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Gerald T, Joshi E, Gold SA, Woldu SL, Meng X, Bagrodia A, Gaston K, Margulis V. Impact of pathologic features on local recurrence in penile squamous cell carcinoma after penectomy. Surg Oncol 2024; 54:102066. [PMID: 38581916 DOI: 10.1016/j.suronc.2024.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSCC) is a rare malignancy that may be cured in cases of local disease by resection of the primary tumor. Risk factors and patterns of local recurrence (LR) have not been well described in cases requiring partial or radical penectomy. In this study, we evaluated risk factors for LR and the impact of frozen and final margin assessment. MATERIALS AND METHODS We evaluated 119 patients with PSCC who had undergone partial or radical penectomy from 2007 to 2023. Data regarding clinical and pathologic features were collected by retrospective chart review. The primary outcome of interest was LR. Determinants of LR were analyzed by Student's t, Fisher's exact, chi-square and logistic regression analysis. Predictive statistics of frozen margin status on final margin were assessed and LR rates for subsets of frozen and final margin interaction were defined. Finally, all cases of positive margins and LR were described to highlight patterns of LR and the importance of margin status in these cases. RESULTS There were 8 (6.7%) cases of local recurrence. There were no significant predictors of LR, although a trend toward increased LR risk was observed among those with a positive final margin. Positive final margins were found in 15 (13%) cases. Frozen margin analysis was utilized in 79 cases, of which 10 (13%) were positive. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen margin status for final margins were 44%, 92%, 40%, and 93%, respectively. There were no LR among cases in which frozen margin was not sent. Analysis of all cases with positive margin and/or LR identified three subsets of patients: CIS or focally positive margin resulting in either no LR or LR managed with minimal local intervention, bulky disease in which survival is determined by response to subsequent therapy rather than local recurrence, and clinically significant local recurrence requiring continued surveillance and intervention despite negative margins. CONCLUSIONS LR is rare, even in cases of larger, proximal tumors requiring partial or radical penectomy. In this study, no statistically significant risk factors for local recurrence were identified; however, analysis of frozen and final margins provided insight into the importance of margin status and patterns of local recurrence. When feasible, visibly intra-operative negative margins are an excellent predictor of low risk for LR, and, in cases of CIS or focally positive margins, further resection to achieve negative margins is unlikely to reduce the risk of clinically significant LR. Additionally, in cases of bulky disease, the goals of resection should be focused toward palliation and next line therapy.
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Affiliation(s)
- Thomas Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eshan Joshi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samuel A Gold
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Kris Gaston
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Yudiana IW, Sugianto R, Ekawati NP, Hutauruk ES. Malignant priapism secondary from metastatic renal carcinoma: Case report: "Malignant Priapism from Kidney Neoplasm". Urol Case Rep 2023; 50:102496. [PMID: 37719182 PMCID: PMC10504526 DOI: 10.1016/j.eucr.2023.102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 09/19/2023] Open
Abstract
Malignant priapism (MP) is defined as a condition of persistent erection of the penile without sexual stimulation due to malignant cell invasion to the cavernous sinus and the efferent veins. We present a case of a man, 63 years old, with previous history of high-grade renal carcinoma pT3N0M0 had been through radical nephrectomy, diagnosed with MP secondary from metastatic renal carcinoma. The management of this case was aspiration of corpora cavernosa and distal shunting with the Al-Ghorab procedure, then continued to total penectomy and perineostomy.
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Affiliation(s)
- I Wayan Yudiana
- Department of Urology, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali, Indonesia
| | - Ronald Sugianto
- Medical Doctor Study Program, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Ni Putu Ekawati
- Department of Anatomical Pathology, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali, Indonesia
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Sigdel PR, Mahaseth N, Pokharel BM, Thapa J, Jalan A, Gharti BB, Pokharel GP, Pandey G, Nepal U, Lamichhane N. Clinicopathological characteristics of carcinoma penis over 10 years in a tertiary-level oncology center in Nepal: a retrospective study of 380 cases. Int Urol Nephrol 2023; 55:589-96. [PMID: 36454449 DOI: 10.1007/s11255-022-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This study was done to find out the clinicopathological characteristics of carcinoma penis in Nepali population and to evaluate various risk factors that predict its inguinal lymph node metastasis. METHODS A retrospective cross-sectional study was carried out at the Urology Unit, Department of Surgical Oncology at BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Case notes of biopsy-proven penile cancer, from January 2012 to December 2021, who underwent some form of surgical intervention were included. RESULTS A total of 380 patients were included in the study. The mean age of the patients was 55.92 ± 13.81 years. At presentation, 78.5% had clinically node-positive disease. The most common treatment for the primary tumor was partial amputation of the penis (74.2%). Bilateral inguinal lymph node dissections were done in 370 cases. The most common histology was the usual SCC in 94.2% of cases and 69% were well differentiated. T3 was the most common staging in 49.4% cases. Pathologically nodal negative status was found in 58% cases. In univariate analysis, factors like duration of symptoms (≥ 6 months), high-risk histopathology (basaloid/sarcomatoid variant), increased T-stage, poorly differentiated tumor, and the presence of PNI or LVI were significantly associated with lymph node metastasis. CONCLUSIONS Penile cancer is a common cancer in developing countries such as Nepal. The majority of the patients present late. Early recognition and prompt treatment are required to improve the overall outcome.
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Chaker K, Ouanes Y, Rinchi M, Cherni N, Bibi M, Dali KM, Nouira Y. Penile gangrene due to improper application of a condom catheter: a case report. J Med Case Rep 2023; 17:30. [PMID: 36717875 PMCID: PMC9887821 DOI: 10.1186/s13256-023-03771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fournier's gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall. CASE PRESENTATION We describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock. CONCLUSION Use of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary.
