1
|
Croghan SM, Cullen IM, Raheem O. Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review. Sex Med Rev 2023; 11:441-459. [PMID: 37204120 DOI: 10.1093/sxmrev/qead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
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.
Collapse
Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin D02 YN77, Ireland
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
| | - Ivor M Cullen
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
- Department of Urology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Omer Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL 60637, United States
| |
Collapse
|
2
|
Firmansyah F, Prapiska FF, Siregar GP, Kadar DD, Warli SM. Evaluation of Health-Related Quality of Life in Patients Receiving Treatment for Penile Cancer: A Single-Center Cross- Sectional Study. Asian Pac J Cancer Prev 2023; 24:1367-1371. [PMID: 37116160 PMCID: PMC10352739 DOI: 10.31557/apjcp.2023.24.4.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Penile cancer is one of the uncommon types of cancer in men. The treatment could significantly impact a patient's quality of life (QOL), leading to difficulties in fulfilling life functions. METHODS This descriptive observational study aimed to describe a situation using a cross-sectional design objectively. The population of this study was all patients with a diagnosis of penile cancer who underwent therapy at the Haji Adam Malik Hospital from September 2020 to September 2021. Quality of life was assessed using EORTC QLQ-C30. RESULTS The respondents' mean age and standard deviation were 54.44 and 8.647 years, respectively. The youngest was 38 years, while the oldest age was 64 years. Most respondents had no history of circumcision (55.6%). All respondents had a poor QOL based on the 28 components in the questionnaire. This study showed that erectile function, changes in sexual function, and overall sexual function were correlated with health-related quality of life (HRQoL) post-treatment. In general, lack of sexual activity is the primary factor responsible for decreasing HRQoL in penile cancer patients. It has been reported that 70% of patients experienced a negative impact on sexuality post-treatment. CONCLUSION The quality of life in patients receiving treatment for penile cancer at RSUP H. Adam Malik, Medan, was poor. It is associated with a lack of sexual activity.
Collapse
Affiliation(s)
| | - Faurizki Febrian Prapiska
- Urology Division, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara/ H. Adam Malik Hospital Medan, Indonesia.
| | - Ginanda Putra Siregar
- Urology Division, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara/ H. Adam Malik Hospital Medan, Indonesia.
| | - Dhirajaya Dharma Kadar
- Urology Division, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara/ H. Adam Malik Hospital Medan, Indonesia.
| | - Syah Mirsya Warli
- Urology Division, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara/ H. Adam Malik Hospital Medan, Indonesia.
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara Medan, Indonesia.
| |
Collapse
|
3
|
Bowen D, Juliebø-Jones P, Somani BK. 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. World J Urol 2022; 40:2399-2410. [PMID: 36059020 DOI: 10.1007/s00345-022-04139-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Daniel Bowen
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
| |
Collapse
|
4
|
Whyte E, Sutcliffe A, Keegan P, Clifford T, Matu J, Shannon OM, Griffiths A. Effects of partial penectomy for penile cancer on sexual function: A systematic review. PLoS One 2022; 17:e0274914. [PMID: 36137121 PMCID: PMC9499284 DOI: 10.1371/journal.pone.0274914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
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 24th 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.
Collapse
Affiliation(s)
- Eleanor Whyte
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Alexandra Sutcliffe
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Philip Keegan
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Tom Clifford
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, United Kingdom
| | - Jamie Matu
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Oliver M. Shannon
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Alex Griffiths
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
| |
Collapse
|
5
|
Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. 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. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
|
6
|
Ghosh P, Chandra A, Mukhopadhyay S, Chatterjee A, Lingegowda D, Gehani A, Gupta B, Gupta S, Midha D, Sen S. Accuracy of MRI without intracavernosal prostaglandin E1 injection in staging, preoperative evaluation, and operative planning of penile cancer. Abdom Radiol (NY) 2021; 46:4984-4994. [PMID: 34189611 DOI: 10.1007/s00261-021-03194-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the performance of non-erectile MRI in staging and preoperative evaluation of penile carcinomas, compared to postoperative histopathology. METHODS In this retrospective study, MRI scans of patients who had undergone surgery for penile carcinoma (n = 54) between January 2012 and April 2018 were read by two radiologists; and disagreement was solved in the presence of a third experienced radiologist. Data necessary for preoperative evaluation and staging were collected and compared with final postoperative histology and the type of surgery performed. All MRI had been performed without intracavernosal injection of prostaglandin E1 and with IV Gadolinium, as per local protocol. RESULTS 54 patients were included in the study (mean age 57.52 ± 12.78). The number of patients with T1, T2, and T3 staging in histopathology were 32, 14, and 8. Moderate interobserver agreement was found for staging, disease-free penile length, and all subsites except urethra, which had weak agreement. Strong agreement of consensus MRI with final histopathological staging was found (49/54, weighted κ = 0.85), with high sensitivity and specificity. Sensitivity and specificity for involvement of corpus spongiosum, corpora cavernosa, and urethra were 95.5% and 93.8%, 87.5% and 97.8%, and 90.9% and 86.1%, respectively. Sensitivity (89.6%) and specificity (100%) of MRI for predicting adequate disease-free penile length were high. CONCLUSION There were acceptable interobserver agreement and good diagnostic performance of MRI for staging and preoperative assessment without intracavernosal injection, especially for higher stages and higher degrees of invasion which require more extensive surgery.
Collapse
Affiliation(s)
- Priya Ghosh
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India.
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Argha Chatterjee
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Dayananda Lingegowda
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Bharat Gupta
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| | - Sujoy Gupta
- Department of Urological Oncology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, Kolkata, West Bengal, 700160, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, 14 MAR (E-W), Rajarhat, Newtown, West Bengal, Kolkata, 700160, India
| |
Collapse
|
7
|
Garcia L, Reis LO, García-Perdomo HA. Living in a rural area as a risk factor for worst outcomes in penile cancer. Int Braz J Urol 2021; 47:1259-1263. [PMID: 34115455 PMCID: PMC8486456 DOI: 10.1590/s1677-5538.ibju.2021.99.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lina Garcia
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Leonardo O Reis
- UroScience, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,Departamento de Urologia, Pontifícia Universidade Católica de Campinas - PUC - Campinas, Campinas, SP, Brasil
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia.,Division of Urology/Urooncology. Department of Surgery. School of Medicine. Universidad del Valle. Cali, Colombia
| |
Collapse
|
8
|
de Castro RB. Editorial Comment: Erectile function after partial penectomy for penile cancer. Int Braz J Urol 2021; 47:523-524. [PMID: 33620996 PMCID: PMC7993955 DOI: 10.1590/s1677-5538.ibju.2019.0119.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rodrigo Barros de Castro
- Serviço de Urologia, Hospital Universitário Antônio Pedro - Universidade Federal Fluminense - UFF, Niterói, RJ, Brasil
| |
Collapse
|
9
|
Favorito LA. Infertility highlighted in International Brazilian Journal of Urology. Int Braz J Urol 2021; 47:479-481. [PMID: 33620993 PMCID: PMC7993941 DOI: 10.1590/s1677-5538.ibju.2021.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
| |
Collapse
|