1
|
Falcone M, Preto M, Gül M, Şahin A, Scavone M, Cirigliano L, Peretti F, Ferro I, Plamadeala N, Gontero P. Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions. Int J Impot Res 2024:10.1038/s41443-024-00967-7. [PMID: 39187573 DOI: 10.1038/s41443-024-00967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/04/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41-61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39-51.39], with the change being statistically significant (mean difference: -10.52, (-19.15), p < 0.001). During the 0-12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: -12.955, -24.14%, [95% CI: -21.52, -4.38], p = 0.002; WLE: -14.1, -22.92%, [95% CI: -26.8, -1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (-3.083, -5.97%, CI: [-14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.
Collapse
Affiliation(s)
- Marco Falcone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy.
- Neurourology Clinic-A.O.U. "Città della Salute e della Scienza"-Unità Spinale Unipolare, Turin, Italy.
- Department of Urology, Biruni University School of Medicine, İstanbul, Turkey.
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Ali Şahin
- Selcuk University School of Medicine, Konya, Turkey
| | - Martina Scavone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Federica Peretti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Ilaria Ferro
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Natalia Plamadeala
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic-A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
Collapse
Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
3
|
Brassetti A, Anceschi U, Cozzi G, Chavarriaga J, Gavrilov P, Gaya Sopena JM, Bove AM, Prata F, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Camacho D, Musi G, Varela R, Breda A, De Cobelli O, Simone G. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr Oncol 2023; 30:1882-1892. [PMID: 36826107 PMCID: PMC9954864 DOI: 10.3390/curroncol30020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
Collapse
Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652666772
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Julian Chavarriaga
- Division of Urology, Clinica Imbanaco, Quiron Salud, Cali 760042, Colombia
- Division of Urology, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Pavel Gavrilov
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | | | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Diego Camacho
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Rodolfo Varela
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Alberto Breda
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| |
Collapse
|
4
|
Surgical technique and outcomes following coronal-sparing glans resurfacing for benign and malignant penile lesions. Int J Impot Res 2021; 34:495-500. [PMID: 34285385 DOI: 10.1038/s41443-021-00452-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/08/2022]
Abstract
The aim of this study is to describe the outcomes for a modified glans-resurfacing technique for benign and malignant penile conditions in which the uninvolved glans corona is preserved in order to maintain glans erogenous sensation. A total of 13 patients underwent coronal-sparing glans resurfacing (CSGR), with follow-up every 3 months for ≥2 years. Positive surgical margin and local recurrence (LR) rates were evaluated. Surgical complications and cosmetic outcomes were also recorded. Patients were asked to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire starting 12 months after the surgery. The median (interquartile range [IQR]) age and follow-up periods were 63 (53-68) years and 29 (14-38) months, respectively. Eight patients were diagnosed with primary penile squamous cell carcinoma (SCC), three had refractory lichen sclerosus, and two had penile intraepithelial neoplasia (PeIN). No surgical complications were recorded. All patients had a complete graft take and reported satisfactory cosmetic results with preserved erogenous sensation. Two cancer patients developed LR which was managed with further penile preserving surgery. The median (IQR) postoperative IIEF-5 value was 20 (17-23). This modified coronal-sparing technique was suitable for glans lesions that spare the coronal ridge and coronal sulcus. Preservation of the coronal ridge helps maintain sexual function and provides excellent cosmetic outcomes.
Collapse
|
5
|
Stroie FA, Houlihan MD, Kohler TS. Sexual function in the penile cancer survivor: a narrative review. Transl Androl Urol 2021; 10:2544-2553. [PMID: 34295742 PMCID: PMC8261429 DOI: 10.21037/tau-20-1228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022] Open
Abstract
Squamous cell carcinoma of the penis is a rare malignancy among men in North America and Europe with an incidence of <1 per 100,00 men. Of all genitourinary cancers, penile carcinoma has the potential to jeopardize sexual function the most. The treatment modalities of penile carcinoma span the gamut from organ-sparing treatments such as topical therapy, laser therapy, radiotherapy, glansectomy, wide-local excision and partial or total penectomy. There is a relative paucity of data in the medical literature describing the impact of penile cancer treatment on sexual function. The majority of available studies use retrospective data from small samples utilizing heterogeneous study tools such as patient interviews and non-validated questionnaires. The most commonly used validated instrument to evaluate sexual outcomes is the International Index of Erectile Function Questionnaire (IIEF), but is limited in that it does not assess patients who perform self-stimulation or achieve sexual stimulation by any means other than penetrative intercourse. Though advances in clinical research continue; large, well-designed comparative studies using validated instruments are elusive. The sexual outcomes after penile cancer are reviewed from the available published data to better assist the patient and the treating physician with medical decision making. With a detailed assessment of sexual outcomes, the physician is better equipped in providing patient centered care to achieve outcomes meaningful for each patient.
Collapse
Affiliation(s)
- Florian A Stroie
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL, USA
| | | | | |
Collapse
|
6
|
Preto M, Falcone M, Blecher G, Capece M, Cocci A, Timpano M, Gontero P. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021; 18:1099-1103. [PMID: 37057466 DOI: 10.1016/j.jsxm.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. AIM The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). METHODS From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. OUTCOMES Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. RESULTS 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. CLINICAL IMPLICATIONS TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions STRENGTHS AND LIMITATIONS: Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. CONCLUSION TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions. M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099-1103.