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Affiliation(s)
- Kays Chaker
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Yassine Ouanes
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Makram Rinchi
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Nizar Cherni
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Mokhtar Bibi
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Kheireddine Mrad Dali
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
| | - Yassine Nouira
- grid.414198.10000 0001 0648 8236Department of Urology, La Rabta Hospital, Bab Saadoun, Tunis, Tunisia
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Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, Camparo P, Fléchon A, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer. Prog Urol 2022; 32:1010-1039. [PMID: 36400476 DOI: 10.1016/j.purol.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital Européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, Boulevard Sainte Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Wibowo E, Wong STS, Wassersug RJ, Johnson TW. Paraphilic Sexual Attraction to Males Without Genitals Is Associated with Traumatic Childhood Experience, Body Image, and Thoughts/Behaviors Related to Genital Ablation. Arch Sex Behav 2022:10.1007/s10508-022-02427-z. [PMID: 36222942 DOI: 10.1007/s10508-022-02427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/11/2022] [Accepted: 09/10/2022] [Indexed: 05/12/2023]
Abstract
In rare cases, some male individuals are sexually attracted to men who have their genitals removed. We investigate here if paraphilic attraction to men without genitals was associated with childhood experience, body image, and thoughts/behaviors related to body modification. An online survey, consisting of both validated questionnaires and questions developed by our team, was launched on the Eunuch Archive and MTurk websites. Out of 875 participants, 48.5 and 32.2% reported being attracted to males without testicles or without a penis, respectively; 49.7 and 31.0% felt they would themselves be attractive without testicles and without a penis, respectively. In terms of body modification, many reported having tattoos (19.0%) and piercings (26.1%). About half (48.3%) had played as children with male action figures without genitals, i.e., GI Joe, and Ken dolls. Additionally, some participants reported having: (1) witnessed animal castration (23.7%); (2) having been threatened with castration during their childhood (11.9%); (3) receiving genital injuries inflicted by others (11.0%); (4) pretending to be castrated (60.2%); (5) thinking of self-castration (54.2%); or (6) injuring their own penis (23.4%). Having received genital injuries inflicted by others was associated with attraction to males without testicles (OR = 1.997, p < .05), but not for attraction to males without a penis. Paraphilic attraction to males without genitals (i.e., castrated or penectomized) was associated with feeling attractive without genitals, having pretended to be castrated, considering self-castration, and having injured one's own penis. In conclusion, paraphilic attraction to males without genitals may be associated with traumatic early life events, body image, and desire for one's own genital ablation.
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Affiliation(s)
- Erik Wibowo
- Department of Anatomy, University of Otago, 270 Great King St., Dunedin, 9016, New Zealand.
| | - Samantha T S Wong
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Thomas W Johnson
- Department of Anthropology (Emeritus), California State University, Chico, CA, USA
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Kawai Y, Banshodani M, Moriishi M, Shizukawa H, Sato T, Shintaku S, Masaki T, Kawanishi H. Penile calciphylaxis in patients with end-stage kidney disease undergoing dialysis: invasive treatment and pain management. Ther Apher Dial 2022; 26:950-959. [PMID: 34984854 DOI: 10.1111/1744-9987.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Penile calciphylaxis is rarely reported in dialysis patients. METHODS We experienced cases of dialysis patients who had penile calciphylaxis between 2003 and 2020. RESULTS Seven patients undergoing dialysis were treated for penile necrosis (hemodialysis [HD], 5; peritoneal dialysis [PD], 1; hybrid therapy comprising PD and HD, 1). Their mean age was 62.8 years and their mean dialysis vintage 116.1 months. All had severe penile pain and were clinically diagnosed with calciphylaxis. Four received partial penectomy and three received percutaneous transluminal angioplasty (PTA) due to rapid aggravation. The number of analgesia types and the critical-care pain observation tool score significantly decreased after invasive treatment (both, P = 0.008). The 90-day and 1-year survival rates after onset were 85.7% and 57.1%, respectively. CONCLUSION In dialysis patients, penile calciphylaxis has poor prognosis; however, invasive treatments for pain management are effective. PTA may be beneficial in dialysis patients in poor condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yusuke Kawai
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Masataka Banshodani
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Misaki Moriishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Hiroko Shizukawa
- Dermatology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Tomoyasu Sato
- Radiology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Sadanori Shintaku
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Hideki Kawanishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
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Sakuma T, Shinohara S. Total penectomy in a hemodialysis-dependent patient: Calciphylaxis-induced penile gangrene. Urol Case Rep 2021; 39:101865. [PMID: 34646738 PMCID: PMC8496090 DOI: 10.1016/j.eucr.2021.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 10/29/2022] Open
Abstract
Penile gangrene secondary to calciphylaxis is rare. A case of gangrene of the penis in a chronic renal failure patient is reported. Extensive vascular calciphylaxis was observed within the penis. A 76-year old man with history of four year-course of hemodialysis complained of pain in the glans penis and subsequent swelling of the penile shaft. Coagulation necrosis of the glans and elevated serum inflammation markers suggested penile infection. As conservative therapies were ineffective, penectomy was performed to prevent systemic sepsis. In the cross sections of the amputated penis, the disease progression from wet gangrene to coagulation necrosis was clearly demonstrated.
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Affiliation(s)
- Takahiko Sakuma
- Department of Laboratory Medicine, Atsumi Hospital, Aichi, Japan
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Gomes Torres JH, Neves Ribeiro SC, Carvalho de Souza I, Fernandes de Almeida Hellebrandt MC, Budib LJ, Freitas Filho LG. Penile necrosis and calciphylaxis. Urol Case Rep 2021; 39:101770. [PMID: 34285881 PMCID: PMC8273354 DOI: 10.1016/j.eucr.2021.101770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
Penile necrosis is an uncommon condition associated, in most cases, with calciphylaxis, also known as calcific uremic arteriolopathy. It is a progressive disease found in approximately 1%–4% of patients with end stage renal disease. Patients with penile calciphylaxis present a mortality rate of up to 70%, with life expectancy of two-and a half months following the diagnosis. We report a severe calciphylaxis case that had to be submitted to a penectomy but survived the penile event.
