A longitudinal long-term observation study on sexual function and satisfaction rates in men with partial penectomy for penile cancer in a prospectively clinical database

Abstract

ABSTRACT Introduction Organ-preserving partial penectomy provides a reasonable oncological approach in managing early-stage penile cancer with preservation of normal urinary function and many men can retain some aspects of sexual domains. However, there is limited published data regarding the longer-term sexual outcomes and satisfaction rates in men who remain sexually active in the context of penile cancer survivorship. Objective To evaluate sexual outcomes and satisfaction rates in sexually active men who underwent partial penectomy at a minimum 36-month follow-up study. Methods A prospective database on men treated with penile cancer was set up in 2011 following ethics approval. All men with pre-existing normal erectile function (EF) as defined by the International Index of Erectile Function (IIEF-5) score of 21 and above, and have a stable active sexual lifestyle were included in this study. Patient demographics including EF and sexual satisfaction scores based on IIEF questionnaire, erection hardness scores (EHS) and Brief Sexual Function Inventory (BSFI), use of erectile agents, and sexual satisfaction outcomes were recorded and compared between preoperative vs. 36 months postoperative. Results Of a total of 85 men with partial penectomy identified over the 10-year period, 44 men reported normal EF preoperatively and were in a stable sexual relationship. Six men underwent subsequent completion penectomy during that time while 3 men were lost to follow-up, and only 25 men were identified to be sexually active. Of these, 4 men can achieve satisfactory spontaneous erection for sexual intercourse, while 18 men take regular phosphodiesterase type-5 inhibitor drugs, and 3 men use intracavernosal injections. The median patient age was 54 (38-70) years, and the median follow-up was 44 (38-118) months. The mean penile length measurements were 4.2cm and 6.8cm in flaccid and erect states. Two-thirds of patients maintained the same frequency and level of sexual desire as before surgery and 36-month postoperative, and 80% continued to have ejaculation and orgasm every time they had sexual intercourse. Deterioration in both IIEF-5 and EHS scores were reported in 80% of patients at the 36 months review with lower sexual domains scores in BMSFI recorded in 72% of patients especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). Multivariate analysis using logistic regression confirmed that older age (OR 1.18, 95% CI 1.02-1.21, p<0.01), shorter penile length (OR 0.45, 95% CI 0.38-0.69, p<0.01) and quality of erection (OR 1.23, 95% CI 1.10-1.41, p<0.01) were significantly associated with lower sexual satisfaction rates. Conclusions While most sexually active men retained the ability to have sexual intercourse following partial penectomy, many required erectile aids and reported clinical deterioration in sexual function and overall satisfaction rates at 36 months. Disclosure Work supported by industry: no.