Collapse
Affiliation(s)
- Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy.
| | - Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy; Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Italy
| | - Gideon Blecher
- Adjunct Lecturer, Department of Surgery. Monash University. Melbourne (Australia) Wellington Rd, Clayton VIC, Australia; Urology Consultant. Department of Urology, The Alfred Hospital. Melbourne, Melbourne VIC, Australia
| | - Marco Capece
- Urology department, Federico II Hospital, University of Naples, Italy
| | - Andrea Cocci
- Urology department, Careggi Hospital, University of Florence, Florence, Italy
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| |
Collapse
|
7
|
Emmanuel A, Watkin N. Update on organ preserving surgical strategies for penile cancer. Urol Oncol 2021; 40:179-183. [PMID: 33610446 DOI: 10.1016/j.urolonc.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
With the passage of time, there has been a major paradigm shift in the surgical management of penile cancer from radical to organ preserving penile surgical techniques, with closer surgical margins which offer good oncological, cosmetic and functional outcomes with improved physical and psychosexual well-being. This article aims to provide an update of the current organ preserving surgical strategies for penile cancer.
Collapse
Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Nick Watkin
- Penile Cancer Centre, St George's Healthcare NHS Trust, London, UK
| |
Collapse
|
8
|
Wang J, Zhang W, Li X. The Diagnosis and Treatment of Lichen Sclerosus and Bulbous Urethral Squamous Cell Carcinoma: A Case Report. Am J Mens Health 2020; 14:1557988320982710. [PMID: 33356763 PMCID: PMC7768855 DOI: 10.1177/1557988320982710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Lichen sclerosus (LS) is a rare disease with malignant potential and has been identified by the European Society of Urology Guidelines as a risk factor for penile squamous cell carcinoma (SCC) cancer. LS combined with urethral squamous cell carcinoma (USCC) is extremely rare. There has been only one case report of this combination in China over the last decade. The prevalence of this combination in East Asian population is unclear. In this report, a 49-year-old patient with the presence of LS, perineal masses, and abscesses was hospitalized. He underwent anti-infectious therapy, meatotomy, perineal abscess incision, and drainage and debridement of the perineal wound. USCC was diagnosed following a series of biopsies and treated with radiation therapy. The patient remains well and alive with no recurrence of USCC 13 months after radiation treatment.
Collapse
Affiliation(s)
- Jun Wang
- Shandong First Medical University, Shandong, China.,Rongcheng People's Hospital, Rongcheng, Shandong, China
| | - Wei Zhang
- Shandong First Medical University, Shandong, China.,Rongcheng People's Hospital, Rongcheng, Shandong, China
| | - Xiaodong Li
- Rongcheng People's Hospital, Rongcheng, Shandong, China
| |
Collapse
|
9
|
Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
Collapse
Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
| |
Collapse
|
10
|
O'Neill S, Barns M, Vujovic F, Lozinskiy M. The role of penectomy in penile cancer-evolving paradigms. Transl Androl Urol 2020; 9:3191-3194. [PMID: 33457290 PMCID: PMC7807362 DOI: 10.21037/tau.2019.08.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Penile cancer is a rare cancer, with the majority treated with penile preserving methods. There remains a role for partial and totally penectomy for advanced and more proximal penile cancers. Significant functional and psychological morbidity can ensue for patients undergoing surgical management. Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3–5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients’ oncologic outcomes—however a role still exists for radical surgery in advanced penile malignancy.
Collapse
Affiliation(s)
- Sarah O'Neill
- Department of Urology, Royal Perth Hospital, Perth, Australia
| | - Mitchell Barns
- Department of Urology, Royal Perth Hospital, Perth, Australia
| | - Filip Vujovic
- Department of Urology, Royal Perth Hospital, Perth, Australia
| | | |
Collapse
|
11
|
Abstract
Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer.
Collapse
Affiliation(s)
- Andrew Fang
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA
| | - James Ferguson
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA.,The University of Alabama, Birmingham School of Medicine- O'Neal Comprehensive Cancer Center , Birmingham, AL, USA
| |
Collapse
|
12
|
Falcone M, Preto M, Oderda M, Timpano M, Russo GI, Capogrosso P, Cocci A, Fode M, Gontero P. Total Glans Resurfacing for the Management of Superficial Penile Cancer: A Retrospective Cohort Analysis in a Tertiary Referral Center. Urology 2020; 145:281-286. [DOI: 10.1016/j.urology.2020.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
|
13
|
Ahmed F, Al-Wageeh S, Al-Shami E, Al-Naggar K, Askarpour MR, Naji M. <p>Penile Injury During Ritual Circumcision</p>. RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s281896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
14
|
Beamer M, Angulo JC, Capiel L, López-Alvarado D, Ramirez EA, Satyagraha P, Nikolavsky D. The buccal belt: a buccal mucosal graft sub-coronal resurfacing for recurrent penile adhesions in patients with lichen sclerosus. Int Urol Nephrol 2020; 52:1491-1497. [DOI: 10.1007/s11255-020-02437-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
|
15
|
Kristinsson S, Johnson M, Ralph D. Review of penile reconstructive techniques. Int J Impot Res 2020; 33:243-250. [PMID: 32152468 DOI: 10.1038/s41443-020-0246-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/08/2020] [Accepted: 02/26/2020] [Indexed: 11/09/2022]
Abstract
Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: 'penile trauma', 'penile cancer', 'lichen sclerosus', 'glansectomy', 'glans resurfacing', 'penile-sparing surgery', 'micropenis', 'aphallia', 'female-to-male sex reassignment surgery', 'scrotal flap' and 'genital lymphoedema'. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0-10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.
