Sexual function after partial penectomy for penile cancer

Quality of Life Evaluation after Partial Penile Amputation for Penile Cancer

BACKGROUND

Penile cancer is most prevalent in developing countries. Both the physiological and psychological consequences for the patient are critical. These consequences result from both the cancer diagnosis and the treatment's effects.

OBJECTIVE

The objective of this study was to evaluate the quality of life (QoL) of patients who have undergone partial penile amputation in terms of general well-being, sexual function, and urinary function.

MATERIALS AND METHODS

This retrospective observational study included 32 patients who underwent partial penile amputation. The european organisation for research and treatment of cancer core quality of life questionnaire (EORTC QLQ C-30) questionnaire was completed postoperatively. Erectile function and satisfaction were assessed retrospectively after partial penile amputation using the International Index of Erectile Function-15.

RESULTS

The mean age of the patients was 54.03 ± 16.02 years. The mean scores for erectile function, orgasm, sexual desire, satisfaction, and overall satisfaction were 16.28 ± 10.83, 7.50 ± 3.30, 5.72 ± 3.35, 8.84 ± 4.77, and 9.12 ± 0.83 preoperatively, and 14.03 ± 8.61, 6.88 ± 2.97, 5.72 ± 3.35, 7.94 ± 4.09, and 7.81 ± 1.00 postoperatively. Mean erectile function, orgasm, satisfaction, and overall satisfaction were significantly decreased postoperatively compared with preoperatively. Erectile function and overall satisfaction improved more in younger years from the preoperative to the postoperative period, whereas they improved less in older years.

CONCLUSION

Although partial penile amputation for penile cancer provides adequate local disease management, appropriate counseling is crucial, especially when the QoL concerns general well-being, sexual function, and urinary function.

Improving Quality of Life and Psychosocial Health for Penile Cancer Survivors: A Narrative Review

Treatment of penile cancer (PC) focuses on organ preservation, employing various surgical and non-surgical approaches. These interventions may lead to disfigurement, impacting patients' functional outcomes and psychosocial well-being. We reviewed studies related to penile health and PC up to February 2024, limited to studies published in English. Studies employing health-related quality of life (HRQoL) assessments have identified a detrimental association between aggressive treatment and overall health status, physical functioning, and relationships. In contrast, organ-sparing demonstrates improved measures related to HRQoL and sexual function. Assessment through validated questionnaires reveals diverse voiding outcomes, and varying impacts on QoL and sexual activity, emphasizing the necessity for multidisciplinary personalized care. Studies highlight substantial variations in sexual function, with patients reporting adaptations, reduced satisfaction, and concerns about body image and sexual well-being. Furthermore, unmet needs include challenges in patient-clinician communication, obtaining information, and accessing psychosocial support. Patient experiences underscore the importance of timely diagnosis, treatment access, and addressing psychological consequences. Organ-sparing approaches have higher QoL preservation and sexual function. Individualized support, including sexual therapy, support groups, and family counseling, is essential for post-treatment rehabilitation. Timely diagnosis and comprehensive care are paramount in addressing the multifaceted impact of PC on patients and families.

Multiparametric Magnetic Resonance Imaging of Penile Cancer: A Pictorial Review

The role of multiparametric magnetic resonance imaging (mpMRI) in assessing penile cancer is not well defined. However, this modality may be successfully applied for preoperative staging and patient selection; postoperative local and regional surveillance; and assessments of treatment response after oncological therapies. Previous studies have been mostly limited to a few small series evaluating the accuracy of MRI for the preoperative staging of penile cancer. This review discusses the principles of non-erectile mpMRI, including functional techniques and their applications in evaluating the male genital region, along with clinical protocols and technical considerations. The latest clinical classifications and guidelines are reviewed, focusing on imaging recommendations and discussing potential gaps and disadvantages. The development of functional MRI techniques and the extraction of quantitative parameters from these sequences enables the noninvasive assessment of phenotypic and genotypic tumor characteristics. The applications of advanced techniques in penile MRI are yet to be defined. There is a need for prospective trials and feasible multicenter trials due to the rarity of the disease, highlighting the importance of minimum technical requirements for MRI protocols, particularly image resolution, and finally determining the role of mpMRI in the assessment of penile cancer.

Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review

INTRODUCTION

Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.

OBJECTIVES

The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.

METHODS

A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.

RESULTS

Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.

CONCLUSION

OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.

Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments

Penile cancer is a rare malignancy, most commonly diagnosed in older men, associated with poor outcomes, dramatic decline in quality of life and sexual function. Squamous cell carcinoma is the most common histopathology of penile cancer, accounting for 95% of all cases. Localized, early-stage penile cancer can be effectively managed through penile-sparing techniques in many cases, though advanced stages of penile cancer carry a poor prognosis. Current innovative treatments are exploring the role of targeted therapy, HPV-directed therapy, immune checkpoint inhibitors and adoptive T-cell therapies in treatment and prevention of relapse of penile cancer. Clinical trials are investigating the potential of targeted therapies and immune checkpoint inhibitors in advanced penile cancer. This review examines the current management of penile cancer and highlights future directions in research and treatment.

Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement

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.

Multi-parametric MRI without artificial erection for preoperative assessment of primary penile carcinoma: A pilot study on the correlation between imaging and histopathological findings

Purpose

We aimed to evaluate the diagnostic potential of non-erectile multi-parametric magnetic resonance imaging (mpMRI) for preoperative assessment of primary penile squamous cell carcinoma (SCC).

Method

Twenty-five patients who underwent surgery for penile SCC were included. Preoperative mpMRI without artificial erection was performed in all patients. The preoperative MRI protocol consisted of high-resolution morphological and functional sequences (diffusion-weighted imaging and dynamic contrast-enhanced MRI perfusion) covering the penis and lower pelvis. T and N staging, according to the 8th edition of the Union for International Cancer Control TNM classification, as well as the largest diameter and thickness/infiltration depth of the primary lesions were determined in all patients. Imaging data were retrospectively collected and compared with the final histopathology reports.

Results

Very good agreement was observed between MRI and histopathology for the involvement of corpus spongiosum (p = 0.002) and good agreement was observed for the involvement of penile urethra and tunica albuginea/corpus cavernosum (p < 0.001 and p = 0.007, respectively). Good agreement was observed between MRI and histopathology for overall T staging and weaker, but still good agreement was observed for N staging (p < 0.001 and p = 0.002, respectively). A strong and significant correlation was observed between MRI and histopathology for the largest diameter and thickness/infiltration depth of the primary lesions (p < 0.001).

Conclusions

Good concordance was observed between MRI and histopathological findings. Our initial findings indicate that non-erectile mpMRI is useful in preoperative assessment of primary penile SCC.

High-Dose-Rate Brachytherapy as an Organ-Sparing Treatment for Early Penile Cancer

BACKGROUND

Low-dose-rate brachytherapy is an effective organ-sparing treatment for patients with early-stage penile cancer. However, only limited data are available on the role of high-dose-rate brachytherapy (HDR-BT) in this clinical setting.

METHODS

Between 2002 and 2020, 31 patients with early penile cancer were treated at our center with interstitial HDR BT at a dose of 18 × 3 Gy twice daily. A breast brachytherapy template was used for the fixation of stainless hollow needles.

RESULTS

The median follow-up was 117.5 months (range, 5-210). Eight patients (25.8%) developed a recurrence; of these, seven were salvaged by partial amputation. Six patients died of internal comorbidities or a second cancer. The probability of local control at 5 and 10 years was 80.7% (95% CI: 63.7-97.7%) and 68.3% (95% CI: 44.0-92.6%), respectively. Cause-specific survival was 100%. Only one case of radiation-induced necrosis was observed. The probability of penile sparing at 5 and 10 years was 80.6% (95% CI: 63.45-97.7%) and 62.1% (95% CI: 34.8-89.4%), respectively.

CONCLUSIONS

These results show that HDR-BT for penile cancer can achieve results comparable to LDR-BT with organ sparing. Despite the relatively large patient cohort-the second largest reported to date in this clinical setting-prospective data from larger samples are needed to confirm the role of HDR-BT in penile cancer.

French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer

OBJECTIVE

To update French oncology guidelines concerning penile cancer.

METHODS

Comprehensive Medline search between 2020 and 2022 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II.

RESULTS

Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organsparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial.

CONCLUSIONS

Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.

Novel portable apparatus for outpatient high-dose-rate (HDR) brachytherapy in penile cancer

BACKGROUND

Penile squamous cell carcinoma (PSC) is traditionally treated with surgical resection with significant morbidity. Penile sparing approaches, such as brachytherapy, require expertise, prolonged inpatient stays, poor patient convenience, and heterogenous plans with variable long-term toxicity. In this study, we describe the protocol for novel portable apparatus created for PSC, allowing outpatient hybrid interstitial/surface brachytherapy, improving homogeneity and patient convenience.

METHODS

A portable brachytherapy apparatus was developed utilizing a foley catheter, prostate template, 6F interstitial catheters, 5 mm bolus, and a jock strap. The apparatus allowed for internal and external catheter placement housed in a jock strap to allow mobility and defecation without affecting the implant. High-dose-rate brachytherapy was performed as an outpatient.

