Update on organ preserving surgical strategies for penile cancer

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

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.

Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review

INTRODUCTION

Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.

OBJECTIVES

The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.

METHODS

A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.

RESULTS

Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.

CONCLUSION

OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.

Venous thrombosis, multiple carcinomatous foci and differences in metastatic pathways of penile carcinoma

The aim of the present study was to explore the life-threatening complications and metastatic pathways of penile squamous cell carcinoma (SCC), as numerous patients with penile cancer are relatively young, are of good general health and have no visceral metastasis, yet have poor survival rates. A total of 94 patients with SCC of the penis who were surgically treated were included in the current study. The coagulation parameters, including prothrombin time (PT), fibrinogen and D-dimer, were analyzed. The patients' age ranged from 25 to 95 years (mean ± standard deviation, 53.3±1.4 years). A total of 77 patients (81.9%) underwent partial penectomy and 17 (18.1%) underwent radical penectomy. The PT was significantly different between patients whose tumour invaded the corpora cavenosum and those whose tumour had not invaded, and between patients with and without pelvic lymph node metastasis. A negative correlation was obtained between PT and pelvic lymph node metastasis. In addition, six typical SCC cases and one metastatic penile carcinoma case manifested with multiple carcinomatous foci, embolisms and evidence of a metastatic pathway occurring simultaneously with tumour progression were presented. The present study indicated that venous thrombosis is one of the life-threatening complications of advanced penile cancer. Furthermore, multiple carcinomatous foci were detected in histological images. Of note, direct clinical evidence for different metastatic pathways of primary and secondary penile carcinoma was provided.

Developing biomedical engineering technologies for reproductive medicine

Infertility is a rising global health issue with a far-reaching impact on the socioeconomic livelihoods. As there are highly complex causes of male and female infertility, it is highly desired to promote and maintain reproductive health by the integration of advanced technologies. Biomedical engineering, a mature technology applied in the fields of biology and health care, has emerged as a powerful tool in the diagnosis and treatment of infertility. Nowadays, various promising biomedical engineering approaches are under investigation to address human infertility. Biomedical engineering approaches can not only improve our fundamental understanding of sperm and follicle development in bioengineered devices combined with microfabrication, biomaterials, and relevant cells, but also be applied to repair uterine, ovary, and cervicovaginal tissues and restore tissue function. Here, we introduce the infertility in male and female and provide a comprehensive summary of the various promising biomedical engineering technologies and their applications in reproductive medicine. Also, the challenges and prospects of biomedical engineering technologies for clinical transformation are discussed. We believe that this review will promote communications between engineers, biologists, and clinicians and potentially contribute to the clinical transformation of these innovative research works in the immediate future.