Collapse
Affiliation(s)
- Sverrir Kristinsson
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK
| | - Mark Johnson
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK
| | - David Ralph
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK.
| |
Collapse
|
16
|
Hayden JP, Browning JT, Peterson AC. Lichen Sclerosus: More Than Meets the Eye. Urology 2020; 139:18-21. [PMID: 32087208 DOI: 10.1016/j.urology.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jill T Browning
- Duke University Medical Center, Department of Pathology, Durham, NC
| | - Andrew C Peterson
- Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC
| |
Collapse
|
17
|
Weibl P, Herwig R. Superficial penile cancer treated with complete excision of the glans epithelium and coverage with a tissue sealant matrix (TachoSil®). Cent European J Urol 2019; 72:204-208. [PMID: 31482031 PMCID: PMC6715082 DOI: 10.5173/ceju.2019.1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/31/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of our work was to demonstrate the feasibility and clinical outcomes after partial excision of the epithelial and subepithelial layer of the glans with subsequent tissue sealant matrix coverage (TachoSil®). Material and methods We enrolled 11 consecutive patients with superficial penile cancer. Under the microscopic guidance, the tumor in the glans area was excised continuously with a minimal lateral margin of 5 mm. The cosmetic result was accessed using a 5-graded scale ranging from very dissatisfied to very satisfied. Results The median patient's age at the presentation was 46 years (range 38-53). Histopathological examination of the specimen confirmed squamous cell carcinoma and tumor-free surgical margins were obtained in all cases. Overall, the tumors were TaG1 in 3 patients, TaG2 in 1 patient, TisG1 in 2 patients, TisG2 in 2 patient, T1aG1 in 2 patients, and T1aG2 in 1 patient. All patients had clinically negative lymph-node status - cN0 (confirmed by aabdominopelvic computed tomography (CT) scan with contrast). During the follow-up of 6 to 36 months (median 18), local recurrence occurred in 1 patient with carcinoma in situ six months after surgery, which was managed by a second glans-preserving surgery without recurrence. The others showed no signs of local recurrence or metastasis during the period of observation. Conclusions These preliminary data suggests that glans-preserving surgical technique using TachoSil® as a defect coverage is technically feasible, functionally safe and cosmetically satisfying. However, well-designed prospective-randomized trial is warranted, to further confirm the clinical utility of our approach.
Collapse
Affiliation(s)
- Peter Weibl
- Landesklinikum Korneuburg - Teaching Hospital, Department of Urology, Korneuburg, Austria
| | - Ralf Herwig
- Department of Reconstructive Urology, Andrology and Mens's Health, Vienna Urology Foundation, Vienna, Austria
| |
Collapse
|
18
|
Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5219048. [PMID: 31312658 PMCID: PMC6595175 DOI: 10.1155/2019/5219048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
Introduction Glans resurfacing has been suggested as a treatment option for the surgical management of superficial penile cancer (Tis, Ta, T1aG1, T1aG2). In this article we describe in detail the glans resurfacing technique with skin graft for penile cancer in a video presentation and we review the current knowledge of the literature. Material and Methods The procedure is described in a stepwise fashion. Initially the patient is circumcised. The glans is marked in quadrants and completely stripped by dissecting and removing the epithelium and subepithelium layer of the glans. Deep spongiosal biopsies are taken to exclude invasion. Each quadrant is sent separately for biopsy. The surface of the graft size needed is estimated. A partial thickness skin graft is harvested from the thigh with a dermatome. The skin graft is then fenestrated. The graft is rolled over the glans and quilted with multiple sutures. A silicone 16F Foley catheter and a suprapubic catheter are placed. The penis is dressed with multiple gauzes and compressed with an elastic band. Results The patient is discharged the next day. The dressing and Foley catheter are removed in 7 days. The patient continues to use the suprapubic catheter for 7 more days. The patient refrains from any sexual activity for 6 weeks and is closely followed. Conclusions Glans resurfacing is an emerging new appealing surgical technique that is already a recommendation in the EAU guidelines for the treatment of premalignant and superficial penile lesions. The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer.
Collapse
|
19
|
Organ-sparing procedures in GU cancer: part 2-organ-sparing procedures in testicular and penile tumors. Int Urol Nephrol 2019; 51:1699-1708. [PMID: 31267441 DOI: 10.1007/s11255-019-02182-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Organ-sparing surgery (OSS) is recommended in selected patients with testicular tumors and penile cancer (PC). The functional and psychological impacts of organ excision for these genital tumors are profound. In this review, we summarize the indications, techniques and outcomes of OSS for these two tumors. METHODS PubMed® was searched for relevant articles up to December 2018. For Testicular sparing surgery (TSS) search, keywords used were; testicular tumors alone and in combination with "testicular sparing surgery", "partial orchiectomy" and outcomes. For penile conserving surgery (PCS), keywords used were: penile cancer alone and in combination with "penile conserving surgery", "partial penectomy" and outcomes. Because of the low quality of available evidence, a narrative rather that systematic review has been performed. RESULTS Indications of TSS are tumors ≤ 2 cm in solitary testis or bilateral tumors and no rete testis invasion. Prerequisites include normal testosterone and luteinizing hormone levels and patient compliance with follow-up. Indications for PCS are distal penile lesions with clinical stage ≤ T1. Adequate penile stump (3 cm) is required after surgery to maintain forward urine stream. Frozen section helps to reduce the risk of recurrence. Local recurrence after PCS is not associated with reduced survival and can be managed with another PCS in selected patients. The reported oncological and functional outcomes following TSS and PCS are adequate. CONCLUSIONS In properly selected patient OSS in testicular and penile tumors has a comparable oncological outcome to total organ excision with added advantages of preserving organ function and psychological well-being.
