Genital elephantiasis. It is a syndrome caused by various inflammatory diseases caused by parasites or ( bacteria ) that are spread through mosquitoes and that increase the size of the external genitalia to the point of incapacitating people to not even be able to walk.
[ hide ]
- 1 Etiology
- 2 Pathogenesis and pathology
- 3 Differential diagnosis
- 4 Treatment
- 5 Most affected countries
- 6 Sources
Penile and scrotal elephantiasis represent a diagnostic and therapeutic challenge . The edema genital chronic could be the result of lymphatic obstruction due to congenital abnormalities , trauma, radiotherapy , neoplastic, surgery, peritoneal dialysis , continuous ambulatory or parasitic infection. Currently, new scientific advances and continuing clinical findings could rule out some of these potential etiologies .
The infection by microorganisms , particularly streptococci , may be another possible cause of this pathology .
It is possible that the inflammatory changes due to repeated lymphangitis or streptococcal cellulitis can produce obstruction of the lymphatic circulation at the level of the lower limbs, which to a greater or lesser extent could lead to the appearance of elephantiasis . The pathological study has shown that, at the cellular level, this would be the consequence of a process of intracanalicular fibrosis
However, some authors have reported patients in whom there is no previous history of lymphangitis or cellulitis. Likewise, cases with genital lymphatic obstruction have been described, in which there was a history of genitourinary infection acquired through sexual contact. Unfortunately, it is not clear whether this infection was caused by Neisseria gonorroheae or Chlamydia trachomatis.
Pathogenesis and pathology
These bacteria are more common in tropical countries, where people suffering from this disease end up with malformations in the bones due to the inflammation so severe that it leads to a general deformation of the body. Venereal lymphogranulomas are the most common in genital elephantiasis.
The differential diagnosis of genital elephantiasis should be made with everything that causes abnormal growth of the genital area, processes secondary to radiation therapy, malignancies , infectious causes, including filariasis , tuberculosis , lymphogranuloma venereum or donovanosis, and podoconiosis ( disease causing elephantiasis in the high valleys of Ethiopia due to lymphedema due to selenium, zirconium, beryllium and lantanum poisoning in basaltic and sulphurous areas). In the bibliographic review of the last 20 years, we only found one case of idiopathic fibromatosis that included the scrotum and penis.
It is clear that according to the etiological cause of penile and / or scrotal edema, treatment may consist of the use of antibiotics ( penicillins , tetracyclines ), antiparasitics (albendazole, ivermectin), which, in cases of early evolution, can be enough to achieve complete remission of the pathology .
For advanced stages, surgical resolution is the only treatment indicated. Such procedures include venous lymphangioplasty and lymphatic anastomosis, which have shown good results. On the other hand, it is also taken into account if the condition is self-limited or if there are significant pathological disorders at the level of the skin , subcutaneous cell tissue and lymphatic vessels. Cases of primary or congenital genital lymphedema have been studied. These situations can be very different from all those described, since according to the experiences of different services, they constitute a real problem due, in large part, to the high recurrence rate that they possess, which inevitably leads to multiple surgical interventions. Although the treatment of choice is surgery , given the high morbidity thereof and the chronicity of the process, there are patients who choose not to undergo surgery.
Most affected countries
Although this muscular hypertrophy usually contracts in childhood , it generally manifests itself in adulthood, causing permanent disability. The countries most affected are: Bangladesh , Ethiopia , the Philippines , India , Indonesia , Myanmar , Nepal , Nigeria or the Democratic Republic of the Congo