Total Penectomy Research Articles

Development of a risk calculator of recurrence in inguinal lymph node metastatic (ILNM) patients with surgically resected penile squamous cell carcinoma (PSCC).

1 Background: ILNM PSCC patients (pts) have heterogeneous outcomes. We aimed to identify risk factors of early recurrence in order to optimize the selection of pts for adjuvant (adj) therapies (tx). Methods: In a multicenter database of 924 pts who underwent ILN dissection, we identified 311 ILNM pts. Pts treated with neoadj chemo (CT) and/or radiotherapy (RT) were excluded. Multivariable Cox regression analyses (MVA) tested for predictors of recurrence, after adjusting for adj tx, age, type of surgery of the primary and smoking status. As primary endpoint, a risk calculator predicting early (24-month) risk of recurrence was developed. As secondary endpoint, the overall survival (OS) benefit of adj tx was examined according to the risk calculator-derived tertiles using Kaplan-Meier analysis. Results: Overall, 159 pts (51.1%) had pN1-2 and 203 (65.3%) pT2-4 disease. Overall, 195 (62.7%) and 78 (25.1%) received partial or total penectomy, whereas 6 (1.9%) local excision and 32 (10.3%) other procedures. Median number of removed and positive ILN were 15 (IQR 9-21) and 2 (IQR 1-3). Pelvic LND was performed in 154 (49.5%) pts, and 39% of them had pelvic LNM. In MVA, ILN ratio (HR: 1.01, p= 0.04), pN3 (HR: 2.53, p=0.002) and positive proximal margin of the primary (HR: 2.13, p=0.02) were significantly associated with recurrence. The c-index of our 3-variable risk calculator was 68%, with a net benefit higher that treat-all option from 20% to 90% threshold-probabilities. Within the cohort of adj CT and/or RT (N=127) pts, intermediate-high tertile had similar median OS (NR vs 107m) compared to pts in the low tertile (p=0.1). Conversely, intermediate-high tertile pts who received observation alone had shorter OS (NR vs 40m) compared to the same pts in the lower tertile (p<0.001). Similar results were obtained for CT and RT separately analyzed. Conclusions: We developed and internally validated a risk calculator to predict early recurrence in ILNM surgically-resected PSCC pts. According to our risk-calculator, pts with intermediate/higher risk of early recurrence may benefit from adj tx. Our risk calculator can be used for counseling and enrolment in ongoing studies.

Melanoma primario de pene

Descripción caso clínico: Masculino de 54 años de edad, sin antecedentes de importancia, valorado por síntomas obstructivos del tracto urinario inferior. Presenta fimosis y se palpa en glande lesión pétrea, se realiza incisión dorsal de prepucio teniendo como hallazgo tumor en glande de aspecto verrugoso, color negro, consistencia pétrea. El tratamiento consistió en penectomía total. Presenta progresión de la actividad tumoral hepática, esplénica y ganglionar inguinal izquierdo además de lesiones blásticas a nivel de l4, t7 y t9. Tratado inicialmente de forma paliativa con temozolamida y posteriormente con inf alfa 2b y ácido zoledrónico. El paciente fallece a los 16 meses de diagnóstico.
 Relevancia: El melanoma de pene neoplasia cutánea maligna agresiva, de rápida progresión y con alta mortalidad, derivado de la proliferación de melanocitos atípicos representa menos del 1% de los casos de cáncer de pene y menos del 0.2% de todos los melanomas. Se han reportado alrededor de 200 casos en la literatura.
 Implicaciones clínicas: No existe tratamiento estandarizado, el tratamiento es quirúrgico mediante penectomía total, sin embargo, no existe un estándar de tratamiento. La opción de tratamiento más racional parece ser una cirugía radical si es posible junto con la terapia adyuvante.
 Conclusiones: El melanoma de pene neoplasia cutánea maligna de mal pronóstico por su gran capacidad de producir metástasis y rápida diseminación principalmente por vía linfática. La quimioterapia y radioterapia son solo paliativas o adyuvantes con resultados variables.

