Abstract:
Introduction
Penile carcinoma is a rare malignancy with significant physical, psychosocial, sexual, and emotional consequences. Recurrent disease often requires repeated surgeries and lymph node dissections, leading to complications such as chronic lymphedema, pain, fatigue, and reduced mobility, impairing quality of life and engagement in daily activities.
Case Description
A 42-year-old male, formerly employed as an electrician, with penile carcinoma diagnosed in 2019, underwent wide local excision with modified inguinal lymph node dissection, followed by glansectomy. Disease recurrence in 2022 required bilateral inguinal and pelvic lymph node dissection with adjuvant chemotherapy and radiotherapy. The patient subsequently developed bilateral lower limb (right > left) and scrotal lymphedema, complicated by non-compliance and multiple right leg wounds. He reported pain, limb heaviness, fatigue, reduced strength and range of motion, and marked difficulty with activities of daily living. Occupational therapy assessment included limb volume measurement using circumferential tape and the truncated cone formula, scrotal girth assessment, Lymphedema Life Impact Scale, Functional Independence Measure, and EORTC QLQ-C30.
Discussion
The patient received a structured occupational therapy programme comprising Complete Decongestive Therapy with multi-layer lymphatic bandaging for bilateral lower limb and genital lymphedema. Additional interventions included scrotal bandaging, skin care education, ADL retraining and modification, psychosocial rehabilitation, energy conservation techniques, caregiver education with home-based self-bandaging training, and vocational counselling. After four weeks, left lower limb volume reduced from 16.64 L to 10.70 L and right lower limb volume from 29.07 L to 14.52 L. Improvements were noted in mobility, comfort, ADL participation, and self-image.
Conclusion
This case demonstrates the vital role of occupational therapy in managing complex oncological lymphedema. Complete Decongestive Therapy, functional training, psychosocial support, and caregiver education led to meaningful improvements in function, independence, quality of life, and body image.