Collapse
|
20
|
Parnham AS, Blecher GA, Minhas S. Treatment of the Primary Tumor: Role of Organ-Preserving Surgery in Penile Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
21
|
Weibl P, Plank C, Hoelzel R, Hacker S, Remzi M, Huebner W. Neo-glans reconstruction for penile cancer: Description of the primary technique using autologous testicular tunica vaginalis graft. Arab J Urol 2018; 16:218-223. [PMID: 29892486 PMCID: PMC5992260 DOI: 10.1016/j.aju.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 11/28/2022] Open
Abstract
Partial penectomy (glansectomy with/or without distal corporectomy) is an acceptable alternative for smaller distal pT3 penile carcinoma lesions in highly motivated and compliant patients. The authors describe a novel technique of neo-glans reconstruction using a tunica vaginalis (TV) testis allograft. However, due to an unclear resection margin on final histology, the patient underwent re-do surgery with a neo-glans revision using the well-established mesh split-thickness skin graft (STSG) technique. The penile length was preserved and the penile and bulbar part of the urethra was additionally mobilised in order to obtain a natural and aesthetic result for the meatus. Neo-glans reconstruction with TV coverage may be another promising alternative, which certainly requires further evaluation. We believe that the donor-site associated morbidity is minimal when compared to other harvesting sites. However, this is just an assumption, because direct comparison data on grafting techniques and neo-glans reconstruction are not available. Nevertheless, we think that for re-do procedures a standardised approach using a STSG technique should be the treatment method of choice.
Collapse
Affiliation(s)
- Peter Weibl
- Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria
| | - Christina Plank
- Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria
| | - Rudolf Hoelzel
- Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria
| | - Stefan Hacker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria
| | - Wilhelm Huebner
- Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria
| |
Collapse
|
22
|
|
23
|
Treatment of the Primary Tumor: Role of Organ-Preserving Surgery in Penile Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_35-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
24
|
Beilan JA, Manimala NJ, Slongo J, Loeb A, Spiess PE, Carrion RE. Surgical Reconstruction After Penile Cancer Surgery. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
25
|
Kamel MH, Bissada N, Warford R, Farias J, Davis R. Organ Sparing Surgery for Penile Cancer: A Systematic Review. J Urol 2017; 198:770-779. [DOI: 10.1016/j.juro.2017.01.088] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Mohamed H. Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Nabil Bissada
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Renee Warford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Judy Farias
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| |
Collapse
|
26
|
Baumgarten AS, Fisher JS, Lawindy SM, Pavlinec JG, Carrion RE, Spiess PE. Penile sparing surgical approaches for primary penile tumors: preserving function and appearance. Transl Androl Urol 2017; 6:809-819. [PMID: 29184777 PMCID: PMC5673820 DOI: 10.21037/tau.2017.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches.
Collapse
Affiliation(s)
| | - John S Fisher
- Division of Urology, University of Tennessee, Knoxville, USA
| | | | | | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, USA
| |
Collapse
|
27
|
Nam JK, Lee DH, Park SW, Kam SC, Lee KS, Kim TH, Kim TS, Oh CK, Park HJ, Kim TN. Clinicopathologic Characteristics and Treatment Outcomes of Penile Cancer. World J Mens Health 2017; 35:28-33. [PMID: 28459145 PMCID: PMC5419113 DOI: 10.5534/wjmh.2017.35.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to assess the clinicopathologic characteristics of penile cancer, including patterns of therapy, oncologic results, and survival. Materials and Methods Between January 2005 and July 2015, 71 patients at 6 institutions who had undergone penectomy or penile biopsy were enrolled. Their medical records were reviewed to identify the mode of therapy, pathology reports, and cancer-specific survival (CSS) rate. Results Clinicopathologic and outcome information was available for 52 male patients (mean age, 64.3 years; mean follow-up, 61.4 months). At presentation, 17 patients were node-positive, and 4 had metastatic disease. Management was partial penectomy in 34 patients, total penectomy in 12 patients, and chemotherapy or radiotherapy in 6 patients. The pathology reports were squamous cell carcinoma in 50 patients and other types of carcinoma in the remaining 2 patients. Kaplan-Meier survival analysis showed a 5-year CSS rate of 84.0%. In univariate and multivariate analyses, the American Joint Committee on Cancer (AJCC) stage and pathologic grade were associated with survival. Conclusions Partial penectomy was the most common treatment of penile lesions. The oncologic outcomes were good, with a 5-year CSS of 84.0%. The AJCC stage and pathologic grade were independent prognostic factors for survival.
