A novel ‘Batman’ scrotectomy technique for the management of scrotal lymphoedema following treatment for penile cancer

Hussain M. Alnajjar, Fabio Castiglione, Kamran Ahmed, Aiman Haider, Raj Nigam, Asif Muneer


Background: To describe a novel ‘Batman’ scrotectomy technique and present our single centre experience in the management of secondary scrotal lymphoedema in penile cancer patients.
Methods: A retrospective review of the medical records of penile cancer patients with extensive and bothersome penoscrotal lymphoedema failing conservative therapy between 2013 and 2018. We analysed patients’ demographics, pre-operative disease stage, post-operative outcomes and complications.
Results: Seven patients with a history of penile cancer and problematic scrotal lymphoedema were managed using a novel ‘Batman’ scrotectomy technique. The mean age was 56.4 (range, 28–71) years. The mean inpatient stay was 4.1 (range, 2–7) days. Two patients (28.6%) were found to have incidental metastatic squamous cell carcinoma (SCC) in the scrotal skin on histological analysis. One patient developed superficial wound dehiscence (Clavien-Dindo grade II) and two patients had mild post-operative residual penile lymphoedema. Following a mean follow-up period of 19 months, 2 patients died due to metastatic penile cancer. One patient developed skin metastases in his thigh and perineum. All of the patients reported a good cosmetic and functional outcome on post-operative review.
Conclusions: Genital lymphoedema is an uncommon side-effect of penile cancer treatment. In severe cases where patients fail conservative treatments, surgical intervention using this technique is effective and feasible.