RESULTS

The apparatus was then used on a 62-year-old male with cT2pN0M0 (stage IIA) PSC with bilateral glans and urethral meatus involvement, who elected for definitive brachytherapy (4000cGy in 10 fractions over 5-days). Given external dwell positions, heterogeneity correction of the template was calculated (AAPM TG186) with <2% variation. Patient had minimal impact on his active lifestyle during treatment and had complete clinical response at 3-months. Grade 2 skin desquamation resolved at 2-months, with no necrosis. At 6-months, he was able to resume sexual intercourse, and at 12-months, he remained disease-free with sexual and urinary function intact.

CONCLUSIONS

Novel portable implant allows for improved patient convenience, reduced inpatient stay, capable of optimizing dosimetry with hybrid brachytherapy. This outpatient treatment allows the opportunity to increase fractionation, offering high local-control and lower toxicity. Future studies utilizing this apparatus for more fractionated regimens with further lower dose-per-fraction (∼3 Gy/fraction) is recommended.

Global outcomes and lessons learned in the management of Fournier's gangrene from high-volume centres: findings from a literature review over the last two decades

INTRODUCTION

Fournier's Gangrene (FG) carries a high mortality and morbidity with underreported short and long-term outcomes. Our aim was to perform a review of the recent literature to evaluate the short and long-term outcomes in patients with FG in the acute setting from large-scale studies.

METHODS

A PubMed search was performed between January 2000 and December 2021 for studies reporting on patients with FG. Exclusion criteria included small samples (n < 100), review articles and animal studies. Primary outcomes of interest were mortality, number of operative episodes for surgical debridement and admission to intensive care unit (ICU). Other outcomes assessed included rate of faecal and urinary diversion, orchidectomy rate, penectomy rate and length of hospital stay.

RESULTS

From a total of 1182 studies, 18 were eligible for inclusion and included in this review. In total, data were analysed from 13,903 FG patients. Mean inpatient mortality rate was 7.3% (range 4.7-40.4%). Mean number of surgical debridement operations performed was 1.8 (range 1.5-4.2). On average, 6.8% (range 3.6-50.5%) and 7% (range 1.2-53.2%) underwent faecal and urinary diversions, respectively. Mean rate of orchidectomy was 5.6%, with rate of penectomy being lower at 0.2%. The mean length of hospital stay was 18.5 days (range 13.0-26.6). On average, 17.5% (range 10.1%-67.5%) required ICU admission for at least a single-system support.

CONCLUSION

Our review from the past twenty years of literature suggests that the mortality for FG, whilst still high, has fallen compared to previous years. Whilst inpatient metrics are well-covered in the literature there is a lack of large-scale studies detailing long-term patient outcomes.

Effects of partial penectomy for penile cancer on sexual function: A systematic review

Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient portion of the penile shaft can be maintained to preserve functionality. This systematic review, which followed the PRIMSA guidelines, aimed to evaluate the effects of partial penectomy for penile cancer on sexual function—the maintenance of which is often a priority in patient groups—and to identify potential factors which may moderate these effects. A systematic search of PubMed, The Cochrane Library, and Open Grey as well as MEDLINE, CINAHL and Open Dissertations via EBSCOhost was conducted from inception through to 24^th March, 2022. Studies were required to include adults aged ≥18 years who had undergone partial penectomy for the treatment of penile cancer, with a quantitative measure of sexual function available pre- and post-surgery. Four eligible articles were identified for inclusion in this review, three of which reported a decrease in sexual function pre- to post-surgery across all domains of the International Index of Erectile Function (IIEF) questionnaire (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction). Conversely, one study reported an increase in sexual function across IIEF domains, except for orgasmic function, which decreased, pre- to post-surgery. Greater penile length was associated with higher post-operative sexual function, whilst increasing age and higher anxiety levels were associated with lower post-operative sexual function levels in one study. Despite the overall drop in sexual function, many patients were still able to maintain satisfactory sex lives following partial penectomy. Given the limited research in this area and small sample sizes across studies, additional well-controlled investigations are warranted to provide further evidence on the effects of partial penectomy for penile cancer on sexual function.

Patient reported outcomes in advanced penile cancer

OBJECTIVE

Patient reports of their symptom burden (i.e., patient-reported outcomes or PROs) have been shown to direct clinicians' ability to personalize care and improve outcomes. A disciplined assessment of PRO in the population of patients with advanced penile cancer (PeCa) has not previously been undertaken. Our center leveraged a significant cadre of patients with PeCa and a significant experience with a well-established PRO: the Edmonton Symptom Assessment Scale (ESAS).

METHODS

After IRB approval, we screened ESAS surveys of 14,781 patients completed between February 2017 and February 2021; these were collected in the Supportive Care and Radiation Oncology clinics. Of these, those with PeCa were divided into 3 cohorts: (A) Those after any partial penectomy procedure without lymph node dissection (LND); (B) Those after partial penectomy procedure with LND; and (C) Those after total penectomy and LND. Patients with recurrent disease were analyzed separately (D). ESAS scores were collated and compared both by individual symptom and cumulatively.

