Surgical Treatment of Male Genital Lymphoedema: Clinical and Patient-Reported Outcomes

Background: Male genital lymphoedema is a rare, chronic and potentially debilitating condition associated with anatomical distortion, urinary and sexual dysfunction, recurrent infections, and impaired quality of life. Although surgical treatment is frequently required in advanced disease, evidence regarding postoperative functional recovery, patient-reported outcomes and long-term recurrence remains limited. Objectives: To evaluate patient-reported improvement in overall quality of life following surgical treatment of primary and secondary male genital lymphoedema. Secondary objectives included the assessment of functional and symptom-related outcomes, surgical satisfaction, postoperative morbidity and patient-reported disease recurrence. Materials and Methods: This retrospective, multi-institutional, single-surgeon observational cohort study included 101 patients who underwent surgical treatment for male genital lymphoedema between November 2011 and July 2026. Clinical and surgical data were retrospectively collected from medical records. Patient-reported outcomes were assessed using a study-specific 19-item questionnaire administered by telephone. The primary outcome was improvement in overall quality of life, defined as a score of 4–5 on questionnaire item Q15. Secondary outcomes included urinary and sexual function, disease-related symptoms, postoperative complications and recurrence. Descriptive and exploratory statistical analyses were performed. Results: Of 98 patients eligible for telephone follow-up, 73 completed the questionnaire (response rate 74.5%), at a median postoperative follow-up of 2.50 years (IQR 1.42–4.33). Improvement in overall quality of life was reported by 60/73 patients (82.2%; 95% CI 71.9–89.3%), while 97.3% expressed favourable overall surgical satisfaction. Improvement was reported in genital swelling (91.8%), urinary function (68.5%), skin infections (67.1%), pain (63.0%), mobility (56.2%) and sexual quality of life (44.3%). Among 29 patients unable to void while standing preoperatively, 26 (89.7%) regained this ability. Early postoperative complications occurred in 15/101 patients (14.9%), including four major complications (4.0%), with no 30-day mortality. Skin graft reconstruction was associated with a higher early complication rate (24.4% versus 7.1%; p = 0.023), although this association may reflect greater disease severity and reconstructive complexity. Patient-reported recurrence occurred in 22/73 respondents (30.1%), including 15 (20.5%) reporting clinically significant manifestations and seven (9.6%) describing mild, non-bothersome recurrence. Conclusions: Surgical treatment of male genital lymphoedema was associated with high patient satisfaction and meaningful improvements in overall quality of life, genital swelling and urinary function. Nevertheless, functional recovery varied across domains, and postoperative complications and recurrent lymphatic manifestations remained relevant. These findings highlight the importance of individualised surgical planning, realistic preoperative counselling and long-term patient-centred follow-up. Prospective multicentre studies incorporating standardised outcome definitions and validated patient-reported measures are needed to identify predictors of sustained surgical success.