Skin metastasis of squamous cell carcinoma of the penis: case report

We report a case of penis cancer at the military hospital in Rabat, about a 75-year-old patient with a history of a bladder tumor that has been treated with radical cysto-prostatectomy with bilateral ilio-obturator scouring and Briker-type urinary diversion. The symptoms were marked by the appearance of an induration of the left corpus cavernosum in its proximal part on a normal penile skin. The biopsy was not possible and MRI was inconclusive, the FDG-PET/CT played a relevant role detecting tumor mass and lymph node metastases. The treatment, after multidisciplinary discussion, consisted of a total penectomy with bilateral orchiectomy completed secondarily by bilateral inguinal scraping. The evolution was marked by the appearance of skin metastases and the death of the patient during chemotherapy.

Primary Leiomyosarcoma of the Penis: A Review and Update of the Literature

Less than 50 cases of Primary Leiomyosarcomas of the Penis (PLOP) have been reported despite this PLOPs are the second most common sarcomas of the penis. The usual site for the development of PLOP is the shaft or base of the penis but the malignancy can affect any site of the penis. PLOPs are likely to be superficially located above the tunica albuginea in comparison with deep seated PLOPs. Superficial PLOPs may be asymptomatic or they may present as lumps, ulcers or nodules on the penis. Deep PLOPs may manifest with dysuria and difficulty with micturition when they compress the urethra. Diagnosis of PLOP is based upon the pathology examination features of specimens of the penile lesion that show interlacing fascicles of spindled-cells that have abundant eosinophilic cytoplasm, focal juxta-nuclear vacuoles and blunt ended nuclei and moderate to severe nuclear atypia, rarely atypical multi-nucleated giant cells and focal necrosis tend to be seen. There may be evidence of many mitoses. Immunohistochemistry studies of PLOP tend to show tumor cells that exhibit positive staining for desmin, muscle specific-actin, and alpha smooth muscle actin. Most often superficial PLOPs tend to be treated by wide complete excision of the tumor with tumor free and clear surgical resection margins. Deep seated PLOPs have also been treated by complete excision in various forms depending upon the site and size of the tumor and some of these have included Wide excision, partial penectomy and total penectomy alone and sometimes with adjuvant chemotherapy/radiotherapy. Some cases of deep PLOPs tend to be associated with the development of recurrences and metastases as well as death of the patient and hence deep PLOPs are aggressive tumors. Some people are of the opinion that chemotherapy and radiotherapy are not effective for the adjuvant treatment of PLOP. For this reason it would appear that there is need for the development of new chemotherapy medicaments that would effectively destroy PLOP tumor cells. There is need to undertake a global multi-center treatment trial of immunotherapy, chemotherapy and radiotherapy in order to streamline the treatment of PLOPs especially deep PLOPs.

Ingenol mebutate therapy in erythroplasia of Queyrat: a new approach.

Erythroplasia of Queyrat (EQ) is a rare squamous cell carcinoma in situ, usually occurring on the glans penis, the prepuce, or the urethral meatus. Therapy is mandatory because it can progress to invasive carcinoma in up to 30% of cases. Treatment options include 5-fluorouracil, curettage, cryotherapy, radiotherapy, laser, partial or total penectomy, and microsurgery, as also with imiquimod and photodynamic therapies. Between 2015 to 2018 we treated five patients, with histologically confirmed EQ, with ingenol mebutate (IM) 0.015% gel applied for 3 days consecutively. Three patients showed complete response at one year follow up. Two patients showed partial response after two months, so they received a second course of therapy with IM. At one-year follow-up, one of them showed complete response, the other partial response. Our experience demonstrated that IM may be considered as an effective and safe treatment option in EQ. IM offers various advantages such as easy and fast application, rapid complete remission, better compliance, few side effects and excellent cosmetical results. The authors call for further exploitation in bigger trials.

Advances in penile reconstructive techniques for primary penile tumors

We present a review on advances in the management of primary penile tumors. Penile cancer is an uncommon disease with numerous implications for not only quantity but also quality of life. We discuss reconstructive options that are available for patients after initial removal of malignancy, with an emphasis on organ-sparing approaches. This review examines possibilities along the spectrum of this disease, dependent on the severity and extent of presenting lesions, with discussion of techniques ranging from glans resurfacing for carcinoma in situ (CIS) to flap reconstruction for tumors requiring total penectomy. We also address frontiers in the field related to tissue engineering and transplantation innovation. These options are presented to provide urologists with a better understanding of the state of the art to optimize patients’ oncologic, functional, and cosmetic outcomes.