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Affiliation(s)
| | | | | | | | - Luiz J Budib
- Department of Urology, Hospital Santa Marcelina, Brazil
| | - Luiz G Freitas Filho
- Department of Pediatric Urology, Universidade Federal de São Paulo, Hospital Santa Marcelina, São Paulo, Brazil
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10
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Harju E, Pakarainen T, Vasarainen H, Törnävä M, Helminen M, Perttilä I, Kaipia A. Health-Related Quality of Life, Self-esteem and Sexual Functioning Among Patients Operated for Penile Cancer - A Cross-sectional Study. J Sex Med 2021; 18:1524-31. [PMID: 34305021 DOI: 10.1016/j.jsxm.2021.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Penile cancer surgery affects physical, psychological, and sexual well-being, but the patient- and treatment-related factors predisposing to worse health-related quality of life (HRQoL) have not been well characterized. AIM We report treatment-related HRQoL changes among penile cancer survivors compared to the general population and the specific deficits that have the most profound effect, and we identify patient-related factors that predispose to a worse perceived HRQoL. METHODS Patients (n = 107) who underwent operations for invasive penile cancer in two Finnish university hospitals from 2009 to 2019 were sent the Patient Reported Outcomes (PROs) questionnaire designed to measure HRQoL, self-esteem, overall sexual functioning, erections, and change in sexual function. We collected clinical information and socio-demographic characteristics, including age, partner status, children, vocational education, and employment status. Associations between patient- and treatment-related factors and HRQoL were analyzed using descriptive statistics and non-parametric tests. Linear regression models were used to compare the HRQoL differences between patients with penile cancer and the age-standardized average for the Finnish population. OUTCOMES A generic measure of HRQoL (15D), the Rosenberg Self-Esteem Scale, Overall Sexual Functioning Questionnaire, the Erection Hardness Score, and self-reported change in sexual functioning. RESULTS Low scores in overall sexual functioning, erectile function, and changes in sexual functioning were associated with a lower HRQoL. An association was found between HRQoL and age, educational level, employment status, and place of residence. The HRQoL had a negative correlation with age. Patients with a high educational level, who were employed, or who lived in urban areas reported higher HRQoL. The mean HRQoL of penile cancer survivors was significantly lower than the age-standardized average HRQoL of the Finnish population. CLINICAL IMPLICATIONS Enhanced support and counseling is needed among penile cancer patients to improve the HRQoL during survivorship. STRENGTHS & LIMITATIONS A nationwide sample with detailed information allowed comparisons of HRQoL between penile cancer patients and the general population. Due to cross-sectional nature of the study, the time between the surgery and the study intervention was heterogeneous, and this may have affected the results. CONCLUSION Penile cancer patients exhibit significant physical and psychological dysfunction, and the lack of sexual activity in general is what most compromises the QoL of penile cancer survivors. Harju E, Pakarainen T, Vasarainen H, et al. Health-Related Quality of Life, Self-esteem and Sexual Functioning Among Patients Operated for Penile Cancer - A Cross-sectional Study. J Sex Med 2021;18:1524-1531.
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Masterson TA, Tagawa ST. A 25-year perspective on advances in an understanding of the biology, evaluation, treatment and future directions/challenges of penile cancer. Urol Oncol 2021; 39:569-576. [PMID: 34219002 DOI: 10.1016/j.urolonc.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
Squamous cell carcinoma of the penis (SCCP) is uncommon in some countries (including the U.S.), but is an important malignancy elsewhere. As a rare disease, progress has been slow compared to more common tumor types discussed in this anniversary issue and most often limited to single-center or retrospective datasets. In this section we describe developments leading to the current standard approach with current research questions.
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Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Scott T Tagawa
- Division of Hematology & Medical Oncology, Department of Medicine and Department of Urology, Weill Cornell Medicine, New York, NY.
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Savoie PH, Morel-Journel N, Murez T, Ferretti L, Rocher L, Fléchon A, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: penile cancer]. Prog Urol 2021; 30:S252-S279. [PMID: 33349426 DOI: 10.1016/s1166-7087(20)30753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE - To update French oncology guidelines concerning penile cancer. METHODS - Comprehensive Medline search between 2018 and 2020 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 organ-sparing 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.
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Affiliation(s)
- P-H Savoie
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, Cedex 09, France.
| | - N Morel-Journel
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, Cedex 5, France
| | - L Ferretti
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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de Vries HM, Chipollini J, Slongo J, Boyd F, Korkes F, Albersen M, Roussel E, Zhu Y, Ye DW, Master V, Le TL, Johnstone PA, Muneer A, Brouwer OR, Spiess PE. Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience. Urol Oncol 2021; 39:500.e9-500.e13. [PMID: 34134926 DOI: 10.1016/j.urolonc.2021.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Perineal urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally-advanced or anatomically unfavorable penile cancer (PC) requiring total penectomy. Here, we report post-operative PU-related complications and PU stenosis rates after total penectomy with PU in a large multicenter cohort of PC patients. METHODS We retrospectively reviewed the medical records of 299 patients who underwent PU as a means of urinary diversion for primary PC across seven international centers from 2000 to 2020. The Clavien-Dindo grading system was used to record 30-day post-operative complications. Cumulative incidence of stenosis was evaluated using the Kaplan-Meier method. RESULTS Median patient age was 67 years (interquartile range (IQR) 58-74), and median follow-up was 19 months (IQR 7.2-57). A total of 58 patients (19%) developed a 30-day post-operative complication, of which 45 (79%) were deemed minor (CD Grade I and II). Wound infection (11%; CD grade I-III) and dehiscence (4.0%; CD grade I-III) were the more common complications. The overall incidence of stenosis was 12% (35/299 patients), of which 26 (74%) needed surgical revision (probability of stenosis revision at one year of 9.3%, median time until the revision: 6.1 months (IQR 3.0-13)). Only two stenoses were seen after two years of follow-up. CONCLUSION We present the most extensive series of PU in the management of PC to date. Wound infections of the primary surgical site were the most common complication. Stenosis occurred mostly within one and a half years after treatment.
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Anderson S, Breen KJ, Davis NF, Deady S, Sweeney P. Penile cancer in Ireland - A national review. Surgeon 2021; 20:187-193. [PMID: 34034967 DOI: 10.1016/j.surge.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Penile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first national review and to evaluate clinicopathological factors affecting survival. SUBJECTS AND METHODS All cases of penile cancer in Ireland between 1995 and 2010 were identified through the National Cancer Registry Ireland (NCRI) and analysed to identify factors affecting survival. RESULTS 360 cases of penile cancer were identified, with a mean age at diagnosis of 65.5 years and 88% (n = 315) of cases occurred in those over 50. 91% (n = 328) of cases were squamous cell carcinomas (SCC). The majority of patients were treated surgically (n = 289), with 57% (n = 206) and 24% (n = 87) undergoing partial penectomy and total penectomy respectively. Only 18% (n = 65) received radiotherapy, and 8% (n = 27) received chemotherapy. Mean overall survival (OS) was 113 months, and five year disease specific survival (DSS) was 70% (95%CI: 59.1-77.8%). Age at diagnosis, nodal status and presence of metastatic disease were independent prognostic markers on multivariate analysis. CONCLUSION This study represents the first national review of penile cancer in Ireland. The annual incidence and survival rates are comparable to European figures, though superior DSS has previously been reported from our institution, highlighting the role for centralisation of care in Ireland. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- S Anderson
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
| | - K J Breen
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
| | - N F Davis
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
| | - S Deady
- National Cancer Registry of Ireland, Ireland
| | - P Sweeney
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
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Abstract
Disorders of sexual development (DSD) have been documented throughout human history with fascination. Healers of all cultures have struggled to explain, and later correct with surgery, the physical manifestations of DSD. DSD was portrayed in the mythology, legends, and art of the ancient Greeks, Romans, Sumerians, Babylonians, and Egyptians. Techniques of feminizing genitoplasties date to the time of Celsus in the time of Christ. Acceptable operative therapy for feminine phenotypes of DSD came in the 19th and 20th centuries. Masculinizing procedures, inherently more complex than feminizing genitoplasties, initially were variations of procedures for severe forms of hypospadias. Today most total penile reconstruction procedures use reconstructive and microvascular techniques invented in 20th century.
