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A morbidly obese male patient was referred to our department for joint-venture excision surgery of a massive genital lymphedema that had increased 10-fold in volume over a 3-year period. The patient underwent two-stage excision and reconstruction surgery including orchiectomy and was discharged with no major complications and reported improved outcome and urogenital function after surgery at 6-month follow-up. Genital lymphedema is a rare and surgically challenging disease that is related to obesity and causes functional and psychosocial impairment. The planning, performance and postoperative care of surgery on bariatric patients requires tailored surgical treatment and the involvement of several different medical professions and specialties. Surgical debulking can bring about satisfactory outcomes and profound improvements in quality of life.