A Retrospective Analysis of Carcinoma Penis Patients Treated at a Cancer Center in Nepal in a Period of Five Years

Introduction: Carcinoma Penis is not an uncommon condition in a developing country like Nepal and comprises 1-10% of all the malignancies in males. In this study we analyzed the demographic and clinicopathological profile of penile cancer patients who visited our cancer center during specified period.
 Methods: This is a descriptive cross-sectional study, that altogether included 218 patients from January 2012 to December 2016 with penile cancer conducted at B P Koirala Memorial Cancer Hospital, Nepal. All the demographic and clinico-pathological data were collected and analyzed using SPSS 16.0 software. Tumor staging was standardized according to the American Joint Committee on Cancer system. Quantitative data were represented as mean and standard deviation whereas categorical variables were expressed as frequencies and percentages of an appropriate denominator.
 Results: Among 218 patients, the mean ± SD age was 53.94 ± 13.69 years. Most were married (88.07%), smokers (67.88%), had poor personal hygiene (70.64%) and had not completed primary school (71.64%). The predominant profession was agriculture (81.65%). Most of the patients (56.88%) were diagnosed in clinical stage III b (T1-3, N2). Management was circumcision alone in 5.5%, Wide local excision in 6.88%, partial penectomy in 66.97% patients, total penectomy with perineal urethrostomy in 11% of patients and 9.63% patients were sent for chemotherapy after initial biopsy for fixed and fungating inguinal nodes. Bilateral inguinal lymph node dissection was performed in 87.15% patients. Most of our patients were uncircumcised (90.82%) Squamous cell carcinoma was the commonest histopathology (98.6%).
 Conclusion: Penile cancer is more common among farmer with low socioeconomic status. The disease is already locally advanced and at the time of diagnosis. Surgery is the main modality of treatment.

Partial penectomy or total penectomy for T1 and T2 squamous cell carcinoma of the penis

Background: To assess prognostic factors and survival outcomes for partial penectomy (PP) and total penectomy (TP) patients with T1 and T2 squamous cell carcinoma of the penis. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 708 penile cancer patients. Among these, 607 underwent PP and 101 underwent TP. Kaplan-Meier analysis was used to compare survival outcomes between PP and TP patients. Univariate and multivariate Cox proportional hazards regression models were used to determine prognostic factors. Results: There were significant differences in marital status and regional lymph node removal between patients of the PP and TP groups. Multivariate regression analysis demonstrated that age [odds ratio (OR) =1.045; 95% confidence interval (CI): 1.034–1.057; P<0.0001], T2 carcinoma (OR =1.388; 95% CI: 1.077–1.788; P=0.0114), node stage N1–3 (OR =3.351; 95% CI: 2.317–4.847; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.498; 95% CI: 0.255–0.972; P=0.0411) were independent predictors of overall survival (OS). Age (OR =1.019; 95% CI: 1.005–1.033; P=0.0065), stage N1–3 (OR =5.127; 95% CI: 3.213–8.181; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.452; 95% CI: 0.219–0.932; P=0.0315) were independent predictors of cancer specific survival (CSS). However, there was no significant difference between PP and TP in terms of OS and CSS. Conclusions: There was no significant difference in terms of OS and CSS between patients treated by PP or TP. T2 was associated with shorter OS, while age and N1–3 were associated with shorter OS and CSS. Removal of ≥4 regional lymph nodes was associated with longer OS and CSS.