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Martz N, Bodokh Y, Gautier M, Thamphya B, Schiappa R, Lam Cham Kee D, Chevallier D, Hannoun A, Chand ME, Hannoun-Levi JM. High-dose rate brachytherapy in localized penile cancer: 5-Year clinical outcome analysis. Clin Transl Radiat Oncol 2021; 27:89-95. [PMID: 33537466 DOI: 10.1016/j.ctro.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Penile cancer is a rare tumor. The organ preservation perspective makes the treatment challenging. For early stage, conservative brachytherapy achieved excellent oncological outcome. Conservative brachytherapy reported encouraging functional results. HDR brachytherapy represents an attractive therapeutic option.
Purpose To analyze the oncological outcome and toxicity profile after conservative treatment based on multicatheter interstitial high-dose rate brachytherapy (MHB) for patients presenting a localized penile cancer. Materials and methods Patients with histologically proven, non-metastatic (T1-T2 N0-N2 M0) localized penile cancer were treated with MHB. Needles were placed under general anesthesia into the target volume using a dedicated template. Treatment planning was performed using a post-implant CT-scan to deliver 35 Gy or 39 Gy (9f, 5d) for adjuvant or definitive treatment respectively. Five-year oncological outcome was evaluated with local relapse-free (LRFS), regional relapse-free (RRFS), and metastasis-free survival (MFS), specific (SS) and overall survival (OS). In pre-treatment and follow-up consultations, skin, urinary and sexual toxicities were investigated using CTCAEv4.0 classification, International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5-items (IIEF-5). Dosimetry data were also analyzed. Results From 03/2006 to 05/2020, with a median follow-up of 72.4 months [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], 29 pts, mainly T1 (75.9%) and N0 (89.7%), underwent MHB. Eleven (38%) and 18 pts (62%) received MHB as adjuvant or definitive treatment respectively. Five-year LRFS, RRFS, MFS, SS and OS were 82%, 82%, 89%, 88% and 73% respectively. Six patients (20.7%) experienced local relapse and underwent salvage penectomy leading to a penile preservation rate of 79.3%. Acute skin toxicity was reported 1 month after MHB, with 28% G1, 66% G2 and 6% G3. Late skin complications were telangiectasia for 5 pts (17%) and necrosis for 3 pts (10.3% requiring hyperbaric oxygen therapy). Comparing pre- and post-treatment status, no significant change was observed for skin appearance, IPSS and IIEF-5. Conclusion MHB represents an efficient first line conservative treatment option for early penile cancers. Oncological outcome and late toxicity profile appear encouraging. However, larger-scale cohorts with longer follow-up are needed to more accurately precise the features of the best candidate to MHB.
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Key Words
- ABS, American Brachytherapy Society
- Brachytherapy
- CCAFU, Cancer Committee of the French Association of Urology
- CT, computerized tomography
- CTCAE, common terminology criteria for adverse events
- CTV, clinical target volume
- Conservative treatment
- DFS, disease-free survival
- DNR, dose non-homogenity ratio
- EAU, European Association of Urology
- EBRT, external beam radiotherapy
- EQD2, equivalent dose in 2Gy fractions
- GC-SFRO, Groupe Curiethérapie/Société Française de Radiothérapie Oncologique
- GEC-ESTRO, Groupe Européen de Curiethérapie/European Society for Therapeutic Radiation and Oncology
- HDB, high-dose brachytherapy
- IIEF, international index of erectile function
- IPSS, international prostate symptom score
- LC, local control
- LDR, low-dose rate
- MDFS, metastatic disease-free survival
- MFU, median follow-up
- MHB, multicatheter interstitial high-dose rate brachytherapy
- MMS, Mohs micrographic surgery
- MRI, magnetic resonance imaging
- NCCN, national comprehensive cancer network
- OS, overall survival
- PDR, pulse-dose rate
- PET, positron emission tomography
- PP, penile preservation
- Penectomy
- Penile cancer
- RC, regional control
- SCC, squamous cell carcinoma
- SFRO, Société Française de Radiothérapie Oncologique
- SS, specific survival
- TNM, tumor node metastasis
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Adler K, Flores V, Kabarriti A. Penile calciphylaxis: A severe case managed with partial penectomy. Urol Case Rep 2020; 34:101456. [PMID: 33102133 PMCID: PMC7578200 DOI: 10.1016/j.eucr.2020.101456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/26/2022] Open
Abstract
Penile calciphylaxis, a rare manifestation of calcific uremic arteriolopathy, is infrequently reported in the literature. Surgical management has demonstrated similar outcomes as conservative management in terms of mean survival time. Therefore, the benefits of surgical intervention for this disease remain controversial. In this report, we present a case of penile calciphylaxis in a hemodialysis-dependent patient with end stage renal disease (ESRD). The interest of this case lies in the severity of illness on initial presentation, which precluded the possibility of conservative management and necessitated penectomy as a means of halting disease progression and improving patient quality of life.
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Affiliation(s)
- Kerry Adler
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Viktor Flores
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Abdo Kabarriti
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
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Kouiss Y, Aynaou M, Houmaidi AE, Mhanna T, Ahmed Y, Ouraghi A, Miri A, Bennani A, Barki A. Penile necrosis by calciphylaxis leading to gangrene in a patient with chronic renal failure on dialysis: A case report. Int J Surg Case Rep 2020; 71:187-191. [PMID: 32470914 PMCID: PMC7533627 DOI: 10.1016/j.ijscr.2020.04.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Penile necrosis by calciphylaxis is a rare disease. The diagnosis of CUA is often difficult. The Management of this rare condition is still a matter of debate.