Collapse
Affiliation(s)
- Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Hoon Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki Soo Lee
- Department of Urology, Dong-A University Hospital, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University Hospital, Busan, Korea
| | - Taek Sang Kim
- Department of Urology, Kosin University Gospel Hospital, Busan, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Tae Nam Kim
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| |
Collapse
|
28
|
A Prospective Study of Total Glans Resurfacing for Localized Penile Cancer to Maximize Oncologic and Functional Outcomes in a Tertiary Referral Network. J Urol 2017; 197:1258-1263. [DOI: 10.1016/j.juro.2016.12.089] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/27/2022]
|
29
|
Dimitropoulos K, Stewart F, Imamura M, MacLennan S, Lam TBL, Vint R, MacLennan G, Omar MI, MacLennan S, Griffiths TRL, Watkin N, Horenblas S, Hakenberg OW, N'Dow JMO, Summerton DJ, Adewuyi T. Surgical management for localised penile cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd011533.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Fiona Stewart
- University of Aberdeen; Academic Urology Unit; Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Mari Imamura
- University of Aberdeen; Academic Urology; Health Sciences Building Foresterhill Aberdeen UK AB25 2ZD
| | - Steven MacLennan
- University of Aberdeen; Academic Urology Unit; Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Thomas BL Lam
- University of Aberdeen; Academic Urology Unit; Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Ross Vint
- NHS Grampian, Aberdeen Royal Infirmary; Urology Department; Foresterhill Aberdeen Scotland UK AB25 2ZB
| | - Graeme MacLennan
- University of Aberdeen; Health Services Research Unit; Aberdeen Scotland UK
| | | | - Sara MacLennan
- University of Aberdeen; Academic Urology Unit; Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - T R Leyshon Griffiths
- University of Leicester, Clinical Sciences Unit, Leicester General Hospital; Department of Cancer Studies and Molecular Medicine; Gwendolen Road Leicester UK LE5 4PW
| | - Nick Watkin
- St. George's Hospital; Department of Urology; Tooting London UK SW17 0QT
| | - Simon Horenblas
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital; Department of Urology; Plesmanlaan 121 Amsterdam Netherlands 1066 CX
| | - Oliver Walter Hakenberg
- Rostock University Hospital; Department of Urology; Schillingallee 35 Rostock Mecklenburg Germany D-18057
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal Infirmary; Urology Department; Foresterhill Aberdeen Scotland UK AB25 2ZB
| | | | - Temitope Adewuyi
- University of Aberdeen; Academic Urology Unit; Foresterhill Aberdeen Scotland UK AB25 2ZD
| |
Collapse
|
30
|
Bickell M, Beilan J, Wallen J, Wiegand L, Carrion R. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer. Urol Clin North Am 2017; 43:545-559. [PMID: 27717440 DOI: 10.1016/j.ucl.2016.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.
Collapse
Affiliation(s)
- Michael Bickell
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Jonathan Beilan
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Jared Wallen
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Lucas Wiegand
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, Tampa, FL, USA.
| |
Collapse
|
31
|
Organ Preservation Surgery for Carcinoma Penis. Indian J Surg Oncol 2017; 8:59-63. [PMID: 28127184 DOI: 10.1007/s13193-016-0573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022] Open
Abstract
Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.
Collapse
|
32
|
Mahesan T, Hegarty PK, Watkin NA. Advances in Penile-Preserving Surgical Approaches in the Management of Penile Tumors. Urol Clin North Am 2016; 43:427-434. [DOI: 10.1016/j.ucl.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 2016; 13:249-57. [DOI: 10.1038/nrurol.2016.54] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Management of Long-Segment and Panurethral Stricture Disease. Adv Urol 2015; 2015:853914. [PMID: 26779259 PMCID: PMC4686630 DOI: 10.1155/2015/853914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/05/2015] [Indexed: 01/18/2023] Open
Abstract
Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.
Collapse
|
35
|
Sedigh O, Falcone M, Ceruti C, Timpano M, Preto M, Oderda M, Kuehhas F, Sibona M, Gillo A, Gontero P, Rolle L, Frea B. Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results? Can Urol Assoc J 2015; 9:E423-7. [PMID: 26279710 DOI: 10.5489/cuaj.2801] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer. METHODS We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square. RESULTS Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004). CONCLUSIONS WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.
Collapse
Affiliation(s)
- Omid Sedigh
- Department of Urology, University of Turin, Turin, Italy
| | - Marco Falcone
- Department of Urology, University of Turin, Turin, Italy
| | - Carlo Ceruti
- Department of Urology, University of Turin, Turin, Italy
| | | | - Mirko Preto
- Department of Urology, University of Turin, Turin, Italy
| | - Marco Oderda
- Department of Urology, University of Turin, Turin, Italy
| | | | - Mattia Sibona
- Department of Urology, University of Turin, Turin, Italy
| | - Arianna Gillo
- Department of Urology, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Luigi Rolle
- Department of Urology, University of Turin, Turin, Italy
| | - Bruno Frea
- Department of Urology, University of Turin, Turin, Italy
| |
Collapse
|
36
|
Skeppner E, Fugl-Meyer K. Dyadic Aspects of Sexual Well-Being in Men with Laser-Treated Penile Carcinoma. Sex Med 2015; 3:67-75. [PMID: 26185671 PMCID: PMC4498823 DOI: 10.1002/sm2.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Coping with cancer, its treatment and recovery are dyadic processes within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. AIM The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and 1 year after organ-sparing laser treatment of penile carcinoma. METHODS A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners, median age 60 (37-73) years and 57 (30-72) years, respectively. Median length of relationship was 29 years (1-54 years). The participants completed structured interviews before treatment, at 6 months' and 12 months' follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication, and life satisfaction. MAIN OUTCOME MEASURES Three well-validated instruments were included: Hospital Anxiety and Depression Scale, International Index of Erectile Function-5, and Life Satisfaction checklist, LiSat-11. The interviews contained the same questions for patients and partners at all three measuring points. RESULTS There was a high level of within-couple agreement on sexual activities, sexual function, and life satisfaction before and after organ-sparring treatment. No significant differences between interview data at 6 and 12 months' follow-up occurred. Before treatment, sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia. At follow-up, increased sexual function was found, with the exception of erectile function and women's orgasm. A rather high proportion was being unsatisfactory sexually inactive. Few had an ongoing verbal (sexual) mutual communication. Couples with an active sexual life at follow-up showed coherence in high satisfaction with life as a whole. CONCLUSION A high level of within-couple agreement concerning sexuality and life satisfaction points to the necessity of including an adequate sexological case history, counseling, and treatment for this group of patients and their partners.
