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March B, Palma CA, Leslie S, Watson G, Lee P, Austin KK, Solomon M, Jeffery N. Phallus Preservation for Locally Advanced Proximal Primary Urethral Carcinoma: Technique and Outcomes. Urology 2023; 173:198-203. [PMID: 36646175 DOI: 10.1016/j.urology.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To describe a novel method of penile sparing perineal urethrectomy for locally advanced proximal primary urethral cancers (PUC). TECHNICAL CONSIDERATIONS In mid-2021, 2 cases underwent pelvic exenterative surgery for pT3 and pT4 PUC. The procedure comprised of a complete urethrectomy, proximal penectomy, en bloc pubectomy and excision of pelvic diaphragm in both cases. One case included a wide excision of scrotum, whilst the other required a prostatectomy and abdominoperineal resection of the rectum to achieve complete tumor resection. A complete R0 resection was achieved in both cases. At 6 months follow up, there is no evidence of ischemic necrosis of the penis and cosmesis is satisfactory to both patients. We provide a comprehensive operative description of both cases, together with illustrations, and discuss the underlying principles of penile preservation in the surgical treatment of locally advanced proximal PUC. CONCLUSION Complete perineal urethrectomy with phallic preservation is feasible in men with locally advanced proximal bulbar urethral cancer in the absence of tumor invasion of the penile shaft. The remnant penis survives off arterial supply from the superficial penile arteries arising from the external pudendal arteries. Phallic preservation may benefit patient's psychological quality of life post-procedure.
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Affiliation(s)
- Brayden March
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Catalina A Palma
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Geoffrey Watson
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Peter Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
| | - Kirk Ks Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
| | - Michael Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Nicola Jeffery
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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ISHII TATSU, HIRATSUKA YOSHIHARU, ABE HIRONORI, IKEDA MINORU, ARIYOSHI ASAMI. SUBCUTANEOUS PENECTOMY AND PHALLOPLASTY USING A TESTICLE FOR INVASIVE URETHRAL CARCINOMA. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65427-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- TATSU ISHII
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - YOSHIHARU HIRATSUKA
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - HIRONORI ABE
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - MINORU IKEDA
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - ASAMI ARIYOSHI
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
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Baskin LS, Turzan C. Carcinoma of male urethra: management of locally advanced disease with combined chemotherapy, radiotherapy, and penile-preserving surgery. Urology 1992; 39:21-5. [PMID: 1728791 DOI: 10.1016/0090-4295(92)90035-u] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Squamous cell carcinoma of the urethra is a rare urologic malignancy. In spite of aggressive management with radical and often times disfiguring surgery and/or radiation therapy, prognosis remains poor. Initial success in treating squamous cell carcinoma of the esophagus and anal canal has been reported with a combined radiation and chemotherapy protocol. In hopes for improving the treatment outcome for patients with squamous cell carcinoma of the urethra, we have applied the new combination chemotherapy/radiation therapy protocol. Herein, we report the successful downstaging (clinical Stage C to pathologic Stage TO) and treatment of squamous cell carcinoma of the anterior urethra with combination chemotherapy/radiation therapy. This was followed with penile-preserving surgery to document local control of disease and to avoid the morbidity of a radical disfiguring operation.
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Affiliation(s)
- L S Baskin
- Department of Urology, University of California, San Francisco
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