Times of India
10 July 2010
By Sumitra Deb Roy
Mumbai, India

Shunned man saved by doctors0
For an entire year, Satara resident M Golve lived like a recluse because his genitalia had assumed an unusual size as well as shape due to a condition rare in Indians. It had grown into a huge mass nearly as big as a football. The penis was three times its size and the scrotum five, and the organs also assumed a strange shape. Life for him became solitary and confusing.

But last month, surgeons at Masina Hospital, Byculla, successfully operated on Golve, 66, restructuring his vital organs and giving him a new lease of life. Golve was suffering from filariasis of the genitalia, which led to a huge swelling and completely obstructed his urinary tract.

Filaria is a condition that can also afflict the arms, legs (elephantiasis) and other parts. While 40% of global filaria cases afflict Indians, doctors said filariasis of the genitalia is rare in Indians.

The challenges in Golve’s case included creating a normal urinary passage as the penis had retracted under the thick skin and assumed a peculiar shape. Typically, in filariasis, the patient’s skin becomes at least five times thicker than normal human skin.

The bizarre changes left Golve confused and alienated in his village. "He could not leave his house due to his appearance. He also had problems walking. So he confined himself to the four walls of his house,’’ said one of his relatives who accompanied him to Mumbai for the surgery. The relative said that Golve’s previous visits to KEM Hospital, Parel, and GT Hospital, Crawford Market, had yielded little relief.

Doctors at KEM created an opening in his lower abdomen for a catheter so he could pass urine. It sorted out medical issues to an extent, but left Golve mentally dissatisfied. After a year, he landed up at Masina, where consultant surgeon Dr Bomi Pardiwalla and a team of other surgeons found the condition treatable.

After tests, they found that even though filaria can cause permanent disability, Golve’s organs were intact and just needed correction. "We treated him for filaria for two weeks and with medication his scrotum shrunk quite a bit even before the surgery,’’ said Pardiwalla, who along with plastic surgeon Dr H M Bhathena and urologist Dr M Andankar operated on Golve.

In six weeks, Golve was operated on thrice. "The challenge was to look for his organ, which was hidden under thick skin and mass. Then, we created an opening in the urinary passage so he could pass urine normally and not with a catheter,’’ said Pardiwalla.

After about 10 days, he was operated on again. Doctors peeled off the thick skin that covered his genitals. "About 80% of the thick skin was gently removed and the remaining skin was used to cover the penis,’’ said Pardiwalla. The third surgery happened after seven days. It was to drain out fluid from the scrotum and give it normal shape. Upto 90% of the scrotum’s skin was also removed.

Golve returned to his village a few weeks back without requiring much post-operative care. A state officer said, "Filaria also causes economic and psychological burdens. Villagers seek help only after cases get severe and urban doctors don’t see much of these cases.”

When Trouble Swells: Filaria Disease & Disability

• Lymphatic filariasis (also known as elephantiasis when it occurs in the legs) is caused by the obstruction of the lymphatic vessels, resulting in a swelling of skin and tissues
• When it occurs in the genitals, it is filariasis of the genitalia
• Filaria can obstruct blood vessels, limiting blood supply and causing skin to become gangrenous
• Filaria causes unusual swelling of the leg, arm, scrotum, vulva or breast, making the skin baggy, thickened and ulcerated
• It can be painful and cause permanent disability at times
• It can also have hidden effects and cause internal damage to the kidneys and lymphatic system

The Sting

• Lymphatic filariasis is caused by various parasitic worms that are present in humans
• It is transmitted by mosquitoes that sting infected humans and pick up the microfilariae
• The infected mosquito passes the worm larvae when it bites someone else
• The larvae can survive and multiply in blood for 4 to 6 years, producing millions of minute larvae

Hope & Cure
Can be treated with medication in initial stages In severe cases, corrective surgeries of the organs may be needed. Also, the unusually thick skin has to be surgically removed

Mapping Occurrence

• Lymphatic filariasis is believed to affect 119 million people in 73 countries
• India accounts for 40% of global cases Prevalence is higher in south
• In Maharashtra, districts like Gadchiroli and Chandrapur do report some cases, though severe ones are rare
• However, filariasis of the genitalia is very rare in India