Collapse
Affiliation(s)
- Elisabet Skeppner
- Department of Urology, Faculty of Medicine and Health, Örebro University Hospital Örebro, Sweden
| | - Kerstin Fugl-Meyer
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Department of Social Work, Karolinska University Hospital Stockholm, Sweden
| |
Collapse
|
37
|
Scarberry K, Angermeier KW, Montague D, Campbell S, Wood HM. Outcomes for Organ-Preserving Surgery for Penile Cancer. Sex Med 2015; 3:62-6. [PMID: 26185670 PMCID: PMC4498822 DOI: 10.1002/sm2.56] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM Squamous cell carcinoma of the penis (PC) has traditionally been treated with partial penectomy with a 2-cm margin. More conservative resection margins have been reported to have no effect on oncologic control, but there is no consensus in the literature regarding functional outcomes after organ-preserving surgery for PC. METHODS Six patients meeting inclusion criteria were retrospectively identified to have received organ-sparing surgery for PC at the Cleveland Clinic from 2003 to 2012. Patient's sexual and urinary quality of life was assessed retrospectively using the International Index of Erectile Function and the patient-reported outcome measure for urethral stricture surgery. RESULTS Three patients (50%) report normal erections but describe intercourse as not very enjoyable and report being dissatisfied with their sex life. The remaining 50% consistently report no sexual activity and denied feeling sexual desire. All report only mild urinary symptoms, including decreased stream (18%) and feelings of incomplete voiding (67%). Eighty-three percent of patients report their sexual symptoms do not interfere with their daily lives. One hundred percent report being satisfied with their procedure. CONCLUSION Our study is the first to use standardized, validated questionnaires to evaluate sexual and urinary function in a North American penile cancer patient population. We report excellent overall urinary function and quality of life following penile-sparing surgery for PC, and our results depict more realistic sexual outcomes than those reported in studies using non-blinded and non-validated methods.
Collapse
Affiliation(s)
- Kyle Scarberry
- Urology Institute, University Hospitals Case Medical Center Cleveland, OH, USA
| | - Kenneth W Angermeier
- Glickman Urological and Kidney Institute, The Cleveland Clinic Cleveland, OH, USA
| | - Drogo Montague
- Glickman Urological and Kidney Institute, The Cleveland Clinic Cleveland, OH, USA
| | - Steven Campbell
- Glickman Urological and Kidney Institute, The Cleveland Clinic Cleveland, OH, USA
| | - Hadley M Wood
- Glickman Urological and Kidney Institute, The Cleveland Clinic Cleveland, OH, USA
| |
Collapse
|
38
|
Zhu Y, Gu WJ, Wang HK, Gu CY, Ye DW. Surgical treatment of primary disease for penile squamous cell carcinoma: A Surveillance, Epidemiology, and End Results database analysis. Oncol Lett 2015; 10:85-92. [PMID: 26170981 DOI: 10.3892/ol.2015.3221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/27/2015] [Indexed: 11/12/2022] Open
Abstract
Current guidelines recommend penile sparing surgery (PSS) for selected penile cancer cases. The present study described the use of PSS in a population-based cohort, and also examined the role of PSS on penile cancer-specific mortality (PCSM). Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to identify individuals that were diagnosed with penile squamous cell carcinoma between 1998 and 2009 and treated with surgery. Patients were sorted into two groups: Local tumor excision (LTE) and partial/total penectomy (PE). Factors associated with the receipt of LTE and PCSM following LTE were examined. In addition, PCSM was compared between LTE and PE following propensity score matching. Of the 1,292 eligible patients, 24.2% underwent LTE. For stage T1 disease, the rates of LTE increased moderately from 29 to 40% over the last decade. Following multivariate analyses, young age, African descent, a tumor size of <3 cm and stage T1 disease were identified to positively influence the receipt of LTE. With a median follow-up period of 55 months, the four-year PCSM rate was 9.8% in patients treated with LTE. Older age, a tumor size of 3-4 cm and regional/distant disease (SEER stage) were significant predictors of PCSM. Furthermore, in matched cohorts with stage T1 disease, the four-year PCSM rates were 8.9 and 10.0% for patients that received LTE or PE, respectively (P=0.93). In conclusion, underuse of PSS is pronounced in the general community with significant age and ethnicity disparities. The current population-based study provides evidence supporting the oncological safety of PSS compared with PE in early-stage disease.
