-names></name><address><email>zbarnabe2004@yahoo.fr</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Paré</surname><given-names>Abdoul Karim</given-names></name><address><email>boupare@yahoo.fr</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Kaboré</surname><given-names>Aristide Fasnéwendé</given-names></name><address><email>ristof78@hotmail.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Yaméogo</surname><given-names>Clotaire</given-names></name><address><email>yameogoclotaire@yahoo.fr</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>Department of Urology Andrology, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso</aff><aff id="Aff2"><label></label>Department of Urology Andrology, Hubert koutoucou Maga Teaching Hospital, Cotonou, Bénin</aff></contrib-group><pub-date pub-type="epub"><day>17</day><month>11</month><year>2014</year></pub-date><pub-date pub-type="collection"><year>2014</year></pub-date><volume>24</volume><elocation-id>16</elocation-id><history><date date-type="received"><day>27</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>21</day><month>10</month><year>2014</year></date></history><permissions><copyright-statement>© Kirakoya et al.; licensee BioMed Central Ltd. 2014</copyright-statement><license license-type="open-access"><license-p>This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><p>Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.</p></abstract><trans-abstract xml:lang="fr"><title>Résumé</title><p>L’éléphantiasis des organes génitaux externes est caractérisé par un lymphodème et un épaississement des téguments responsable de l’aspect de peau de pachyderme. C’est une pathologie invalidante. La chirurgie de reconstruction constitue souvent la seule alternative pour restaurer l’aspect esthétique et fonctionnel de ces organes atteints. Nous rapportons un cas d’un volumineux éléphantiasis des organes génitaux externes chez un sujet de 52 ans qui a bénéficié avec succès d’une plastie péno scrotale dans le service d’urologie du CHU/YO.</p></trans-abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Elephantiasis</kwd><kwd>Penoscrotal</kwd><kwd>Scrotoplasty</kwd></kwd-group><kwd-group xml:lang="fr"><kwd>Éléphantiasis</kwd><kwd>Péno scrotal</kwd><kwd>Scrotoplastie</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2014</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1" sec-type="intro"><title>Introduction</title><p>Penoscrotal elephantiasis can lead to hudge enlargement of the scrotal sac and the penis. It is as a result of lymphatic obstruction and subsequent infiltration of the subcutaneous tissue of the external genitalia with lymph [<xref ref-type="bibr" rid="CR1">1</xref>]. The causes are multiple. It cripple both psychological and physical well-being of the patient. It tends to become an exotic entity even in countries south of the Sahara [<xref ref-type="bibr" rid="CR2">2</xref>, <xref ref-type="bibr" rid="CR3">3</xref>]. The main stay of treatment is surgery.</p><p>We aim to report a case of penoscrotal elephantiasis which was managed at the Department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou (Burkina Faso).</p><sec id="Sec2"><title>Observation</title><p>A 52 year old cultivator, presented to the department of Urology, Yalgado Ouedraogo Teaching Hospital with history of gradual enlargement scrotal sac over twelve years. The swelling was painless and itchy. No history of a lower urinary tract symptoms, pelvic surgery or venereal disease. Physical examination revealed a hudge scrotal sac extending down to the upper third of the legs (Figure <xref rid="Fig1" ref-type="fig">1</xref>). The scrotal skin show many scratch marks and hypopigmented areas. The penile sharp is buried within the scrotal mass. This made it difficult to examine the penis. Urine comes out through a tunnel leading to the glans penis. Testicles could not be palpated due to hudge nature of the scrotal mass. The rest of the physical exam was normal.<fig id="Fig1"><label>Figure 1</label><caption><p><bold>Scrotal mass.