Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

Abstract

Background: Men with localized invasive penile cancer (PC) can be treated with organ-sparing treatments with different functional and aesthetical outcomes. Thus, the aim of this study is to investigate sexual outcomes in patients with PC confined to the glans that underwent wide local excision (WLE) vs. glansectomy with urethral glanduloplasty. Methods: Complete data from 60 patients with PC were analyzed at our institution from 2017 to 2022. Patients were asked for personal habits and clinical features. PC was assessed with a clinical visit and imaging techniques. At the outpatient follow-up visit or phone call, all patients compiled the Changes in Sexual Function Questionnaire (CSFQ) and the International Index of Erectile Function in its short 5-item form (IIEF-5). Erectile function (EF) impairment was categorized using Cappelleri’s criteria. Results: Overall, 34 patients with PC confined to the glans (c ≤ T2N0) were included. Of those, 12 underwent WLE and 22 underwent glansectomy with urethral glanduloplasty. Using multivariable logistic regression, glansectomy (OR: 3.49) and diabetes (OR: 2.33) were associated with erectile disfunction (IEEF < 22). Meanwhile, using multivariable linear regression analysis, younger patients (Coeff: −2.41) and those that underwent glansectomy (Coeff: −7.5) had a higher risk of sexual function impairment, according to the CSFQ. Conclusions: Patients with PC ≤ T2N0 that underwent WLE have better outcomes in terms of sexual functioning than the patients who underwent glansectomy and uretheral gladuloplasty. Further research is needed to clarify the outcomes of penile-sparing surgery, to inform patients in pre-surgical counseling more comprehensively, and to meet their post-operative expectations more effectively.

A comprehensive review of current knowledge on penile squamous cell carcinoma

“…Penile cancer and its treatment have a significant impact on sexual wellbeing, both physiologically and psychologically, with more than 40% of patients impacted negatively post-surgery in at least one of these domains ( 56 – 58 ). Organ sparing procedures are often considered to have better outcomes than more radical approaches ( 21 , 48 , 57 ) however, some reports have shown that sexual outcomes after WLE and glansectomy with urethral glanduloplasty still have some reduction in sexual function. Glanduloplasty patients appear to exhibit a worse international index of Erectile Function (IIEF-5) and Changes in Sexual function (CSFQ) scores post-surgery ( 57 ).…”

“…It consists of several aspects including, but not limited to, ability to obtain and maintain erection, achievement of orgasm, sexual desire, intercourse satisfaction and overall sexual satisfaction (56). Penile cancer and its treatment have a significant impact on sexual wellbeing, both physiologically and psychologically, with more than 40% of patients impacted negatively post-surgery in at least one of these domains (56)(57)(58). Organ sparing procedures are often considered to have better outcomes than more radical approaches (21, 48, 57) however, some reports have shown that sexual outcomes after WLE and glansectomy with urethral glanduloplasty still have some reduction in sexual function.…”

“…A similar trend was observed for total intercourse satisfaction, this is linked to both frequency of intercourse and enjoyability thereof. According to available data is seems that the impact on sexual health is dependent both on patient demographics and the treatment method but also the psychological health of the patient (56)(57)(58). Factors such as age, partnership relationship and penile length post surgery seems to play a major role in reports of dysfunction and dissatisfaction with sexual activity.…”

Improving Quality of Life and Psychosocial Health for Penile Cancer Survivors: A Narrative Review

“…At 12 months post-surgery, those who underwent glansectomy (n = 22) exhibited poorer IIEF-5 and CSFQ scores compared to the wide local excision (WLE) group (n = 12). Patients with diabetes who underwent glansectomy exhibited a higher susceptibility to experiencing erectile dysfunction, with more pronounced dysfunction observed in younger patients [29].…”

Preoperative Albumin-to-Alkaline Phosphatase Ratio as an Independent Predictor of Lymph Node Involvement in Penile Cancer

“…To date, surgery stands as the primary treatment for PC. However, for precancerous lesions or early-stage malignancies, less invasive approaches, such as topical chemotherapy with imiquimod or 5-fluorouracil (5-FU), laser therapy, or brachytherapy may be considered, Medicina 2024, 60, 414 2 of 8 since radical treatments may exhibit profound negative impact on the patient's sexual function, quality of life (QOL), social interactions, self-image and self-esteem [3].…”