MP11-01 LARGEST MULTI-CENTER INTERNATIONAL EXPERIENCE WITH PERINEAL URETHROSTOMY IN THE MANAGEMENT OF PENILE CANCER

Abstract

INTRODUCTION AND OBJECTIVE: Perineal Urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally advanced/anatomically unfavorable penile cancer (PC) requiring total penectomy (TP). Prior studies would suggest a rate of failure, particularly of PU stenosis (PUS), of 8-30% however this is poorly studied. We present a large, multi-institutional experience with PU related to PC. METHODS: A total of 246 patients underwent PU as a means of urinary diversion in the management of primary PC across 6 international centers (Belgium, Brazil, China, Netherlands and 2 US sites) from 1997 to 2019. The median follow-up was 53.1 months. RESULTS: Median age at time of PU was 67 years (30-91). The underlying diagnosis was penile cancer in all cases, with the histology being SCC in 93%. A total of 86 Pts (35%) developed early post-operative complications, most common being: wound infection (15%), dehiscence (5%) and tissue necrosis (2%). The median length of hospital stay post-PU was 4 days (1-34).The overall incidence of PUS was 14% (N=35), with no significant difference among participating centers. None of the patients with PUS had received neoadjuvant therapy. Seven of 35 Pts who developed PUS had received adjuvant chemotherapy (OR=1.7) and 8 of 35 Pts had received adjuvant radiotherapy (OR=1.9). Tumor staging did not impact the incidence of PUS. Time to intervention for management of PU stenosis was 204 days (57 days to 2.1 years). Initial treatment of PUS was urethral dilation in 7 patients and surgical revision in 28 patients. CONCLUSIONS: We report the largest surgical series of PU in the setting of the management of PC with a longer follow-up than previously reported. PU is a reliable and effective means of diverting urine among patients requiring such aggressive surgical resection, nevertheless complications are not uncommon which are important to convey to patients in addition to vigilance in their early identification and management. PU stenosis occurred in 14% of our patient population, with most of these requiring surgical revision. Adjuvant chemotherapy and radiotherapy were significant risk factors, and this is a possible reflection of selection bias of patients with more aggressive disease.New techniques were described on the reconstructive literature for urethral stricture disease and may be used on the oncologic setting. Future studies are needed in order to evaluate better outcomes but patients undergoing PU should be advised of possibility of revision procedures, especially when radiation or chemotherapy is required. Source of Funding: None