Lymphedema involves the accumulation of fluid in the skin, causing it to become thick and leathery. Because of gravity, the fluid accumulation usually is worse in lower portions of the body such as the scrotum and the legs. The amount of fluid that can collect in the genital skin can be considerable. In severe cases, genital lymphedema can be painful and debilitating and can make walking and movement difficult.
Diagnosing genital lymphedema typically requires ruling out other possible causes for genital swelling like congestive heart failure or pelvic cancers. If no clear cause can be determined and the amount of bother is high, a surgical approach can achieve excellent functional and cosmetic results. The very thick and heavy genital skin can be surgically removed and the penis and scrotum skin grafted, in order to unbury it. This surgery is often called the “Charles procedure”. The results are typically excellent and patients can achieve good functional results that can improve walking and urination, as well as an acceptable cosmetic penis.