Collapse
Affiliation(s)
- Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Wei-Jie Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Hong-Kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Cheng-Yuan Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Malignant penile lesions are uncommon but represent a challenge for reconstructive surgeons because their treatment has a profound effect on appearance and quality of life of the patient. RECENT FINDINGS Partial or total penectomy remains the gold standard in the treatment of penile carcinoma. However, less invasive options that may improve quality of life are being considered, based on stage and grade of the tumor. SUMMARY A variety of surgical options exist for penile cancer treatment. In this article, we review various reconstructive approaches after initial surgical management of penile carcinoma. Regardless of reconstruction method, the goals remain the same: creating a functional and aesthetically acceptable phallus with the ability to void standing and to achieve sexual function.
Collapse
|
40
|
Abstract
Penile cancer is a rare disease, accounting for ~1% of all malignancies in men. Poor awareness of the condition among the public and clinicians often causes long delays in diagnosis and treatment, which may result in the development of advanced disease that might require extensive and emasculating surgery. In the UK, the development of supraregional penile cancer centres has pooled resources and expertise, which has led to considerable improvements in our understanding and management of this rare condition over the past decade. However, significant gaps in our knowledge still exist. Several areas of diagnosis and management remain areas of controversy, ranging from preventive strategies and treatment of premalignant disease to the assessment of lymph node involvement and the management of advanced disease.
Collapse
|
41
|
Håkansson U, Kirrander P, Uvelius B, Baseckas G, Torbrand C. Organ-sparing reconstructive surgery in penile cancer: initial experiences at two Swedish referral centres. Scand J Urol 2014; 49:149-54. [DOI: 10.3109/21681805.2014.955822] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
42
|
Kim JH, Park JY, Song YS. Traumatic penile injury: from circumcision injury to penile amputation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:375285. [PMID: 25250318 PMCID: PMC4164514 DOI: 10.1155/2014/375285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/16/2014] [Accepted: 08/16/2014] [Indexed: 02/07/2023]
Abstract
The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.
Collapse
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yun Seob Song
- Department of Urology, Soonchunyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
| |
Collapse
|
43
|
Pandey A, Dican R, Beier J, Keller H. Buccal mucosal graft in reconstructive urology: Uses beyond urethral stricture. Int J Urol 2014; 21:732-4. [DOI: 10.1111/iju.12403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Abhishek Pandey
- Department of Urology; Pediatric Urology and Urological Oncology; Sana Hospital Hof; Hof Germany
| | - Razvan Dican
- Department of Urology; Pediatric Urology and Urological Oncology; Sana Hospital Hof; Hof Germany
| | - Jörn Beier
- Department of Urology; Pediatric Urology and Urological Oncology; Sana Hospital Hof; Hof Germany
| | - Hansjörg Keller
- Department of Urology; Pediatric Urology and Urological Oncology; Sana Hospital Hof; Hof Germany
| |
Collapse
|
44
|
Shapiro D, Shasha D, Tareen M, Tareen B. Contemporary management of localized penile cancer. Expert Rev Anticancer Ther 2014; 11:29-36. [DOI: 10.1586/era.10.209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
45
|
Iatrogenic penile glans amputation: major novel reconstructive procedure. Case Rep Urol 2014; 2013:741980. [PMID: 24379983 PMCID: PMC3860129 DOI: 10.1155/2013/741980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
Circumcision is a very common urological practice. Even though it is relatively safe, it is not a complication-free procedure. We describe a patient that underwent a neonatal circumcision complicated by iatrogenic complete glans amputation. Reconstructive repair of a neoglans using a modified traditional method was used. Postoperative followup to 90 days is illustrated. Despite being a simple procedure, circumcision in unprofessional hands can have major complication impacting the emotional and sexual life of patients. Surgical reconstruction is possible with varying satisfactory results.
Collapse
|
46
|
Pérez-Niño J, Fernández N, Sarmiento G. Partial penectomy and penile reconstruction. Initial surgical management of localized penile cancer. Actas Urol Esp 2014; 38:62-5. [PMID: 24103396 DOI: 10.1016/j.acuro.2013.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/07/2013] [Accepted: 04/12/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical management for penile carcinoma is mutilating and affects significantly quality of life. Hereby we present our experience on penile reconstruction (PR) immediately after oncologic resection. MATERIALS AND METHODS We included all patients from January 2007 until April 2012 who underwent PR after partial penectomy (PP). Patients included in the study were seen at four different hospitals. All procedures were done by the same surgeon. Information included were: oncological status at the moment of surgery, surgical technique used for reconstruction. Each case was also registered photographically. On follow-up visits data about outcome and patient's satisfaction were registered. RESULTS During the study period 15 patients underwent PR. Average age at the moment of surgery was 49 years. Average follow-up was 15 months. In 12 patients PR was made at the same time as PP. Of those, four cases underwent glans resurfacing, 2 glandectomy, 6 partial penectomy, and the remaining 3 have had PP in a different time in the past. Every case underwent a split thickness graft procedure. Only 2 patients had postoperative complications. One of them presented urethral stricture and the other graft ischemia. Three patients had positive nodes at the moment of PP and two during the follow-up. None of the cases have presented local recurrence and only one died. On follow-up the remaining patients refer a good quality of life and felt happy with aesthetic results. CONCLUSIONS Given the results presented hereby we propose that PR must be part of the same procedure as the PP.