RESULTS

Twenty-two PeCa patients completed 122 ESAS surveys in this time and are included in this analysis: a median of 4 ESAS surveys (mean = 5, range = 1-19) were completed by each patient. The symptom with the highest median ESAS score was Tiredness (3.00). Patients with recurrent disease had the highest cumulative symptom score (median score = 30). Patients after total penectomy with LND had a higher cumulative symptom score (14.4) than those with partial penectomy and LND (7.9). Patients with partial penectomy without LND had a cumulative score of 22.

CONCLUSIONS

PROs provide an insight into the morbidity of therapies for advanced PeCa, and the most symptoms are reported by patients with recurrent disease.

Step-by-Step Guide to Surface Mold Applicator-Based Brachytherapy in a Case of Early Carcinoma Penis: An Organ-Preserving Approach

Purpose In this report we discuss an individually customized surface mold applicator technique to treat a case of early carcinoma penis. This case report is one of its kind which describes the brachytherapy treatment planning based on orthogonal X-ray technique.

Material and methods T1N0 disease with squamous cell carcinoma histology involving the foreskin of penis and abutting the glans penis was treated by surface mold applicator technique. Impression of the organ was taken using alginate. Cast was prepared from the impression using Type 4 gypsum. The acrylic mold-based applicator was fabricated on the cast. The catheters were positioned and fixed on the acrylic mold. The organ is placed in the mold-based applicator and the catheters are reconstructed on two-dimensional imaging. The brachytherapy is delivered by the 18-channel high-dose rate Oncentra brachytherapy using Ir192 source. The dose given was 45 Gy in 15 fractions, twice daily more than 6 hours apart.

Results Patient was reviewed after 6 weeks for follow-up and there was complete regression of the ulcer. At present, patient is on follow-up for the last 10 months and is now disease-free.

Conclusion With judicious patient selection, surface mold brachytherapy is an attractive alternative to the interstitial brachytherapy. It is comfortable for the patient, is easily repeatable, and is time saving in high work load and limited resource settings. Early results with this technique are promising.

What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes

Context

The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump.

Objective

To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options.

Evidence acquisition

The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included.

Evidence synthesis

The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being.

Conclusions

Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods.

Patient summary

We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.

Sexual and urinary function after organ sparing surgery for penile cancer: A questionnaire study of consecutive patients over a 3-year period in a single region

Objective:

The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function.

Method:

Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included.

Results:

A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down.

Conclusion:

Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.

Guia de cáncer de pene de la Sociedad Colombiana de Urología

El cáncer de pene tiene una incidencia de 1.11 por 100.000 habitantes en Colombia, representado en el 95% por carcinoma de células escamosas el cual representa una alta morbilidad y mortalidad, La Sociedad Colombiana de Urología realizo la adaptación de la guía de cáncer de pene para el año 2021 con revisión de la literatura, esta guía permite realizar una evaluación y tratamiento del cáncer de pene, en muchas ocasiones con el objetivo de preservación de órgano utilizando la ecografía como determinante para evaluar el compromiso de la lesión a las estructuras del pene, los estudios de extensión dependerán de hallazgos al examen físico como ganglios o compromiso local de la enfermedad, de acuerdo al tipo de lesión y su estadificación puede recibir terapia con agentes tópicos, radioterapia, cirugía láser, cirugía preservadora de órgano o penectomía total; La linfadenectomía inguinal permitirá mejorar la supervivencia en tumores de riesgo intermedio y alto (>pT1G2), posteriormente la quimioterapia adyuvante esta en el grupo de pacientes en el cual la intención sea curativa, aunque en terapia paliativa de segunda línea se encuentran los platinos y texanos como alternativa pero con pobre respuesta (<30%); los esquemas de seguimiento se realiza de acuerdo al estadio y el compromiso ganglionar. Al final se presentan los resultados de actividad sexual después de cirugía preservadora de órgano; Esta guía abarca la literatura actualizada del cáncer de pene, el cual es útil para el manejo por parte de los profesionales de salud del país.

The outcomes of glansectomy and split thickness skin graft reconstruction for invasive penile cancer confined to glans

OBJECTIVE

To report surgical, functional and patient reported outcomes(PROs) of glansectomy(GS) and split-thickness skin graft(STSG) reconstruction in case of locally invasive penile cancer(PC) MATERIALS AND METHODS: : A retrospective analysis from May 2015 to August 2019 was conducted. Inclusion criteria were age<80, a "de novo" malignancy, clinically confined PC (≤T2) with histological confirmation. Complications, recurrence-free(RFS), cancer-free(CFS) and overall survival(OS) were described. Functional outcomes and PRO's were explored using validated questionnaires and "ad hoc" created questionnaire respectively. Kaplan-Meier analysis, t-Student and the Mann-Whitney U test were used to estimate survival and postsurgical functional changes respectively.