Prevenir Complicações: Linfadenectomia Inguinal Modificada Vídeo-Assistida no Estadiamento do Tumor do Pénis

A linfadenectomia inguinal modificada permite um estadiamento correto na maioria dos casos de carcinoma do pénis sem gânglios inguinais palpáveis. Atualmente, é possível reproduzir a técnica cirúrgica clássica por via vídeo-assistida, com resultados oncológicos semelhantes e menor taxa de complicações.&#x0D; O artigo reporta um caso de tumor do pénis, sujeito a penectomia total (pT3NxMx), sem gânglios inguinais palpáveis, onde se realizou uma linfadenectomia inguinal modificada vídeo-assistida (LIMVA) bilateral, sendo descrita a técnica cirúrgica da LIMVA direita.&#x0D; Neste artigo são descritos todos os passos da técnica cirúrgica (posicionamento do doente, disseção romba profundamente à faixa de Scarpa, identificação dos limites anatómicos da disseção, identificação dos vasos femorais, identificação da veia safena até a fossa ovalis, excisão dos gânglios e encerramento).&#x0D; A grande vantagem da LIMVA é a diminuição de complicações pós-operatórias, nomeadamente a baixa taxa de deiscência da ferida operatória e de edema dos membros inferiores.

Partial penectomy or total penectomy for T1 and T2 squamous cell carcinoma of the penis?

BackgroundTo assess prognostic factors and survival outcomes for partial penectomy (PP) and total penectomy (TP) patients with T1 and T2 squamous cell carcinoma of the penis.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was used to identify 708 penile cancer patients. Among these, 607 underwent PP and 101 underwent TP. Kaplan-Meier analysis was used to compare survival outcomes between PP and TP patients. Univariate and multivariate Cox proportional hazards regression models were used to determine prognostic factors.ResultsThere were significant differences in marital status and regional lymph node removal between patients of the PP and TP groups. Multivariate regression analysis demonstrated that age [odds ratio (OR) =1.045; 95% confidence interval (CI): 1.034–1.057; P<0.0001], T2 carcinoma (OR =1.388; 95% CI: 1.077–1.788; P=0.0114), node stage N1–3 (OR =3.351; 95% CI: 2.317–4.847; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.498; 95% CI: 0.255–0.972; P=0.0411) were independent predictors of overall survival (OS). Age (OR =1.019; 95% CI: 1.005–1.033; P=0.0065), stage N1–3 (OR =5.127; 95% CI: 3.213–8.181; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.452; 95% CI: 0.219–0.932; P=0.0315) were independent predictors of cancer specific survival (CSS). However, there was no significant difference between PP and TP in terms of OS and CSS.ConclusionsThere was no significant difference in terms of OS and CSS between patients treated by PP or TP. T2 was associated with shorter OS, while age and N1–3 were associated with shorter OS and CSS. Removal of ≥4 regional lymph nodes was associated with longer OS and CSS.

A Case of Penile Pyoderma Gangrenosum Treated with Steroid Administration without Penectomy

We report a case of idiopathic penile pyoderma gangrenosum that was successfully treated with corticosteroid treatment without penectomy. A 67-year-o1d man with induration and tenderness of the penile shaft visited a local hospital. A penile abscess was suspected on magnetic resonance imaging, and needle biopsy did not reveal malignancy. After the tension of the penile shaft had worsened, he was referred to our hospital where surgical drainage and re-biopsy were performed. Microbiological cultures revealed no growth, and pathological examination revealed no evidence of malignancy. Despite drainage, the abscess recurred on postoperative day 18. With a working diagnosis of penile pyoderma gangrenosum, we initiated prednisolone 30 mg once daily followed by taper and performed a second surgical drainage, leaving the wound open to heal by secondary intention. Wound discharge declined gradually, and no recurrence of abscess has yet been observed. Pyoderma gangrenosum is clinically diagnosed when subcutaneous chronic inflammatory findings are present without concurrent bacterial infection. Corpus cavernosum abscess presenting as the initial symptom of pyoderma gangrenosum is rare. Most cases of recurrent corpus cavernosum abscess eventually result in total penectomy. In this case, we successfully avoided penectomy by suspecting pyoderma gangrenous and initiating prednisolone treatment appropriately.

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

PurposeTo report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis.MethodsThis was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed.Results55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan–Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival.ConclusionsOSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.

Evaluation of Paclitaxel, Ifosfamide, and Cisplatin (TIP) Regimen on Penile Cancer in Adam Malik Medan: A Single Center 2 Years of Experience.

