BERKELEY, CA (UroToday.com) - The past two decades have seen the emergence of organ-preserving techniques for penile cancer surgery.[1,2] Prior to this, penile cancer had been managed by radical surgery or radiotherapy with little thought to organ preservation, and although oncological outcomes were good, functional outcomes and patient satisfaction were not optimal.[3] Penile cancer remains rare in the Western world, and in the UK setting is managed in supra-regional units, leading to a considerable body of experience acquired in those centres.[4]
| "...we have shown that penile-preserving surgery can achieve good penile cancer control with minimal morbidity and reduced psychosexual side effects." |
In this study, we describe our experience with penile-preserving techniques in a UK penile cancer centre (Sunderland Royal Hospital). Our catchment population is just over 4 million and we manage around 30 new penile cancer cases annually. For penile-preserving surgery, we employ a multi-disciplinary approach and carry out the operations with plastic surgeons, particularly employing their great expertise in skin grafting. In this series, we describe a cohort of 65 patients with a mean follow-up of 40 months, which is one of the longest follow-up series noted for penile-preserving surgery in the literature.
Four main surgical techniques are employed, including glansectomy and glanuloplasty, partial glansectomy and glanuloplasty, glans relining, and distal corporectomy with reconstruction. Glansectomy and glanuloplasty was performed in 46 cases (70%) with partial glansectomy in one (2%), glans relining in three (5%) and glansectomy, distal corporotomy and reconstruction in 15 cases (23%). In all, 20% of patients had cancer in situ (CIS) on final histology and 72% had moderate (G2) or poorly differentiated tumours (G3); 75% of tumours were stage T1 orT2 with the rest being CIS.
There were no fatalities during the study period. In all, 60 patients (92%) had been followed up for ≥2 years. During the follow-up period, there were four local recurrences (6%). In two cases the patients had verrucous carcinoma, one of which had a positive margin at initial excision. These two cases were managed by further wide local excision. One patient required a redo glansectomy, and the other required a partial penectomy due to high-risk disease and positive margin. The median time to recurrence was 15 months.
Early complications included partial graft loss in one patient requiring re-grafting. In the medium term, there were graft contractures in three patients requiring redo procedures. Meatal stenosis was the commonest long-term complication -- occurring in five patients -- and this required meatal dilatation under general anaesthetic.
In terms of functional outcomes at 1 year, 85% of patients reported ‘good’ erections.
In summary, we have shown that penile-preserving surgery can achieve good penile cancer control with minimal morbidity and reduced psychosexual side effects.
References:
- Austoni E, Fenice O, Kartalas Goumas Y, Colombo F, Mantovani F, Pisani E. New trends in the surgical treatment of penile carcinoma. Arch Ital Urol Androl 1996; 68: 163–8
- Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int 2000; 86: 459–65
- Narayana AS, Olney LE, Loening SA, Weimar GW, Culp DA. Carcinoma of the penis: analysis of 219 cases. Cancer 1982; 49: 2185–91
- National Institute for Health and Clinical Excellence (NICE). NHS UK. Improving Outcomes in Urological Cancers, London: NICE, 2002: 83–6. 2002
Written by:
Rajan Veeratterapillay and Damian Greene 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.
Department of Urology, Sunderland Royal Hospital, UK
Organ-preserving surgery for penile cancer: Description of techniques and surgical outcomes - Abstract
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