Introduction Penile calciphylaxis is a rare disease whose diagnosis is not easy. It is associated with chronic renal failure. It is a result of media calcification and blood vessels’ fibrosis such as penile arteries that eventually lead to gangrene formation in extremities and penis. Calcific uremic arteriolopathy is commonly associated with secondary hyperparathyroidism and high level of calcium and phosphate. Presentation of case In this paper, we report a case of penile necrosis induced by calciphylaxis associated with chronic renal failure and diabetic macroangiopathy. We performed a partial and total amputation in two stages because of the wound infection. The patient died one week after a total penectomy. Discussion The skin biopsy is the gold standard for the diagnosis despite being a risky process. In most cases, appropriate medical management is advocated. The treatment of this pathology is still controversial. Conclusion The management of this rare situation is controversial, and its diagnosis is still difficult due to the scarcity of reported cases.
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Affiliation(s)
- Youssef Kouiss
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco.
| | - Mohammed Aynaou
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Amine El Houmaidi
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Tarik Mhanna
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Yacoub Ahmed
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | | | - Achraf Miri
- Department of Pathology, Mohamed VI University Hospital, Oujda, Morocco
| | - Amal Bennani
- Department of Pathology, Mohamed VI University Hospital, Oujda, Morocco
| | - Ali Barki
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
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Cassell A, Yunusa B, Manobah B, Wambo D. Management guidelines of penile cancer- a contemporary review of sub-Saharan Africa. Infect Agent Cancer 2020; 15:26. [PMID: 32377231 PMCID: PMC7195778 DOI: 10.1186/s13027-020-00293-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penile cancer is a rare malignancy with prevalence higher in areas of high Human Papilloma Virus (HPV) such as Africa, Asia and South America. In middle- and low-income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. MAIN BODY OF THE ABSTRACT A literature review was conducted from 1992 to 2019 using PubMed, Google Scholar, African Journal Online and Google with inclusion of 27 publications with emphasis on the Sub-Saharan literature. Findings revealed that most men with penile cancer in Sub-Saharan Africa (SSA) present with locally advanced to advanced disease with devastating consequences. The option of penile sparing procedure is reduced with most treatment option directed to mutilating surgeries. The lack of appropriate chemotherapy and radiotherapy worsens the prognosis in the region. SHORT CONCLUSION Human Papilloma Virus (HPV) vaccination may not be cost-effective for most regions in SSA. Therefore, early childhood circumcision might be the best advocated alternative for prevention.
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Affiliation(s)
- Ayun Cassell
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Bashir Yunusa
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Burgess Manobah
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Desire Wambo
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
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Wibowo E, Wong STS, Wassersug RJ, Johnson TW. Characteristics of Males Who Obtained a Voluntary Penectomy. Arch Sex Behav 2020; 49:793-803. [PMID: 31845147 DOI: 10.1007/s10508-019-01607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 05/12/2023]
Abstract
We report here on survey data from 11 genetic males, who had voluntary penectomies without any explicit medical need, yet did not desire testicular ablation. This group was compared to a control group of men who completed the same survey but had no genital ablation. The penectomy group was less likely to identify as male than the control group. They were also more likely to have attempted self-injury to their penis (at a median age of 41.5 years), been attracted to males without penises, and felt that they were more physically attractive without a penis than the controls. Motivations for voluntary penectomy were aesthetics (i.e., a feeling that the penile removal made them more physically attractive) or eroticism (i.e., at least two individuals thought that a penectomy would make them a better submissive sexual partner). In terms of sexual function, the penectomized and control groups reported comparable sexual function, with six penectomized individuals claiming to still be able to get and keep an erection, suggesting possible incomplete penile ablation. In their childhood, penectomized individuals were more likely than the controls to have pretended to be castrated and to have involved the absence of genitals of their toys in their childhood play. We discuss characteristics and sexual outcomes for individuals who have had a voluntary penectomy. A future study with a larger sample size on men who desire penectomies is warranted.
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Affiliation(s)
- Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Samantha T S Wong
- Department of Educational & Counselling Psychology, McGill University, Montreal, PQ, Canada
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Thomas W Johnson
- Department of Anthropology, California State University-Chico, Chico, CA, 95929, USA.
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Savoie PH, Fléchon A, Morel-Journel N, Murez T, Ferretti L, Camparo P, Rocher L, Sèbe P, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020: tumeurs du pénis French ccAFU guidelines — Update 2018—2020: Penile cancer. Prog Urol 2018; 28:S131-S146. [PMID: 30361138 DOI: 10.1016/j.purol.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.008.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.008.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Suarez-Ibarrola R, Cortes-Telles A, Miernik A. Health-Related Quality of Life and Sexual Function in Patients Treated for Penile Cancer. Urol Int 2018; 101:351-357. [PMID: 30149391 DOI: 10.1159/000491827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the impact of primary surgery, partial and total penectomy, and of inguinal lymphadenectomy on health-related quality of life (HRQoL) and the sexual function of penile cancer patients. MATERIALS AND METHODS We invited 15 patients surgically treated for penile cancer in the Regional Hospital of Specialized Medicine of the Yucatan Peninsula between 2012 and 2016 to complete the SF-36 quality of life and International Index of Erectile Function (IIEF-5) sexual function questionnaires. We evaluated the impact of primary surgery type and inguinal lymphadenectomy on the outcome of HRQoL and sexual function. RESULTS A total of 10 patients (66%) completed the SF-36 questionnaire. Surgery type and extent of resection were overall not associated significantly with worse outcomes on the assessed domains of quality of life. However, men treated with partial penectomy reported significantly more pain (p = 0.0547) than men treated with total penectomy. Similarly, men who underwent lymphadenectomy reported significantly more pain (p = 0.0547) than those who were spared from the procedure due to the -primary tumor´s stage and grade. Sexual function was severely affected (IIEF mean = 6.5) in patients treated with partial penectomy. CONCLUSIONS Although partial penectomy and lymphadenectomy were significantly associated with more postoperative pain, no differences were observed in other HRQoL domains. Sexual function was severely affected in patients treated with partial penectomy.