RESULTS

34 patients were enrolled. Median follow-up was 12(IQR:12-41) months. Positive surgical margins were detected in 2.9% of cases, requiring salvage surgery.Postoperative complications occurred in 29.4%, most commonly being a graft partial loss(17.6%), meatal stenosis(5.8%) or genital wound infection(5.8%). Disease recurrence occurred in 17.6% of cases with a median elapsed time of 16 months(12-41). 12-month RFS was 88.2%, whilst CSS and OS were 91 % at the same time point. Glans sensation was preserved in 91.2% of cases. 88.2% of patients reported to be fully satisfied with the postoperative aesthetic appearance of the penis, 91.2% of patients would recommend the same procedure to someone else. Limitations include retrospective design and the lack of a control group CONCLUSIONS: : GS with STSG minimizes the impact on urinary and sexual functions without jeopardizing oncological control in locally advanced PC.

Optimal surgical margin for penile‐sparing surgery in management of penile cancer—Is 2 cm really necessary?

Introduction

Classical teaching of a 2 cm macroscopic surgical margin for surgical treatment of primary penile cancer is overly aggressive. Contemporary evidence suggests narrow but clear margins have similar survival outcomes for localized disease. This study aims to determine the oncological outcome of using a risk‐adapted algorithm to selection of macroscopic surgical margin based on biopsy grade of disease: 5 mm margin for grade 1, 10 mm margin for grade 2, and 20 mm margin for grade 3.

Methods

This is a retrospective case series of patients who underwent penile‐sparing surgery for biopsy‐proven penile SCC by a single surgeon from May 2010 through to January 2019. Clinicopathological data were extracted from medical records. Primary outcome was the positive margin rate. Secondary outcomes were overall survival (OS), cancer‐specific survival (CSS), metastasis‐free survival (MFS), and local recurrence‐free survival (RFS). Kaplan‐Meier survival analysis was used to determine survival outcomes.

Results

A total of 21 patients were included in this study. The median age was 65. Pre‐operative biopsy grade was grade 1 in 19.1% of patients, grade 2 in 47.6%, and grade 3 in 33.3%. The median size of tumor on examination was 20 mm. Using a grade‐stratified algorithm for macroscopic surgical margin, only one patient (4.8%) had a positive margin. This patient had G1T3 disease and proceeded to have a total penectomy for oncological clearance. The median margin clearance was 7 mm. The 12‐month OS, CSS, MFS, and local RFS were 94.6%, 94.6%, 81.0%, and 92.3%, respectively.

Conclusion

This study suggests that using a grade‐stratified approach to aim for a narrower macroscopic surgical margin does not appear to significantly alter the oncological outcome, with a negative margin rate of 95.2% in our this series. This enables more men to be eligible for organ preserving surgery and thereby improve their quality of life in the urinary function and sexual function domain. Larger prospective studies are warranted to confirm these findings.

Sexual function in the penile cancer survivor: a narrative review

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.

Functional and Patient Reported Outcomes Following Total Glans Resurfacing

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.

Erectile function after partial penectomy for penile cancer

PURPOSE

To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status.

MATERIALS AND METHODS

We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy.

RESULTS

A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED.

CONCLUSION

Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.

Phallus Preservation in Penile Cancer Surgery: Patient-reported Aesthetic & Functional Outcomes

OBJECTIVE

To assess patient-reported outcomes of oncoplastic penile reconstruction using standardized questionnaires. Whilst organ-preserving penile cancer surgery has evolved, aiming to preserve genital function, reduce psychological morbidity of radical penectomy, and maximise patient quality of life, few studies have evaluated patients' final perceptions.

METHODS

Following ethical approval, patients post partial/radical glansectomy with reconstruction 2016-2019, under a single surgeon, were identified. Patients were posted a modified Index of Male Genital Image, the IIEF-5, a customised questionnaire exploring outcomes of urinary and sensory function and the EORTC QLQ-C30 to complete and return. Questionnaires were nonidentifiable, however study ID linked responses to the procedure performed.

RESULTS

A total of 130 questionnaires were received from 35 patients post penile reconstruction, giving a response rate of 71.4% (35/49). Mean time from surgery was 22 months (4-51), and mean age 61 years (31-79). The majority (82.4%, n = 28) were satisfied or felt neutral about the appearance of their genitalia. High satisfaction with postprocedure urinary function was reported; 85.3% (29/34) could void from a standing position and 79.4% (27/34) reported little or no spraying of urine. Nineteen patients (55.89%) were sexually active, with mean IIEF-5 scores of 14.9 (5-25) (partial glansectomy) and 15.8 (5-25) (radical glansectomy). Mean QoL over past week on 7-point EORTC QLQ-C30 scale was 5.88 (3-7).

