Primary penile cancer organ sparing treatment

Abstract

Introduction: Surgical treatment of penile cancer is usually associated with mutilation; alterations in self-esteem and body image; affecting sexual and urinary functions; and declined health-related quality of life. Recently, organ sparing treatment has appeared and led to limiting these complications.

Material and methods: An extensive review of the literature concerning penile-preserving strategies was conducted. The focus was put on indications, general principles of management, surgical options and reconstructive techniques, the most common complications, as well as functional and oncological outcomes.

Results: Analyzed methods, e.g.: topical chemotherapy, laser ablation therapy, radiotherapy, Moh's microscopic surgery, circumcision, wide local excision, glans resurfacing and glansectomy are indicated in low-stage tumors (Tis, Ta-T2). After glansectomy, reconstruction is also possible.

Conclusions: Organ sparing techniques may achieve good anatomical, functional, and psychological outcomes without compromising local cancer control, which depends on early diagnosis and treatment. Penile sparing strategies are acceptable treatment approaches in selected patients with low-stage penile cancer after establishing disease-risk and should be considered in this population.

Keywords: QoL; organ sparing treatment; penile cancer.

Figure 1

Initial step in glans resurfacing where the epithelium and subepithalial tissue is removed from the spongiosum by sharp dissection.

Figure 2

Split-skin graft is sutured with interrupted absorbable sutures to the meatal and shaft edges after removal of epithelium and subepithalial tissue during glans resurfacing.

Figure 3

Developing the plane to allow separation of the glans from corpora cavernosa during the intial step of glansectomy.

Figure 4

Ventral spatulation of the urethra and formation of a new meatus by fixing it to the corpora cavernosa.

Figure 5

Split-skin graft is placed creating a neoglans covering the corporal tips.

Figure 6

Completed glansectomy with split-sking graft.