BACKGROUND:Penile tumour is a rare tumour in the genitourinary system, account for 0.4-0.6%. Although rare, patients are often unaware and come in late stage, so the use of chemotherapy agents is becoming crucial.AIM:This study was conducted to evaluate responses and overall survival rate of Paclitaxel, Ifosfamide, and Cisplatin (TIP) regimen in penile cancer with nodal involvement.METHODS:We included all medical records of penile squamous cell carcinoma patients associated with nodal involvement who acquired TIP regimen in Adam Malik Hospital between 2014 and 2016. We administered 175 mg/m2 of Paclitaxel on day 1, 1200 mg/m2 of Ifosfamide on days 1 to 3, and 25 mg/m2 of Cisplatin on days 1 to 3 as our standard TIP regimen. The regimen was re-administered every 21-28 days. Characteristics of the patient including age, history of circumcision, races, primary lesion of the tumour and TNM staging were noted. Adverse event, clinical responses, and overall survival were assessed and evaluated.RESULTS:We extracted data from 17 patients of penile cancer with nodal involvement who acquired TIP regimen with a mean age of 44.18 ± 11.13 years old from our medical records. Only 10 patients completed the full 4 cycles of the regimen. Four patients died before completion, two patients refused to continue the regimen, and 1 patient is still on the second cycle. Total penectomy was the most frequent procedure had taken, and clinical stage T4 and N3 was the most findings at initial diagnosis. There was no complete response noted. Six patients were noted as partial response, and 1 patient was noted as progressive disease. The Kaplan-Meier curve shows an overall 6 months (95% CI: 4.4-7.6 months) of survival with a median of follow-up time was 7 (1-11) months. In subgroup analysis, we found that the responder group has significantly better overall survival than the non-responder group (log-rank test, p = 0.004).CONCLUSION:Paclitaxel, Ifosfamide, and Cisplatin (TIP) regimen give significant clinical benefit in penile cancer with nodal involvement.

MP73-15 THE SYSTEMIC INFLAMMATORY MARKERS IN PERIPHERAL BLOOD BEFORE SURGICAL TREATMENT IN PENILE SQUAMOUS CELL CARCINOMA ARE PREDICTORS OF SURVIVAL

INTRODUCTION AND OBJECTIVES:Penile cancer is an aggressive and uncommon disease. Greater than 95% are caused by squamous cell carcinomas (SCC).There is growing evidence to support the association of systemic inflammation in cancer development and progression. We aimed to evaluate whether systemic inflammatory markers in peripheral blood before penectomy and before radical inguinal lymph node dissection (ILND) may be prognostic marker.METHODS:We retrospectively reviewed data from 230 patients with penile cancer followed between 2009 and 2018 in a single center, to identify 126 patients who were submitted to total or partial penectomy and 79 patients who were submitted to ILND for non-metastatic PSCC. We evaluated neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR) obtained preoperatively. The cut-off point of NLR ≥ 3.0 was chosen following positive results found in previous studies in penile cancer and the cut-off point of LMR and PLR was chosen f...

Predictor factor of inguinal lymph lode metastasis in men with penile cancer at Sanglah General Hospital, Denpasar, Bali

Background: To know predictor factors of inguinal node metastasis in penile cancer. Methods: A retrospective study about penile cancer in Sanglah Hospital, Bali, from 2011 to 2015. Patients had undergone partial or total penectomy, and inguinal node dissection or excisional biopsy for histopathology finding. Results: A 65 penile cancer patients were diagnosed for 5 years. Mean age was 53,24 ± 13,42 years. Fifteen were excluded and 25 of 50 patients (50%) had inguinal node metastasis. There were significant correlation between pathologic stage (p=0,021), histologic grade (p=0,020) and vascular invasion (p=0,008) with the presence of inguinal node metastasis. Primary tumor of pT1 showed 14% inguinal node metastasis compared to pT2 (42%), pT3 (67%), and pT4 (100%). Histologic grade I, had 22% inguinal node metastasis compared to grade II (50%), and grade III (100%). Only 39% patients without vascular invasion had inguinal node metastasis compared to 83% with vascular invasion. Conclusion: Pathologic stage of primary tumor, histologic grade and vascular invasion were predictor factors of inguinal node metastasis in penile cancer.

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.