CONCLUSION

We report good aesthetic and functional outcomes in a unique study exploring penile cancer surgery patient-reported outcome measures. These results strongly support phallus-preserving phallic-preserving strategies as the standard of care in eligible patients undergoing penile cancer surgery.

Penile Cancer: Managing Sexual Dysfunction and Improving Quality of Life After Therapy

PURPOSE OF REVIEW

To review the most current literature on how the treatment for penile cancer can affect quality of life and to discuss current treatment options to overcome sexual dysfunction and ultimately improve patient wellbeing.

RECENT FINDINGS

Multiple medical and surgical therapies exist to address the high incidence of sexual dysfunction following penile cancer treatment. Advancements and refinements in the neophalloplasty, penile prosthesis, and penile lengthening procedures have opened the door to improved long-term outcomes. Additionally, studies continue to highlight the severe psychological toll that penile cancer treatment can have on patients. We explore the potential options for addressing the inherent psychologic effects of these treatments and highlight the need for further research in this domain. Although rare, it is important for all urologists to be familiar with the treatments and post-treatment sequelae of penile cancer. Penile cancer is associated with dramatic decline in quality of life and sexual function. Multiple medical and surgical therapies exist that addresses these concerns. Additionally, urologists must also be mindful of the psychologic component regarding surgical disfigurement and the decline in sexual function.

Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes

BACKGROUND

Local recurrence rates (LRRs) after Mohs micrographic surgery (MMS) for male genital cancers have been reported in only a few small case series, and patient-reported outcomes (PROs) have not been studied.

OBJECTIVE

To determine the LRR and PROs after MMS for male genital skin cancers.

METHODS

Retrospective review of all male genital skin cancers removed with MMS between 2008 and 2019 at an academic center. LRR was determined by chart review and phone calls. PROs were assessed by survey.

RESULTS

A total of 119 skin cancers in 108 patients were removed with MMS. Tumors were located on the penis (90/119) and scrotum (29/119). Diagnoses included squamous cell carcinoma in situ (n = 71), invasive squamous cell carcinoma (n = 32), extramammary Paget disease (n = 13), melanoma (n = 2), and basal cell carcinoma (n = 1). The LRR was 0.84% (1/119), with a mean follow-up time of 3.25 years (median, 2.36 years). The majority of survey respondents reported no changes in urinary (66%) or sexual functioning (57.5%) after surgery.

LIMITATIONS

Retrospective single-center experience; short follow-up time; low survey response rate; no baseline functional data.

CONCLUSION

MMS for male genital skin cancer has a low LRR and high patient-reported satisfaction with urinary and sexual function.

The role of penectomy in penile cancer-evolving paradigms

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.

Penile Sparing Techniques For Penile Cancer

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.

Clinical outcomes of glansectomy with split-thickness skin graft reconstruction for localized penile cancer

INTRODUCTION

Penectomy as the traditional surgical treatment of penile cancer has substantial adverse functional and psychological impact. Glansectomy with split-thickness skin graft (STSG) reconstruction aims to provide curative resection while maximizing functional outcomes and minimizing psychological harm. We describe our outcomes of glansectomy with STSG reconstruction for penile cancer in a Canadian setting.

METHODS

We identified patients undergoing glansectomy with STSG genital reconstruction for squamous cell carcinoma of the penis from July 2006 to July 2019 at a single center. Patients undergoing glansectomy for reasons other than penile cancer were excluded. We collected clinical and pathological data, including patient demographics, 90-day complications, positive margin rate, local recurrence rate, disease-specific survival, and functional outcomes. Descriptive statistics were used to characterize our cohort and to examine outcomes.

RESULTS

Twelve men met study criteria with a median age of 62 years. Seven patients had failed prior treatment. The 90-day complication rate (Clavien >2) was 0% and graft take was excellent in all cases. The positive margins rate was 16.7% (n=2). Local recurrence occurred in two patients (16.7%), one of whom underwent a repeat organ-sparing surgery for salvage, while the other underwent radical penectomy for high-risk pathological features. Disease-free survival at a median followup of 14 months was 91.7% (11/12). Standing voiding and erectile function, as well as satisfactory cosmesis, were preserved in all patients.

CONCLUSIONS

Glansectomy with STSG reconstruction is a safe and effective treatment for men with localized penile cancer with simultaneous preservation of cosmesis, as well as urinary and sexual function.

Assessment of selected quality of life domains in patients who have undergone conservative or radical surgical treatment for penile cancer: an observational study

Background Surgery is the standard treatment for organ-restricted penile cancer, but it is also a disfiguring procedure that can profoundly affect quality of life. Using a survey, in this study we assessed the effect of different surgical invasiveness on satisfaction in selected life domains of patients who underwent penile-sparing surgery and partial penectomy.

