Partial Glansectomy Research Articles

Distal urethral carcinoma: Contemporary management with phallus preserving techniques

IntroductionPrimary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma. MethodsSeven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020. ResultsThe mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date. ConclusionPenile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.

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

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.

Organ-sparing surgical and nonsurgical modalities in primary penile cancer treatment.

To provide an overview of the current state of literature on organ-sparing approaches in penile cancer. Surgical as well as nonsurgical approaches can be adapted in the right setting, in an effort to spare patients from the burden of total or subtotal penectomy wherever possible. In this review, we focus on surgical approaches. Narrower surgical margins do not seem to affect overall survival rates, neither do local recurrences. This has allowed a paradigm shift towards more sparing approaches locally. Contrary to what was previously thought, margins of a few millimetres suffice for adequate local cancer control. This allows laser therapy, wide local excisions, partial glansectomy and other surgical techniques to be performed in an organ-sparing fashion. Ablative techniques such as brachytherapy and external beam radiotherapy also provide adequate local cancer control. These sparing approaches have an important effect on psychological and functional outcomes; however, they are insufficiently adapted even in larger referral centres. Organ-sparing techniques should be used in penile cancer surgery whenever possible. Patient selection for the most appropriate technique is key to provide good cosmetic and functional results while remaining oncologically safe.

Brachytherapy for conservative treatment of invasive penile carcinoma in older patients: Single institution experience.

No study has examined the possibility to perform an organ sparing strategy in older patients with penile carcinoma, and amputation is frequently proposed. We report our experience of interstitial brachytherapy for the conservative treatment of penile carcinoma confined to the glans in patients aged of 70years and more. A total of 55 patients candidates to conservative brachytherapy were identified. Median age was 73.8years (range: 70-95years). Patients underwent a circumcision then 3-4weeks later, an interstitial brachytherapy was delivered, median dose of 65Gy (range 55-74Gy). Salvage surgery was discussed in patients with histological confirmation of residual/relapsed tumor. With median follow-up of 9.0years, eight patients (14.5%) experienced a relapse, including five patients with local relapse. Three patients with local relapse only underwent salvage penile surgery, including two partial glansectomies and one total penectomy, and were in second complete remission at last follow-up. Among 55 patients analyzed for late side effects, seven patients (13.0%) presented pain or ulceration, 12 (22.2%) experienced urethral or meatal stenosis requiring at least one dilatation, two patients (3.7%) experienced both ulcerations and urethral complication. Three patients (5.5%) needed partial glansectomy for focal necrosis. At five years, estimated overall survival rate was 74.5% (95%CI: 62.0-87.0%) and local relapse free rate was 91.0% (95%CI: 82.6-99.4%). Brachytherapy is feasible in selected older patients with penile carcinoma, with efficacy and toxicity rates comparable to that of other series in younger patients.

Erythroplasia of Queyrat

A 58-year-old Caucasian male presented to the urology clinic reporting an approximate one-year history of a persistent irritating, slowly progressive, glans penis redness. Biopsy revealed penile squamous cell carcinoma in situ. He underwent a partial glansectomy with circumcision and skin grafting. At three months follow-up there is no evidence of local disease recurrence. In western countries, primary malignant penile cancer is uncommon, with an incidence of less than 1 per 100,000 males. Squamous cell cancer accounts for more than 95% of cases of penile cancer. Squamous cell carcinoma in situ on the penile mucosa or transitional surfaces is also known as Erythroplasia of Queyrat. In the region, one third of penile squamous cell carcinoma in situ cases progress to invasive squamous cell carcinoma.

Organ‐preserving surgery for penile cancer: description of techniques and surgical outcomes

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Organ-preserving surgeries for penile cancer have been described to reduce the morbidity associated with traditional operations. Patients derive better functional outcomes from penile-preserving surgery, although local recurrence rates can be higher. Excellent results can be obtained at large-volume centres. With close follow-up, local recurrences can be identified and treated promptly (often with further local excision). • To describe the outcomes of organ-preserving surgery for penile cancer at a UK tertiary referral centre. • Patients at Sunderland Hospital (UK) between 2001 and 2008 who had squamous cell tumours limited to the glans penis underwent penile-preserving surgery including total glansectomy and glanuloplasty, partial glansectomy, glans relining and distal penectomy with glans reconstruction. • Recurrence rates, cosmetic and functional outcomes were recorded. • In all, 65 patients were identified with a median follow-up of 40 months. Local recurrence was present in four patients (6%) despite 72% having intermediate or poorly differentiated tumours and 30% with T2 disease. • Complications included partial graft loss (1.5%), graft contractures (4.5%) and meatal stenosis (7.5%). • In all, 5% were deemed to have poor cosmetic outcome and 85% described good erections at 1 year after surgery. • Penile-preserving surgery can achieve good penile cancer control with minimal morbidity and reduced psychosexual side-effects.

