Sexual outcomes after organ potency-sparing surgery and glans reconstruction in patients with penile carcinoma

Abstract

Introduction:Radical surgery is the “gold standard” for treatment of invasive penile carcinoma but very poor aesthetic, functional and psychological outcomes have been reported. Our purpose was to assess the impact of organ potency-sparing surgery in locally confined carcinoma of the penis.Materials and Methods:We evaluated retrospectively 42 patients with early penile cancer (Ta,T1,T2), treated with glandulectomy and glanduloplasty with urethral mucosa and sparing of cavernosal apexes, or glandulectomy and limited apical resection in cases of Stage T2. Sexual function, ejaculation and libido were evaluated with an IIEF-15 questionnaire before the appearance of neoplasia (about three months before the surgery) and six months after surgery. Quality of life was evaluated by the Bigelow-Young questionnaire. The scores relating to two weeks prior to the surgery have been compared to those obtained six months after surgery. The statistical analysis was conducted using t-Student for repeated measures and analysis of variance.Results:Six months after surgery 73% of patients reported spontaneous rigid erections, 60% coital activity while 76% of the group treated with urethral glanduloplasty reported normal ejaculation and orgasm, regained an average of 35 days after surgery. The average IIEF-15 scores reported in the entire series in the domains of erection, libido and coital activity of the pre-cancer period were not statistically different than those recorded six months after surgery. In the group treated with glandular reconstruction, pre-and postoperative IIEF-15 mean scores related to ejaculation and orgasm domains were not significantly different. Mean scores of Bigelow-Young questionnaires related to sexual pleasure, familial, social and professional relationships showed significant improvement after surgery.Conclusions:Potency sparing-sparing surgical treatments have a positive impact on a wide spectrum of the patient's life including family relationships, and social and working conditions.

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

“…Although local recurrence rate was higher after OSS, the majority of patients were managed with further OSS, extended surgery such as partial penectomy only being necessary in 27.3% of patients. Thus, OSS is a safe alternative to radical amputation [14,26,27,33,34]. Tumors staged pT2 and above were mainly managed by partial penectomy in our study; but there is no general consent concerning recommended techniques in invasive penile cancer [35].…”

“…Various studies evaluating sexual and urinary dysfunction after penile-preserving surgery using different questionnaires (e.g. International Index of Erectile Function questionnaire; IIEF) [28] confirmed excellent overall urinary function and quality of life [16,26,29]. Patients with (partial) penectomy reported more sexual and urinary problems than those treated with OSS [23,30].…”

“…Partial or total penectomy have both shown to result in good local control with a low risk of local recurrence of 4-5% [22], yet carry the burden of sexual dysfunction and reduced functional and urinary quality of life [23,24]. Current evidence suggests that OSS maintains a sexual and urinary function, and psychological health [25][26][27]. Various studies evaluating sexual and urinary dysfunction after penile-preserving surgery using different questionnaires (e.g.…”

Primary penile cancer organ sparing treatment

“…It is an acceptable treatment modality for Tis, Ta and T1a disease. Literature supports its use for extensive pre-malignant lesions and carcinoma in situ, where it can be performed as a primary procedure or when treatment with topical agents fails [15, 35, 36]. …”

“…Depasquale's technique of cavernous rotation in which the extremities of corpora are separated and rotated ventrally and then sutured under the urethra to imitate the appearance of the glans and coronal sulcus was used in one series with good cosmetic and functional results, yet with considerably high complications rate of 27% [34]. Since reduction of penile sensitivity seems to be a major functional problem after grafting, neoglans formation by everting the spatulated urethra was also tried to avoid this side effect [36, 41]. …”