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Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology, University of Freiburg Medical Center, Faculty of Medicine, Freiburg, Germany
| | - Arturo Cortes-Telles
- Department of Pulmonary Physiology, Regional Hospital of Specialized Medicine of the Yucatan Peninsula, Yucatán, Mexico
| | - Arkadiusz Miernik
- Department of Urology, University of Freiburg Medical Center, Faculty of Medicine, Freiburg, Germany
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Coelho RWP, Pinho JD, Moreno JS, Garbis DVEO, do Nascimento AMT, Larges JS, Calixto JRR, Ramalho LNZ, da Silva AAM, Nogueira LR, de Moura Feitoza L, Silva GEB. Penile cancer in Maranhão, Northeast Brazil: the highest incidence globally? BMC Urol 2018; 18:50. [PMID: 29843769 PMCID: PMC5975591 DOI: 10.1186/s12894-018-0365-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/14/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The objectives of this study were to determine the minimum incidence of penile cancer in the poorest Brazilian state, and to describe the epidemiologic and clinical characteristics of patients diagnosed with the disease. METHODS A retrospective study of 392 patients diagnosed with penile cancer in the three most important referral center in the state was conducted during 2004-2014. RESULTS The age-standardized incidence was 6.15 per 100,000 and the crude annual incidence was 1.18 per 100,000. More than half (61.1%) of the tumors were histological grades 2 and 3, and 66.4% of tumors were classified as at least stage T2. The average age of patients was 58.6 ± 15.7 years (range, 18 to 103 years), with 20.8% of patients ≤40 years of age at diagnosis. The vast majority underwent penectomy (93%). Only 41.8% underwent lymphadenectomy, 58 patients (14.8%) received chemotherapy, and 54 patients (13.8%) received radiotherapy. Stage 3/4 and vascular invasion were statically significant at disease-free survival analysis. CONCLUSION The state of Maranhão has the highest incidence of penile cancer in Brazil and globally. Tumors are locally advanced and at the time of diagnosis, and there is a high frequency among young individuals. Patients have a low socioeconomic status, making it difficult to complete treatment and receive appropriate follow-up.
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Affiliation(s)
| | - Jaqueline Diniz Pinho
- Federal University of Pará, Brazil, Gov. José Malcher Avenue, Belém, 66055-260, Brazil
| | - Janise Silva Moreno
- Aldenora Bello Cancer Hospital, Seroa da Mota Street, Apeadouro, São Luís, 65031-630, Brazil
| | | | | | - Joyce Santos Larges
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil
| | - José Ribamar Rodrigues Calixto
- Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil
| | - Leandra Naira Zambelli Ramalho
- Department of Radiology and Pathology, Ribeirão Preto Medical School of University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, 14049-900, Brazil
| | - Antônio Augusto Moura da Silva
- Public Heath Departament, Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
| | | | - Laisson de Moura Feitoza
- Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
| | - Gyl Eanes Barros Silva
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil.
- Department of Radiology and Pathology, Ribeirão Preto Medical School of University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, 14049-900, Brazil.
- Ribeirão Preto Medical School - USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
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24
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Yang TY, Wang TY, Chen M, Sun FJ, Chiu AW, Chen YH. Penile Calciphylaxis in a Patient with End-stage Renal Disease: A Case Report and Review of the Literature. Open Med (Wars) 2018; 13:158-163. [PMID: 29756051 PMCID: PMC5941707 DOI: 10.1515/med-2018-0025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/19/2018] [Indexed: 11/15/2022] Open
Abstract
Penile calciphylaxis is a rare cause of penile gangrene that presents in patients with end-stage renal disease. The rates of comorbidity and mortality of penile calciphylaxis are extremely high. Unlike other penile gangrene, such as Fournier's gangrene, the benefit of aggressive surgical therapy is controversial. Here we present a case of penile calciphylaxis in a 43-year-old man with end-stage renal disease on hemodialysis. He received total penectomy but died due to multisystem complications 2 weeks after surgery. We review the literature on the management options and outcomes in patients with penile calciphylaxis.
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Affiliation(s)
- Ti-Yuan Yang
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tao-Yeuan Wang
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Allen W. Chiu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hsin Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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25
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate the trends in multidisciplinary management of localized penile cancer and systemic therapy for advanced disease in the evolving era of targeted and immune checkpoint therapy. RECENT FINDINGS Organ preservation (surgical or incorporating radiation) and reconstructive techniques are important considerations for quality of life in penile cancer survivors. Although local recurrence may be higher with organ preservation, salvage therapy appears successful. Inguinal and pelvic node management requires multidisciplinary care, including chemotherapy; optimal use of radiation has not been fully defined. Advanced in understanding the biology of penile cancer, particularly with regard to epidermal growth factor receptor (EGFR) and HPV status, have led to clinical trials of targeted and immune therapy for patients with refractory disease. Refinements in the management of penile cancer are occurring, though level 1 evidence remains scarce. Referral to specialized centers will facilitate successful completion of clinical trials to advance standard care in this disease.
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26
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Kamel MH, Tao J, Su J, Khalil MI, Bissada NK, Schurhamer B, Spiess PE, Davis R. Survival outcomes of organ sparing surgery, partial penectomy, and total penectomy in pathological T1/T2 penile cancer: Report from the National Cancer Data Base. Urol Oncol 2017; 36:82.e7-82.e15. [PMID: 29153943 DOI: 10.1016/j.urolonc.2017.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/14/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the survival outcomes of organ sparing surgery (OSS), partial penectomy (PP), and total penectomy (TP) in pathological stage pT1/pT2 penile cancer (PC) as reported in the United States National Cancer Data Base. METHODS Patients with pT1/pT2 PC, treated with surgery as their primary treatment modality were classified into 3 groups according to the type of surgery into OSS, PP, and TP. Patient and tumor characteristics of the groups were compared using bivariate analysis, and Cox- proportional hazard model was used for survival analysis. RESULTS A total of 4,238 patients were examined. There were 1,211, 2,360, and 584 patients in the OSS, PP, and TP groups, respectively. In 83 patients, the type of surgery was missing. The 5- and 10-year overall survival rates for OSS, PP, and TP were 88% and 74% vs. 85% and 72% vs. 79% and 63%, respectively (P ≤ 0.001). In addition, in a multivariable model for predictors of patient survival, OSS did not predict poor patient survival (hazard ratio = 0.88, CI: 0.64-1.21). CONCLUSIONS Our results demonstrate, at national level, OSS in early stage PC provided comparable outcomes in selected patients compared to PP and TP. Also, organ preservation was not associated with any significant reduction in patient survival in early stage PC. Our results help with early stage PC patient informed treatment decisions and anticipated outcomes.
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Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt.
| | - Jun Tao
- Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR
| | - Joseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt
| | - Nabil K Bissada
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Hospital, Houston, TX
| | - Benjamin Schurhamer
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR
| | - Philippe E Spiess
- Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR
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27
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Campbell RA, Alzweri LM, Sopko NA, Macura KJ, Burnett AL. Penile Calciphylaxis: The Use of Radiological Investigations in the Management of a Rare and Challenging Condition. Urol Case Rep 2017; 13:113-116. [PMID: 28507910 PMCID: PMC5429139 DOI: 10.1016/j.eucr.2017.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022] Open
Abstract
Penile calciphylaxis is a rare phenomenon of penile necrosis observed in patients with hemodialysis-dependent end-stage renal failure. Multiple treatments have been proposed including conservative management, surgical debridement and penectomy; yet, the prognosis remains extremely poor. Here, we describe a patient with protracted resolution of dry gangrene of the glans, which failed conservative management of wound care and pain management. Radiological studies revealed extensive calcification of abdominal aorta and branching vessels including the penile arteries. Due to intolerable pain, the patient required total penectomy. Earlier surgical intervention guided by findings on radiological studies may improve quality of life in this population.