747 ORGAN PRESERVING SURGERY FOR PENILE CANCER – DESCRIPTION OF TECHNIQUES AND SURGICAL OUTCOMES

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2012747 ORGAN PRESERVING SURGERY FOR PENILE CANCER – DESCRIPTION OF TECHNIQUES AND SURGICAL OUTCOMES Rajan Veeratterapillay, Aluru Pavan, Susan asterling, Sam Rao, and Damien Greene Rajan VeeratterapillayRajan Veeratterapillay Sunderland, United Kingdom More articles by this author , Aluru PavanAluru Pavan Sunderland, United Kingdom More articles by this author , Susan asterlingSusan asterling Sunderland, United Kingdom More articles by this author , Sam RaoSam Rao Durham, United Kingdom More articles by this author , and Damien GreeneDamien Greene Sunderland, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.833AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, radical surgery or radiotherapy has been used for malignant penile lesions with little thought to organ preservation. Recent evidence has paved the way for glansectomy and wide local excision for management of penile cancer confined to the glans. METHODS Patients at Sunderland Hospital (UK) between 2001 and 2008 who had squamous cell tumours limited to the glans penis underwent penile preserving surgery including total glansectomy and glanuloplasty, partial glansectomy, glans relining and distal penectomy with glans reconstruction. Recurrence rates, cosmetic and functional outcomes were recorded. RESULTS 65 patients were identified with a median followup of 40 months. Local recurrence was present in 4 patients (6%) despite 72% having intermediate or poorly differentiated tumours and 30% with T2 disease. Complications included partial graft loss (1.5%), graft contractures (4.5%), meatal stenosis (7.5%) and positive margin (3%). 5%were deemed to have poor cosmetic outcome and 85% described good erections at one year postop. CONCLUSIONS Penile preserving surgery can achieve good penile cancer control with minimal morbidity and reduced psychosexual side effects. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e306 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajan Veeratterapillay Sunderland, United Kingdom More articles by this author Aluru Pavan Sunderland, United Kingdom More articles by this author Susan asterling Sunderland, United Kingdom More articles by this author Sam Rao Durham, United Kingdom More articles by this author Damien Greene Sunderland, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Early invasive squamous cell carcinoma of the penis presenting in a 39-year-old man

Penile cancer, albeit an uncommon malignancy, commonly affects men aged between 50 and 70 years, often with a history of predisposing factors such as Bowen's disease or leukoplakia. We describe a case of early invasive squamous cell carcinoma of the penis in a 39-year-old man with no history of predisposing factors, treated by a partial glansectomy.

The Use of Bovine Collagen and Skin Graft for Reconstruction of the Glans Penis Following Cancer Resection

Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and functional preservation. Although various methods have attempted to achieve both goals, none have succeeded entirely. In this report, we introduce a novel reconstructive technique on a 64-year-old patient with squamous cell carcinoma of the glans penis. The technique consisted of two staged procedures. First, a dermal substitute, consisting of bovine collagen, was sutured onto the defect after partial glansectomy and three weeks later, the integrated dermis was covered with autologous non-meshed partial thickness skin graft. Use of this dermal substitute in a staged fashion allowed for ability to await final pathologic margins prior to definitive reconstruction and increased dermal thickness. After 9-month follow-up, sexual function returned within 3 months and the patient remained healed. We found this technique to be useful in concurrently preserving penile function and cosmesis. Future studies should include more patients and longer follow-up.

Glansectomy with split-thickness skin graft for the treatment of penile carcinoma

Using our prospectively derived database, we identified 17 patients with squamous-cell carcinoma involving the glans penis, who were treated using organ-sparing surgery between March 2003 and January 2008. Of them, two were treated with partial glansectomy with primary glans closure, and 15 underwent total glans amputation and reconstruction of a new glans using a split-thickness skin graft (STSG). These 15 patients represent the subject of our study (mean age 51 years, range 42 to 59 years). Overall, two patients had early partial loss of the graft and of them, one required surgical regrafting. Two late complications occurred, consisting of one meatal stenosis and one postoperative phimosis. At a mean follow-up of 36 months, functional results were extremely satisfactory. All patients maintained their erectile function with good vaginal penetration starting from 3 months after surgery, with a range between 2 and 6 months. Orgasm and ejaculation were preserved in all patients, although reduced glans sensitivity was reported by all patients. No local recurrences were reported.

Wiederherstellung von Gewebedefekten der Glans penis mittels Mundschleimhauttransplantation

The purpose of the present communication is the presentation of a surgical method for treating tissue defects of the glans penis through free transplantation of a piece of the patient's buccal mucosa. Defects of the glans penis are most frequently formed from excision of a primary tumour or benign lesions through partial or total glansectomy. During a 2-year period (2004-2005), at the Clinic of Urology of the Medical University, Sofia, 10 patients having penile cancer were diagnosed and treated. Out of these, 6 (60%) were found to be in T1 N0 M0 stage. In 5 (50%) of the said cases, a free mucosa transplant was used to cover the tissue defect remaining after partial or total glansectomy. In 4 (80%) cases buccal mucosa was used, and in 1 (20%) lower lip mucosa. The histological results from the operations performed confirmed the staging of the disease, with 4 flat-cell and 1 verrucosa cancer. Within the early post-operative period, no surgical complications were noted, not only at the site of extraction of the transplant, but also at the site of its transplantation. Late complications and relapses have not been observed. Our initial experience utilising the free transplantation of mucosa extracted from the oscular cavity for replacement of a surgical defect after partial or complete glansectomy has proven to be an alternative to the available treatment methods. Buccosa is more suitable in the case of a partial glansectomy because it has a thicker wall.

Reconstructive surgery in penile trauma and cancer

This article provides an overview of the current concepts in reconstructive surgery following penile trauma, penile fracture and penile cancer. It covers the initial management of penile trauma, with the aim of preservation of as much viable tissue as is practical, and also provides advice on dealing with penile avulsion and amputation injuries. The best treatment for penile fracture-immediate surgical exploration and repair-is outlined and discussed. Finally, penile cancer management is reviewed, from initial biopsy to definitive treatment of the penile lesion-including wide excision, partial glansectomy, total glansectomy, and partial and total penectomy. It is concluded that appropriate surgery in all these conditions reduces subsequent long-term problems in sexual function, cosmesis, psychology, and (in cancer cases) longevity. The same reconstructive techniques can be applied for different penile conditions, and it is suggested that surgeons become experienced in genital surgery as a whole, rather than in oncology or trauma alone.