BERKELEY, CA (UroToday.com) - It is generally accepted that patients with penile primary tumors exhibiting favorable histological features (stages Tis, Ta, T1; grade 1 and grade 2 tumors) are at a low risk for metastases and best suited for organ-sparing or glans-sparing procedures.
However, treatment choice is influenced by tumor size, its position on the glans or in the corpora cavernosa, and experience of the treating urologist. The goal of treatment is to preserve glans sensation where possible or, at least, to maximize penile shaft length. Such approaches include topical treatments, radiotherapy, laser ablation, Mohs surgery, and limited excision strategies. However, topical treatments, radiotherapy, and laser ablation cannot provide us with the accurate pathology while lasting during a relatively long treatment cycle. The Mohs micrographic surgery method has a high curative rate for low-stage tumors, but the results are highly variable and technique dependent.
We reported detailed data of 12 cases, with primary penile cancer about the oncological control, sexual function, and cosmetic results after our glans-preserving surgery. At a follow-up of 36 to 90 months (mean 62.5 ± 17.2), recurrence occurred in 1 patient with carcinoma in situ in the sixth month after surgery, which was managed by a second glans-preserving surgery, without recurrence.
The dense tunica albuginea probably represents a barrier to the spread of cancer into the corpus cavernosum. We removed all of the penile skin and subcutaneous tissue to tunica albuginea to prevent the recurrence of the tumor. Adjacent shaft skin was mobilized to resurface the raw surface where primary closure may not be possible, or where primary closure would give an unacceptable cosmetic result. The sleeve technique was used to resurface the raw surface of the tumor located on penile shaft. This kind of operation preserved the glans penis as much as possible, and it achieved a pretty restoration of the penis while eradicating the local tumor. Perioperative, frozen-section analysis ensured the tumor-free margin, and postoperative pathologic results confirmed the safety and reliability of this technique.
All of the patients returned to normal sexual activity within 1 month after surgery without abnormal sensation or appearance of the glans penis. The shape and appearance of the glans penis was preserved in every patient. We compared sexual function of every patient before and after the operation using the international index of erectile function (IIEF) questionnaire. All of these 12 cases were satisfied with their sexual function after operation, according to the interview result. A healthy and normal appearance after the operation helped patients recapitulate their self-image and self-esteem.
With careful patient selection and meticulous follow-up, this technique is especially suitable for young men with superficial penile cancer. It has the potential to preserve normal anatomy and functions of the glans penis, where possible. However, more experiences are required to further to access this technique.
Written by:
Pengchao Li and Ninghong Song, PhD., MD., as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Glans-preserving surgery for superficial penile cancer - Abstract
