The incidence of primary penoscrotal lymphedema is much lower than lymphedema of extremities; furthermore, in Europe, one can usually find secondary forms. Its progression is passed through the same stages as lymphedema of the extremities.
In the case of lipohypertrophy and/or elephantiasis, the surgery is necessary. The authors in their paper call the attention to indications for surgery, particular steps by the surgery and post-operative care.