Presented Thursday, 06 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Classical surgical treatment of penile cancer involves safe oncological but mutilating operations, difficult to accept, especially by young patients; conservative alternatives - radiotherapy, laser treatments and topical 5 fluorouracil, have a major oncological risk. The techinque and results of glansectomy and circumcision for penile carcinoma with skin graft on the corporal heads, a surgical method which combines oncological safety with a very good cosmetic and functional outcome, are presented.

Methods: Between January 2003 and November 2006, 17 patients (37-54 years old) with glans and prepuce tumors, were operated on using this method. Diagnosis protocol included physical examination, preoperative biopsy, abdomino-pelvic CT and chest xray. Two silk ligatures were placed on the distal part of the prepuce, in order to isolate the tumoral lesions. A circumferential subcoronal incision of the skin, dartos and Buck’s fascia was performed. The prepuce and glans were dissected from the corpora cavernosa and then excised. Biopsies with frozen sections from the albuginea of the corpora cavernosa were taken. We decided to graft the corporal heads with split thickness skin in 11 cases and full thickness skin in 6 cases. Pathological findings revealed scuamous cell carcinoma pT1G1-2 in 12 cases and pT2G2 in 5 cases. In 9 cases with palpable inguinal lymph nodes, 6 weeks after the operation we performed bilateral inguinofemoral lymph nodes dissection with negative result at pathological examination in 5 cases and positive in 4 cases when we continued with bilateral pelvic lymph nodes dissection and chemotherapy.

Results: The surgical course was uneventful, with viability of the skin graft and patient discharge in the 10th postoperative day in all cases. We registered no local or lymphnodes tumoral recurrences between 6 to 46 months postoperative. Aesthetic and functional outcome - a neoglans reconstruction with conservation of the maximum length of the penis was very good, with acceptable sexual activity. Another advantage of the method, the meatus, has no tendency to develop stenosis and also we can detect early and eventually local recurrence.

Conclusions: Glansectomy and circumcision with skin graft on the corporal heads in the treatment of penile cancer, is a safe oncological operation with a very good aesthetic and functional outcome.

Authors: Gingu C, Harza M, Patrascoiu S, Serbanescu B, Stefan B, Zogas V, Stoica R, Tica D, Cerempei V, Sinescu I

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