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Affiliation(s)
- Rebecca A Campbell
- Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Laith M Alzweri
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Nikolai A Sopko
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Katarzyna J Macura
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.,Department of Radiology and Radiological Sciences, The Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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28
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Jo DI, Choi SK, Kim SH, Kim CK, Chung H, Kim HS. Local Excision for the Treatment of Penile Verrucous Carcinoma. Urol Case Rep 2017; 13:16-18. [PMID: 28417078 PMCID: PMC5389106 DOI: 10.1016/j.eucr.2017.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/16/2017] [Indexed: 11/24/2022] Open
Abstract
Penile verrucous carcinoma is known for its favorable biologic behavior and lack of metastatic potential. For preservation of function, treatment has been focused on partial penectomy. Despite partial penectomy for preservation of minimal functional and aesthetic aspects, patients have experienced psychosexual problems. A 73-year-old man had a cauliflower-like verrucous carcinoma on the penile glans and coronary sulcus diagnosed by using excisional biopsy. He underwent degloving excision to save the penile shaft and glans penis. Surgical margin was 3 mm. He had been tumor-free at the 2-year follow-up. For maximum preservation of the functional and aesthetic aspects, we recommend degloving excision.
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Affiliation(s)
- Dong In Jo
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Sang Kyu Choi
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Soon Heum Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Cheol Keun Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Hong Chung
- Department of Urology, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Hong Sup Kim
- Department of Urology, Konkuk University School of Medicine, Chungju, Republic of Korea
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29
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Campbell RA, Slopnick EA, Ferry EK, Zhu H, Kim SP, Abouassaly R. Disparity between pre-existing management of penile cancer and NCCN guidelines. Urol Oncol 2017; 35:531.e9-531.e14. [PMID: 28363474 DOI: 10.1016/j.urolonc.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/13/2017] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the locoregional management of penile cancer before the introduction of NCCN guidelines and how much shift in practice patterns is required to meet the guidelines. METHODS The National Cancer Data Base was queried to identify 6,396 patients with squamous cell carcinoma of the penis diagnosed between 2004 and 2013. The cohort was divided into management groups based on the NCCN guidelines: cTa and cTis (cTa/is), pT1 low grade (T1LG), pT1 high grade (T1HG), and pT2 or greater (T234). These groups were analyzed to determine if management of locoregional disease complies with the 2016 NCCN guidelines and logistic regression analyses were performed to determine factors associated with adherence. RESULTS Nationwide management of the primary tumor closely follows the NCCN guidelines, with 96.9% adherence for cTa/is, 91.4% for T1LG, and 94.2% for T234. Management of regional lymph nodes (LNs) was inadequate with only 62.9% of patients with clinical N1 or N2 disease undergoing regional LN dissection (LND). The percentage of patients with known LN metastases who received regional LND increased over time (46.2% in 2004 to 69.4% in 2013, P = 0.034). Patients treated at community cancer programs (odds ratio [OR] = 0.26, 95% CI: 0.19-0.35), comprehensive community cancer programs (OR = 0.34, 95% CI: 0.29-0.41), and integrated network cancer programs (OR = 0.36, 95% CI: 0.25-0.52) were significantly less likely to receive LND compared with patients treated at academic comprehensive cancer programs. CONCLUSIONS Before the introduction of NCCN guidelines, national practice patterns for the management of the primary tumor were consistent with the recommendations. However, the management of regional LNs deviated from the guidelines, reflecting an area for improvement.
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Affiliation(s)
- Rebecca A Campbell
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Emily A Slopnick
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Elizabeth K Ferry
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Hui Zhu
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Simon P Kim
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Robert Abouassaly
- Department of Urology, UH Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
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30
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Sèbe P, Ferretti L, Savoie PH, Morel-Journel N, Fléchon A, Murez T, Rocher L, Camparo P, Méjean A, Durand X. [CCAFU french national guidelines 2016-2018 on penile cancer]. Prog Urol 2016; 27 Suppl 1:S167-S179. [PMID: 27846930 DOI: 10.1016/s1166-7087(16)30707-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this work is to establish guidelines proposed by the external genital organ group of the CCAFU for the diagnosis, treatment and follow-up of penile cancer. MATERIAL AND METHODS The multidisciplinary working party studied 2013 guidelines exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation. RESULTS The most common histological type is squamous cell carcinoma. Clinical examination of the penis is usually sufficient to access local extension. It can be completed by MRI to assess deeper extension. Physical examination of both groins must evaluate inguinal regional lymph nodes involvement. In the presence of palpable lymph nodes, abdomen and pelvis computed tomography and 18F-FDG PET-CT are recommended. Sentinel lymph node biopsy is recommended in the case of penile cancer with high risk of lymph node extension with no palpable lymph nodes. Treatment of the primary tumour is usually surgical. It must be as conservative as possible while ensuring negative surgical margins. Brachytherapy or local treatment can be proposed in some cases. Bilateral inguinal lymph node areas must be systematically treated. Inguinal lymphadenectomy alone has a curative role in patients with metastatic invasion of a single node (stage pN1). In the case of more extensive lymph node involvement, multimodal management combining chemotherapy, surgery, and possibly radiotherapy has to be considered. CONCLUSIONS The treatment of penile cancer is usually surgical possibly in combination with chemotherapy in the presence of lymph node extension. The main prognostic factor is lymph node involvement, requiring appropriate management at the time of diagnosis.x © 2016 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - X Durand
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France
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31
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Takamatsu D, Shiota M, Sugimoto M, Uozumi T, Uchi H, Takeuchi A, Takahashi R, Tatsugami K, Yokomizo A, Oda Y, Furue M, Eto M. A case report of primary malignant melanoma of male urethra with distinct appearance in multiple regions. Int Cancer Conf J 2016; 5:174-177. [PMID: 31149449 PMCID: PMC6498338 DOI: 10.1007/s13691-016-0252-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022] Open
Abstract
A 66-year-old man presented with macrohematuria. Cystoscope examination found a 5 mm nodular tumor at external urethral orifice and multiple papillary tumors at fossa navicularis of urethra; those are non-black colored. Transurethral resection of the urethra tumor was performed, and pathologically diagnosed as malignant melanoma. Image examinations showed no lymphadenopathy and metastasis. Accordingly, total penectomy was conducted to remove the remaining tumors, resulting in surgically curative resection. After the operation, monthly interferon-β injection into inguinal region has been administered as adjuvant therapy, resulting in no recurrence at 6 months after penectomy.