METHODS

Forty patients who underwent penile-sparing surgery (n=13) or partial penectomy (n=27) were enrolled in the study. The response rate was 71%. Information was obtained after surgery on sexuality, self-esteem, masculinity and partner relationships using the International Index of Erectile Function, the Self-Esteem Scale and the Conformity to Masculinity Norms Inventory questionnaires. We evaluated the effect of primary surgery type on selected domains of quality of life and correlations between study variables after surgery.

RESULTS

High self-esteem, satisfactory erectile function and masculinity results in both groups were comparable to those in the published literature. Men who underwent less disfiguring treatment had a significantly higher sense of masculinity than those who underwent partial penectomy (P=0.05). No significant differences were observed in erectile dysfunction and self-esteem. The level of aggressiveness of a surgical procedure was a predictor of sense of masculinity (P=0.01), but was not associated with self-esteem and sexual dysfunction (P=0.28 and P=0.55 respectively); 83% of patients were able to satisfactorily maintain partner relationships.

CONCLUSIONS

Disfiguring treatments for penile cancer significantly interfere with the sense of masculinity, but sexual functioning and self-esteem do not differ according to the type of surgical procedure. Most men maintained stable partner relationships after surgery, regardless of surgery type.

Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Introduction and objectives:

The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis.

Materials and methods:

We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates.

Results:

A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%).

Conclusions:

In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer.

Level of evidence:

Not applicable for this multicentre audit.

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

PURPOSE

To report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis.

METHODS

This was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed.

RESULTS

55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan-Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival.

CONCLUSIONS

OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.

[Psychosocial effects in patients with penile cancer : A systematic review]

BACKGROUND

Psychological stress of patients with penile cancer arises from the cancer diagnosis itself and the treatment consequences. In addition, there is cancer-specific distress. There is the chance of cure in localized stages and in those with limited regional lymph node metastases but this requires surgery and often adjuvant chemotherapy. This systematic review gives a summary of the existing literature to date.

MATERIALS AND METHODS

A critical database search using Medline was made in Ovid from 1946 to 2017, in the Cochrane Central Register of Controlled Trials (CENTRAL) and in the Web of Science from 1900 to 2017. This was complemented by a search of the World Health Organization's International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. The reference lists of the included studies were manually searched for additional references.

RESULTS

Selected studies (n = 10) addressed the psychosocial effects of penile cancer treatment on quality of life and sexual function. Due to the heterogeneity of the study designs only a narrative description of the results was possible. Defects or mutilation due to penile cancer cause psychological distress in a significant number of patients. Organ-sparing interventions have a positive impact on quality of life and sexual function.

CONCLUSION

The external genitals are a focus of sexual identity. Mutilating treatment causes significant distress but organ-sparing treatment and reconstruction positively influence quality of life.

Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship

INTRODUCTION

A common negative sequela of cancer treatment in men is sexual dysfunction, which can have a significant psychological impact and can contribute to feelings of depression, anxiety, and other mental health issues. Management of cancer survivors' psychological and mental well-being plays an important role in the treatment and recovery process.

AIM

To identify how sexual dysfunction impacts the lives of male cancer survivors and to provide clinicians with treatment recommendations specific to this patient population.

METHODS

A total of 51 peer-reviewed publications related to sexual dysfunction in male cancer survivors were selected for analysis. Sources were chosen based on relevance to current cancer therapies, causes and psychological impacts of sexual dysfunction, and treatment recommendations for clinicians caring for cancer survivors. PubMed search terms included "sexual dysfunction," "cancer survivorship," and "male cancer survivors."

MAIN OUTCOME MEASURES

Measures of sexual dysfunction were based on cancer survivors reporting inadequate erectile capacity for penetrative sexual intercourse, decreased sensitivity of the genitalia, or inability to enjoy sex.

RESULTS AND CONCLUSIONS

Sexual dysfunction was present in male cancer survivors from diverse ages, cancer diagnoses, and treatments of cancer. Many of the men surveyed presented with psychological distress resulting from their posttreatment sexual dysfunction. This had a significant negative impact on their sexual self-esteem, body image, and mental health. Sexual and social development was delayed in survivors of childhood cancer. Healthcare practitioners should initiate conversations with patients regarding the potential for sexual dysfunction at the time of cancer diagnosis and throughout treatment and follow-up. Physical symptoms of sexual dysfunction should be treated, whenever possible, using phosphodiesterase 5 inhibitors or other interventions, and all cancer survivors presenting with psychological distress related to sexual dysfunction should be offered professional counseling. Twitchell DK, Wittmann DA, Hotaling JM, et al. Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship. Sex Med Rev 2019;7:614-626.