</bold></p></caption><graphic xlink:href="12610_2014_29_Fig1_HTML" id="d30e268"></graphic></fig></p><p>Looking at the epidemiological and clinical findings, we made a diagnosis of penoscrotal elephantiasis. The patient had taken a dose of anti filarial drugs (albendazol and ivermectin). He washed the scrotal mass twice per day for three days with a polividon solution. Preoperative testing was performed before surgical procedure. He underwent surgical excision of the subcutaneous tissues and reconstruction of his penis and his scrotum. The procedure was performed as follows:<list list-type="bullet"><list-item><p>Anterior midline incision was made over the scrotal mass, this delivered the penis. The skin of the inner side of the tunnel was found to be normal and was preserve to cover the penis (Figure <xref rid="Fig2" ref-type="fig">2</xref>).</p></list-item></list><fig id="Fig2"><label>Figure 2</label><caption><p><bold>Anterior midline incision in the scrotal mass.</bold></p></caption><graphic xlink:href="12610_2014_29_Fig2_HTML" id="d30e289"></graphic></fig><fig id="Fig3"><label>Figure 3</label><caption><p><bold>Postoperative appearance of the external genitalia.</bold></p></caption><graphic xlink:href="12610_2014_29_Fig3_HTML" id="d30e301"></graphic></fig></p><p><list list-type="bullet"><list-item><p>Two oblique incisions were made toward the groin starting from cranial end of the previous incision, to find and dissect the spermatid cords and testicles.</p></list-item><list-item><p>Excision of subcutaneous tissue with careful haemostasis.</p></list-item><list-item><p>Resection of all abnormal tissue covering the penis.</p></list-item><list-item><p>Fixation of the testicles to the bottom of the skin flaps to be used for scrotal reconstruction.</p></list-item><list-item><p>Excision of excess skin.Drainage of both hemi-scrotum which were closed separately using absorbable sutures (Figure <xref rid="Fig3" ref-type="fig">3</xref>).</p></list-item><list-item><p>Bladder was drained with size 20 F foley’s urethral catheter.</p></list-item></list></p><p>The excised scrotal mass contained gelatinous liquid. The subcutaneous tissue was very thick and whitish. All resected tissue weighed 12 kg.</p></sec></sec><sec id="Sec3"><title>Result</title><p>The postoperative outcomes were marked by anaemia, which was corrected by compatible blood transfusion. The drains were removed on the fourth post-operative day. No further complication was noted. The penis and the scrotum were cosmetically acceptable at 3 weeks and 5 months post-operative review. The scrotal sac was much reduced and flexible (Figure <xref rid="Fig4" ref-type="fig">4</xref>).<fig id="Fig4"><label>Figure 4</label><caption><p><bold>Appearance of the external genitalia after 3 months.</bold></p></caption><graphic xlink:href="12610_2014_29_Fig4_HTML" id="d30e346"></graphic></fig></p></sec><sec id="Sec4" sec-type="discussion"><title>Discussion</title><p>The penoscrotal elephantiasis can be defined as massive enlargement of the scrotal sac secondary to a subcutaneous accumulation of lymphatic fluid. It is also called lymphedema [<xref ref-type="bibr" rid="CR1">1</xref>, <xref ref-type="bibr" rid="CR2">2</xref>]. The essential findings to make diagnosis were the appearance of pachyderm skin. It has a debilitating effect on both physical and psychological well-being of the patient. Fortunately the incidence has greatly reduced. It is responsible for 2.1% of giant scrotal sac in Mali [<xref ref-type="bibr" rid="CR3">3</xref>], while in Senegal N’doye et al. [<xref ref-type="bibr" rid="CR4">4</xref>] reported an annual incidence of 2 cases.</p><p>In tropical countries, microfilaria is the leading cause of elephantiasis of the male external genitalia [<xref ref-type="bibr" rid="CR5">5</xref>]. The diagnosis is mostly made based on epidemiological evidence and clinical features especially in the early phase of the disease.