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Affiliation(s)
- Dai Takamatsu
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Masaaki Sugimoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Uozumi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Hiroshi Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Ryosuke Takahashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Akira Yokomizo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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32
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Abstract
Cutaneous horn refers to unusually cohesive keratinized material and not a true pathologic diagnosis. Though cutaneous horn has been described at various sites, horn over the penis is very rare and represents the most unusual site. The role of chronic irritation, phimosis, surgical trauma and radiotherapy have been implicated in penile horn formation. Penile horns present as elongated, keratinous, white or yellowish projections that range from a few millimeters to centimeters in size arising from the glans penis. Histopathology of the keratotic mass reveals nothing but keratin. The underlying mass may vary from verruca vulgaris to squamous cell carcinoma. The treatment is based on the pathology.
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Affiliation(s)
- Kaliaperumal Karthikeyan
- Department of Dermatology and STD, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
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33
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Karthikeyan K. Penile cutaneous horn: An enigma-newer insights and perspectives. Indian J Sex Transm Dis AIDS 2015. [PMID: 26392650 PMCID: PMC4555894 DOI: 10.4103/2589-0557.156692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cutaneous horn refers to unusually cohesive keratinized material and not a true pathologic diagnosis. Though cutaneous horn has been described at various sites, horn over the penis is very rare and represents the most unusual site. The role of chronic irritation, phimosis, surgical trauma and radiotherapy have been implicated in penile horn formation. Penile horns present as elongated, keratinous, white or yellowish projections that range from a few millimeters to centimeters in size arising from the glans penis. Histopathology of the keratotic mass reveals nothing but keratin. The underlying mass may vary from verruca vulgaris to squamous cell carcinoma. The treatment is based on the pathology.
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Affiliation(s)
- Kaliaperumal Karthikeyan
- Department of Dermatology and STD, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India,Address for correspondence: Prof. Kaliaperumal Karthikeyan, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet - 605 017, Puducherry, India. E-mail:
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34
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Tarbunou Y, Davis CL, Costa J, Williams C. Warty Condylomatous Squamous Cell Carcinoma of the Penis in a 19-Year-Old. Urol Case Rep 2014; 2:79-81. [PMID: 26955552 PMCID: PMC4733032 DOI: 10.1016/j.eucr.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/03/2014] [Indexed: 12/02/2022] Open
Abstract
Warty carcinoma of the penis is an unusual neoplasm and a variant of penile squamous cell carcinoma. As with other types of penile cancer, risk factors include human papillomavirus infection, poor personal hygiene, and being uncircumcised. The typical case is an exophytic mass arising from the glans penis, frequently large (4-5 cm), and with invasion into corpus spongiosum. The diagnosis is typically made by tumor biopsy. Treatment depends on the stage of disease and includes partial vs total penectomy, with or without prophylactic or therapeutic bilateral lymphadenectomy. We present an unusual case of penile cancer in a 19-year-old patient.
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Affiliation(s)
- Yauhen Tarbunou
- Division of Urology and Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA; Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Cindy L Davis
- Division of Urology and Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA; Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Joseph Costa
- Division of Urology and Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA; Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher Williams
- Division of Urology and Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA; Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA
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Challa VR, Swamyvelu K, Amirtham U, Shivappa P. Sarcomatoid carcinoma of penis with bilateral inguinal metastases-a case report and review of literature. Indian J Surg 2013; 76:316-8. [PMID: 25278657 DOI: 10.1007/s12262-013-0965-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022] Open
Abstract
Sarcomatoid carcinoma or carcinosarcoma of the penis is a rare entity with 36 cases reported in the literature. A 61-year-old male presented with swelling in the glans and shaft of the penis with bilateral inguinal lymph node metastases. He underwent total penectomy with bilateral inguinal block dissection. Histopathology revealed sarcomatoid carcinoma of the Penis with bilateral inguinal lymph node metastases. The patient later developed bilateral lung metastases in 6 months and was succumbed to death. Sarcomatoid carcinoma or carcinosarcoma is a rare malignancy with poor prognosis.
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Affiliation(s)
- Vasu Reddy Challa
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | | | - Usha Amirtham
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Prashanth Shivappa
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
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Abstract
INTRODUCTION Epithelioid sarcoma of the penis is a slowly growing soft tissue neoplasm that rarely arises from the penis. AIM The aim of this case is to describe this rare pathology and to underline the importance of differential diagnosis with benign diseases such as Peyronie's disease. METHOD We report the case of a 20-year-old man who referred the onset of a progressive left dorsolateral penile curvature (about 60°) started 3 years before. The patient was evaluated with two US examinations that revealed two sites of tunical thickening with normal hemodynamic evaluation. The physical examination demonstrated a dorsal fibrotic plaque of about 2.5 cm. RESULTS A juvenile form of Peyronie's Disease was diagnosed, and the patient was scheduled for surgical treatment (plaque's incision/excision and grafting). Intraoperative appearance showed that the great part of the left cavernous body was substituted by a very tough tissue which deeply involved the erectile tissue; intraoperative frozen section was suspicious for mesenchymal epithelioid neoplasm. In order to obtain definitive histological analysis and collect proper informed consent, we preferred to proceed with our original project, applying a dual graft (buccal mucosa and allograft dermal matrix) to cover the wide excised area. The final histological report confirmed the diagnosis of epithelioid sarcoma. Postoperative CT and MRI, at 3 and 6 months from surgery, were negative for metastases. The patient underwent radical intervention after 6 months. CONCLUSIONS Epithelioid sarcoma of the penis and Peyronie's Disease can present with similar clinical findings although they obviously entail a different clinical progress. Since the diagnosis of neoplasm can be established only by the pathologist on biopsy specimen, in cases of unusual clinical presentation of Peyronie's disease (especially in young men suffering from a fast-growing penile induration), an early histological assessment should be performed to avoid the possibility of misdiagnosis in case of this poor-prognosis disease and to assure the definitive diagnosis.
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Affiliation(s)
- Fulvio Colombo
- Department of Surgery, Andrology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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