Collapse
|
47
|
Zukiwskyj M, Daly P, Chung E. Penile cancer and phallus preservation strategies: a review of current literature. BJU Int 2013; 112 Suppl 2:21-6. [PMID: 24127672 DOI: 10.1111/bju.12205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Penile cancer is a rare malignancy in most developed nations but its management can have significant anatomical, functional and psychological effects in patients. Whilst total penectomy used to be widely practiced, it is associated with significant psychological consequences pertaining to body image and masculinity, with loss of sexual function and the ability to void upright. Recent advances in surgical techniques and technologies has allowed for many organ-sparing techniques with acceptable psychosexual and oncological outcomes. Factors to be considered in phallus preservation treatment include: local invasion, tumour stage and the ability to achieve complete oncological control. Topical chemotherapeutic agents, laser ablation, radiotherapy, Mohs micrographic surgery, glansectomy and partial penectomy have been frequently used to interfere as little as possible with functional anatomy without compromising local cancer control. The difficulty with these phallus-preserving techniques is the potential risk of disease recurrence both locally and distally. Providing that patients are suitable for penile-sparing therapy, have been informed adequately on risk of tumour recurrence and are willing to commit to rigorous close surveillance, good functional outcome as well as oncological control can be achieved.
Collapse
Affiliation(s)
- Marianna Zukiwskyj
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | |
Collapse
|
48
|
Glans amputation during routine neonatal circumcision: mechanism of injury and strategy for prevention. J Pediatr Urol 2013; 9:763-8. [PMID: 23137994 DOI: 10.1016/j.jpurol.2012.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Glans injury during circumcision is an uncommon yet potentially devastating complication. Its mechanism remains poorly understood. Herein we critically evaluate a case series and, based on common characteristics, hypothesize the mechanism of injury as well as means to prevent it. METHODS Retrospective review of circumcision-related glans amputation cases referred for evaluation and management, focusing on detection of common history and presentation patterns in order to evaluate possible underlying mechanisms. RESULTS A neonatal elective circumcision was conducted using a Mogen clamp and an oblique injury to the ventro-lateral aspect of the glans was noted in 6 cases referred over a 5-year period, suggesting a similar trauma pattern. The urethra was consistently involved. The amputated segments were reattached as free composite grafts in 2/6 cases. Three patients underwent delayed glansplasty months after the trauma in an attempt to restore natural symmetry and cosmesis. In one case a buccal mucosa graft was employed to rebuild the ventral coronal sulcus. CONCLUSIONS Trauma pattern suggests that the ventral glans is at high risk for injury by traction on incompletely released ventral preputial adhesions with subsequent glans entrapment. Practitioners performing neonatal circumcisions, particularly with a Mogen clamp, should exercise adequate release of ventral adhesions to prevent this complication.
Collapse
|
49
|
|
50
|
Gulino G, Sasso F, Palermo G, D’Onofrio A, Racioppi M, Sacco E, Pinto F, Antonucci M, D’Addessi A, Bassi P. Sexual outcomes after organ potency-sparing surgery and glans reconstruction in patients with penile carcinoma. Indian J Urol 2013; 29:119-23. [PMID: 23956513 PMCID: PMC3737667 DOI: 10.4103/0970-1591.114033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Radical surgery is the "gold standard" for treatment of invasive penile carcinoma but very poor aesthetic, functional and psychological outcomes have been reported. Our purpose was to assess the impact of organ potency-sparing surgery in locally confined carcinoma of the penis. MATERIALS AND METHODS We evaluated retrospectively 42 patients with early penile cancer (Ta,T1,T2), treated with glandulectomy and glanduloplasty with urethral mucosa and sparing of cavernosal apexes, or glandulectomy and limited apical resection in cases of Stage T2. Sexual function, ejaculation and libido were evaluated with an IIEF-15 questionnaire before the appearance of neoplasia (about three months before the surgery) and six months after surgery. Quality of life was evaluated by the Bigelow-Young questionnaire. The scores relating to two weeks prior to the surgery have been compared to those obtained six months after surgery. The statistical analysis was conducted using t-Student for repeated measures and analysis of variance. RESULTS Six months after surgery 73% of patients reported spontaneous rigid erections, 60% coital activity while 76% of the group treated with urethral glanduloplasty reported normal ejaculation and orgasm, regained an average of 35 days after surgery. The average IIEF-15 scores reported in the entire series in the domains of erection, libido and coital activity of the pre-cancer period were not statistically different than those recorded six months after surgery. In the group treated with glandular reconstruction, pre-and postoperative IIEF-15 mean scores related to ejaculation and orgasm domains were not significantly different. Mean scores of Bigelow-Young questionnaires related to sexual pleasure, familial, social and professional relationships showed significant improvement after surgery. CONCLUSIONS Potency sparing-sparing surgical treatments have a positive impact on a wide spectrum of the patient's life including family relationships, and social and working conditions.
Collapse
Affiliation(s)
- Gaetano Gulino
- Department of Urology, Catholic University of Rome, Italy
| | | | | | | | - Marco Racioppi
- Department of Urology, Catholic University of Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of Rome, Italy
| | | | | | | | | |
Collapse
|