PENILE CANCER: A STUDY OF 9 CASES AT HASAN SADIKIN HOSPITAL BANDUNG BETWEEN JANUARY 2010 AND DECEMBER 2015

Objective: Penile cancer are the rarest carcinoma of the genitourinary system that are often devastating for the patient and frequently diagnostically and therapeutically challenging for the Urologist. In view of this, it would be interesting to study the incidence, demographics, presentation, and treatment of the patients. The aim of this study was to report the status of penile cancer at Hasan Sadikin Hospital Bandung. Material &amp; Methods: This was a retrospective study of 9 patients. We study the incidence, demographics, presentation, and treatment of the patients at Hasan Sadikin Hospital Bandung between January 2010 and December 2015. Results: The mean age of the patients was 50.44 ± 12.09 years old. All patients had squamous cell carcinoma. Five patients underwent partial penectomy, 4 patients underwent total penectomy and perineostomy for urinary diversion. Four patients had lymph node localization. A Superficial lymph node dissection was performed in two patients. One of our patient was referred to hemato-oncologist for chemotherapy. Conclusion: Penile cancer seems rare in our hospital. General public should be educated about genital hygiene and early circumcision in male infant as a prophylactic measure. An understanding of the various operative procedures for treatment of the primary tumor and regional lymph nodes is therefore critical in the successful management of this condition.

Expression of LHCG receptors in the human penis

The aim of this study is to investigate the expression of the luteinizing hormone/choriogonadotropin (LHCG) receptor in the human penis to see, if the luteinizing hormone (LH) effects are possible in the spongious and cavernous tissue of the penis. The number of men with erection disturbances increases significantly simultaneously with the elevated LH concentrations between 40 and 70 years. It is possible that the elevated LH concentrations may influence locally the erectile mechanisms. The precondition for this is the expression of LHCG receptors in the penis. Penile tissue was obtained from three patients undergoing total or partial penectomy due to a rectal cancer with secondary penile metastasis or squamous cell carcinoma of the penis. Immunohistochemistry was used for the detection of the LHCG receptor. Positive immunoreaction for LHCG receptors was discovered in the endothelial cells of cavernous spaces in the corpus cavernosum and corpus spongiosum penis, also in the endothelial cells of the capillary walls in all patients. Our results show that LHCG receptor is expressed in the spongious and cavernous tissue of the human penis. This finding suggests that LH can affect the spongious and cavernous tissue in human and play a significant role in the development of erectile dysfunction among the aging men.

Development of a Novel Prognostic Risk Score for Predicting Complications of Penectomy in the Surgical Management of Penile Cancer.

Penectomy for PC is useful in staging, disease prognosis, and treatment. Limited studies have evaluated its surgical complications. We sought to assess these complications and determine predictive models to create a novel risk score for penectomy complications. A retrospective review of patients undergoing PC surgical management from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program was performed. Data were queried for partial and total penectomy among those with PC. To develop predictive models of complications, we fit LASSO logistic, random forest, and stepwise logistic models to training data using cross-validation, demographic, comorbidity, laboratory, and wound characteristics as candidate predictors. Each model was evaluated on the test data using receiver operating characteristic curves. A novel risk score was created by rounding coefficients from the LASSO logistic model. A total of 304 cases met the inclusion criteria. Overall incidence of penectomy complications was 19.7%, where urinary tract infection (3.0%), superficial surgical site infection (3.0%), and bleeding requiring transfusion (3.9%) were most common. LASSO logistic, random forest, and stepwise logistic models for predicting complications had area under the curve (AUC) [95% confidence interval] values of 0.66 [0.52-0.81], 0.73 [0.63-0.83], and 0.59 [0.45-0.74], respectively. Eleven variables were included in the risk score. The LASSO model-derived risk score had moderately good performance (area under the curve [95% confidence interval] 0.74 [0.66-0.82]). Using a cutoff point of 6, the score attains sensitivity 0.58, specificity 0.74, and kappa 0.26. PC management through penectomy is associated with appreciable complications rates. Predictive models of penectomy complications performed moderately well. Our novel prognostic risk score may allow for improved preoperative counseling and risk stratification of men undergoing surgical management of PC.

P11 - Total penectomy, a compromise for life: Results from the pecad study

P11 - Total penectomy, a compromise for life: Results from the pecad study