Phallus Preservation in Penile Cancer Surgery: Patient-reported Aesthetic & Functional Outcomes

Abstract

To assess patient-reported outcomes of oncoplastic penile reconstruction using standardised questionnaires. Whilst organ-preservingpenile cancer surgery hasevolved aiming to preserve genital function, reduce psychological morbidity of radical penectomy and maximise patient quality of life, few studies have evaluated patients' final perceptions. Following ethical approval, patients post partial/radical glansectomy with reconstruction 2016-2019, under a single surgeon, were identified. Patients were posted a modified Index of Male Genital Image, the IIEF-5, a customised questionnaire exploring outcomes of urinary and sensory function and the EORTC QLQ-C30 to complete and return. Questionnaires were non-identifiable, however study ID linked responses to the procedure performed. A total of 130 questionnaires were received from 35 patients post penile reconstruction, giving a response rate of 71.4% (35/49). Mean time from surgery was 22 months [4-51], and mean age 61 years [31-79]. The majority (82.4%, n=28) were satisfied or felt neutral about the appearance of their genitalia. High satisfaction with post-procedure urinary function was reported; 85.3% (29/34) could void from a standing position and 79.4% (27/34) reported little or no spraying of urine. Nineteen patients (55.89%) were sexually active, with mean IIEF-5 scores of 14.9 [5-25] (partial glansectomy) and 15.8 [5-25] (radical glansectomy). Mean QoL over past week on 7-point EORTC QLQ-C30 scale was 5.88 [3-7]. We report good aesthetic and functional outcomes in a unique study exploring penile cancer surgery patient-reported outcome measures. These results strongly support phallic-preserving strategies as the standard of care in eligible patients undergoing penile cancer surgery.