Risk factors for the delay in the diagnosis of penile lesions: results from a single center in Italy

BACKGROUND

Early diagnosis is fundamental for the investigation and treatment of penile lesions. There is an unfortunate documented delayed in presentation and diagnosis of penile lesions. Literature is scant regarding the risk factors contributing to this delay in a Mediterranean population. Few previous reports are published in entirely different homogeneous populations. The objective of this study was to provide an analysis of the causes and risk factors related to the delay of the first medical visit in a North Italian population subgroup.

METHODS

From September 2004 to September 2017, 184 consecutive patients were treated at our institute with a surgical approach for a penile lesion. The epidemiological factors and reasons for the delay to diagnosis were recorded during personal or telephonic interviews. Univariate logistic regression models were performed to screen for an effect of the clinical and demographic variables on the delay in diagnosis. Variables with a P value <0.05 were entered into multivariate analysis, where the delay in diagnosis was the dependent variable.

RESULTS

One hundred and thirteen patients were enrolled. The average patient age was fifty-eight. The average delay between the appearance of the lesion and the first medical consultation was fifty-three days. The principal cause of delay was the lack of knowledge of penile lesions and secondly, the feeling of embarrassment of having to visit a doctor. The multivariate analysis reported a significant correlation between the level of education, sexual activity and extramarital affairs on the delay in presentation (P values respectively: 0.01, 0.009 and 0.04).

CONCLUSIONS

Patients education regarding this pathology and its potential danger is inadequate and thus it is necessary to implement a campaign of information and prevention in order to reduce delayed diagnosis.

Trends in incidence, mortality and survival of penile squamous cell carcinoma in Norway 1956-2015

We examine trends in incidence, mortality and survival of penile squamous cell carcinoma (SCC) in Norway over 60 years. Data on all cases of penile cancer diagnosed in Norway during 1956-2015 were obtained from the Cancer Registry of Norway. Trends in age-standardized rates of penile SCC incidence, mortality and 5-year relative survival were assessed by the annual percentage change statistic and joinpoint regression. A total of 1,596 penile cancer cases were diagnosed during 1956-2015, among which 1,474 (92.4%) were SCC. During 2011-2015, the age-standardized incidence and mortality of penile SCC were 0.91 (95% confidence interval (CI): 0.78; 1.05) and 0.50 (0.42; 0.60) per 100,000, respectively, and the 5-year relative survival was 61.6% (41.9; 76.4). The incidence of SCC increased during 1956-2015, with an average annual percentage change (AAPC) of 0.80% (0.46; 1.15). The increase was strongest among men diagnosed at a relatively early age (age<=64 years; AAPC: 1.47% (0.90; 2.05)). Mortality also increased over the study period (AAPC: 0.47% (0.10; 0.85)), whereas 5-year relative survival did not change (AAPC: 0.08% (-0.19; 0.36)). We conclude that the incidence of penile SCC has increased at a moderate and constant rate during 1956-2015, and that the most consistent increase occurred among younger men. Mortality also increased during the study period. However, survival did not change, thus changes in diagnostics and treatment had little impact on survival from penile SCC. Since a substantial proportion of penile SCC is caused by human papillomavirus (HPV), the incidence increase may in part be attributed to increased exposure to HPV in the population.

Penile cancer sparing surgery: The balance between oncological cure and functional preservation

Penile cancer presents the dual challenge of achieving oncological cure while ,simultaneously, attempting to preserve sexual function. Herein is a review of the issues involved in appropriate patient selection as well as surgical technique. Recommendations regarding follow up and monitoring are also provided.

Penile sparing surgical approaches for primary penile tumors: preserving function and appearance

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.

Psychosocial impact of penile carcinoma

Penile carcinoma is a rare malignancy with a potential for local invasion and regional/distant extension. Penile cancer can be cured in over 80% of cases if diagnosed early. However, local treatment, although potentially lifesaving, can be mutilating and devastating for the patient's psychological well-being. In patients with long-term survival after penile cancer, sexual dysfunction, voiding problems and cosmetic penile appearance may adversely affect the patient's quality of life. Although there is little data in the literature about psychosocial impact of penile carcinoma, organ-preserving treatment seems to allow for better quality of life and sexual function and should be offered to all patients whenever feasible.

Penile transplantation: A long way to routine clinical practice

Organ transplantation is an ideal treatment for certain late-stage diseases. With the report of a penile transplantation in Tygerberg Hospital, South Africa, this topic has, once again, aroused exploration in the field. At present, two penile transplantation operations have been performed and gained some positive results. Patients can gain void standing, erectile function and better cosmetic appearance. However, debates and potential risks still exist. Here, we briefly review the progress of studies in this filed and discusses the potential risks and debates in penile transplantation.