</p><p>Though the diagnosis is made clinically, some laboratory test may be of importance. The microfilariae may be found in the serum, ultrasonography of scrotal sac may pick the adult worms and isotope bi pedal lymphography or radiography may be needed to outline the lymphatics [<xref ref-type="bibr" rid="CR1">1</xref>]. The aetiology of penoscrotal elephantiasis can be divided into two groups:<list list-type="bullet"><list-item><p>Primary or congenital elephantiasis. In these cases, there is a congenital abnormality of the lymphatic system leading to lymphatics obstruction. It may manifest early or later (Meige disease) in life.</p></list-item><list-item><p>Secondary elephantiasis. These may be caused by parasitic infection (lymphatic filariasis), bacterial infection, urethral stenosis, pelvic tumor or radiotherapy [<xref ref-type="bibr" rid="CR6">6</xref>–<xref ref-type="bibr" rid="CR10">10</xref>]. Treatment may consist of antibiotics especially in the acute phase before the formation of irreversible injuries to the tissue [<xref ref-type="bibr" rid="CR6">6</xref>, <xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR10">10</xref>]. Delay presentations seem to be common as reported by several African authors [<xref ref-type="bibr" rid="CR2">2</xref>, <xref ref-type="bibr" rid="CR4">4</xref>, <xref ref-type="bibr" rid="CR5">5</xref>]. The main stay of treatment of chronic elephantiasis which is associated with irreversible subcutaneous damage remains surgery. Surgical techniques can be divided into two groups.</p></list-item><list-item><p>Conserving surgery: this is a lymphangioplasty in order to improve lymphatic drainage. These techniques have been abandoned due contradicting results [<xref ref-type="bibr" rid="CR11">11</xref>].</p></list-item><list-item><p>Surgical excision: its principle is complete removal of all affected tissue (total lymphangiectomy) and penoscrotoplasty. Reconstructive techniques vary [<xref ref-type="bibr" rid="CR1">1</xref>, <xref ref-type="bibr" rid="CR4">4</xref>, <xref ref-type="bibr" rid="CR5">5</xref>]. Many used skin graft with its attendant risk of impaired spermatogenesis due to a change in testicular temperature. Others used scrapped healthy part of the scrotum [<xref ref-type="bibr" rid="CR1">1</xref>]. We have used this technique for the reconstruction of neoscrotal sac. We are inspired by the technique described by Ouzilleau [<xref ref-type="bibr" rid="CR12">12</xref>] but with a slight modification on scrotoplasty and the use of a skin flap to cover the penis. In uncircumcised patients, the foreskin can be used to cover the distal part of the penile sharp [<xref ref-type="bibr" rid="CR13">13</xref>]. The surgical excision of the mass and scrotoplasty provides good results [<xref ref-type="bibr" rid="CR13">13</xref>]. Complications of this technique include haemorrhage iatrogenic urethral injury, hematoma and surgical site infection. We transfuse after surgery due to primary and reactionary haemorrhage. Incomplete excision may lead to recurrence [<xref ref-type="bibr" rid="CR11">11</xref>]. Post-operative review revealed satisfactory outcome, both functionally and aesthetically.</p></list-item></list></p></sec><sec id="Sec5" sec-type="conclusions"><title>Conclusion</title><p>External genitalia elephantiasis is a debilitating condition. It causes both psychological and physically distress. When it affects the external genitalia, there may delay in presentation due to private nature of the area. The commonest aetiological factor in the tropics is microfilariasis. Surgical excision followed by a penoscrotoplasty gives excellent result.</p><sec id="Sec6"><title>Consent</title><p>Written consent was obtained from the patient for publication of this Case report and any accompanying images.</p></sec></sec></body><back><fn-group><fn><p><bold>Competing interests</bold></p><p>The authors declare that they have no competing interests.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>KB participated to the surgical management of the patient and contributed to the data collection, analysis of case and the drafting of the manuscript. ZB contributed to evaluation and revised the manuscript. PAK contributed critically revised the manuscript. KAF revised the manuscript. YA contributed to surgery management of the case and the drafting of the manuscript. 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