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O'Connell KA, Thomas JL, Murad F, Zhou G, Sonpavde GP, Mossanen M, Clinton TN, Ji-Xu A, Alton K, Spiess PE, Rossi AM, Schmults CD. Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma. J Urol 2024; 211:90-100. [PMID: 37788015 PMCID: PMC10841097 DOI: 10.1097/ju.0000000000003736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes. MATERIALS AND METHODS This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care centers. The cohort consisted of 189 patients with histologic diagnosis of in situ or T1a cutaneous squamous cell carcinoma of the penis at Brigham and Women's, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models. RESULTS The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 disease-specific deaths. Primary tumors were excised with PDEMA (N = 30), excision/circumcision (N = 110), or penectomy/glansectomy (N = 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated. CONCLUSIONS Initial results are encouraging that PDEMA surgical management effectively controls early-stage penile squamous cell carcinoma.
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Affiliation(s)
- Katie A O'Connell
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob L Thomas
- Division of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Fadi Murad
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Timothy N Clinton
- Division of Urology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California
| | - Kristina Alton
- Department of Psychiatry and Behavioral Neurosciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anthony M Rossi
- Division of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Chrysalyne D Schmults
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Cilio S, Tufano A, Pezone G, Alvino P, Spena G, Pandolfo SD, Del Prete P, Amato C, Damiano R, Salonia A, Autorino R, Izzo A, Passaro F, Perdonà S. Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer. Curr Oncol 2023; 30:10501-10508. [PMID: 38132399 PMCID: PMC10742874 DOI: 10.3390/curroncol30120765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
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.
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Affiliation(s)
- Simone Cilio
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00161 Rome, Italy
| | - Gabriele Pezone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pierluigi Alvino
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Gianluca Spena
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Savio Domenico Pandolfo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Claudio Amato
- Dipartimento di Chimica e Tecnologia del Farmaco, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Salonia
- Unit of Urology/Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, 20141 Milan, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
| | - Francesco Passaro
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy
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Croghan SM, Cullen IM, Raheem O. Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review. Sex Med Rev 2023; 11:441-459. [PMID: 37204120 DOI: 10.1093/sxmrev/qead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin D02 YN77, Ireland
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
| | - Ivor M Cullen
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
- Department of Urology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Omer Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL 60637, United States
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Scornajenghi CM, Asero V, Bologna E, Basile G, De Angelis M, Moschini M, Del Giudice F. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review. Curr Opin Urol 2023; Publish Ahead of Print:00042307-990000000-00098. [PMID: 37377374 DOI: 10.1097/mou.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Penile cancer (PeCa) is an orphan disease due to its rare incidence in high-income countries. Traditional surgical options for clinical T1-2 disease, including partial and total penectomy, can dramatically affect patient's quality of life and mental health status. In selected patients, organ-sparing surgery (OSS) has the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of various OSSs currently available for men diagnosed with PeCa seeking an organ-preserving option. RECENT FINDINGS Patient survival largely depends on spotting and treating lymph node metastasis at an early stage. The required surgical and radiotherapy skill sets cannot be expected to be available in all centers. Consequently, patients should be referred to high-volume centers to receive the best available treatments for PeCa. SUMMARY OSS should be used for small and localized PeCa (T1-T2) as an alternative to partial penectomy to preserve patient's quality of life while maintaining sexual and urinary function and penile aesthetics. Overall, there are different techniques that can be used with different response and recurrence rates. In case of tumor recurrence, partial penectomy or radical penectomy is feasible, without impacting overall survival.
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Affiliation(s)
- Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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White J, Mason R, Lawen T, Spooner J, Faria KVM, Rahman F, Ramasamy R. Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments. Res Rep Urol 2023; 15:165-174. [PMID: 37288454 PMCID: PMC10243351 DOI: 10.2147/rru.s387228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Penile cancer is a rare malignancy, most commonly diagnosed in older men, associated with poor outcomes, dramatic decline in quality of life and sexual function. Squamous cell carcinoma is the most common histopathology of penile cancer, accounting for 95% of all cases. Localized, early-stage penile cancer can be effectively managed through penile-sparing techniques in many cases, though advanced stages of penile cancer carry a poor prognosis. Current innovative treatments are exploring the role of targeted therapy, HPV-directed therapy, immune checkpoint inhibitors and adoptive T-cell therapies in treatment and prevention of relapse of penile cancer. Clinical trials are investigating the potential of targeted therapies and immune checkpoint inhibitors in advanced penile cancer. This review examines the current management of penile cancer and highlights future directions in research and treatment.
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Affiliation(s)
- Joshua White
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tarek Lawen
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Spooner
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Kauy V M Faria
- Department of Urology, Institute of Cancer of São Paulo, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Farah Rahman
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Pang KH, Muneer A, Alnajjar HM. Glansectomy and Reconstruction for Penile Cancer: A Systematic Review. Eur Urol Focus 2022; 8:1318-1322. [PMID: 34903488 DOI: 10.1016/j.euf.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/24/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
Penile cancer (PeCa) is a rare disease, with a global incidence of 36068 new cases reported in the 2020 GLOBOCAN database. Narrower excision margins are now acceptable without compromising survival. Glansectomy is commonly performed for invasive PeCa confined to the glans penis. The majority of data on glansectomy are from small single-centre series. We provide a contemporary update on the outcomes of glansectomy via a systematic review of glansectomy for PeCa. Overall, 20 studies were included in the analysis. The local recurrence rate was 2.6-16.7%. The incidence of salvage penectomy for positive margins and/or recurrence was 1.2-8.3%. The disease-specific survival rate was 89-96.6%. A split-thickness skin graft was commonly used to reconstruct a neoglans and the graft loss rate was 1.5-23.5%. The incidence of meatal stenosis was 2.8-14.3%. Good cosmetic outcomes and normal erections were reported in 95-100% and 50-100% of cases, respectively. Glansectomy provides acceptable oncological control without significantly compromising functional outcomes. PATIENT SUMMARY: Penile cancer invading into the head of the penis can be surgically treated with a procedure called glansectomy that has good cancer control and cosmetic outcomes. In addition, penile length can be preserved, which allows men to urinate standing up and to achieve penetrative sexual intercourse.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Section of Andrology, Pyrah Department of Urology, St James' Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; UCL Male Genital Cancer Centre, Division of Surgery and Interventional Science, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Hussain M Alnajjar
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
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Sakalis VI, Campi R, Barreto L, Garcia-Perdomo HA, Greco I, Zapala Ł, Kailavasan M, Antunes-Lopes T, Marcus JD, Manzie K, Osborne J, Ayres B, Moonen LM, Necchi A, Crook J, Oliveira P, Pagliaro LC, Protzel C, Parnham AS, Albersen M, Pettaway CA, Spiess PE, Tagawa ST, Rumble RB, Brouwer OR. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. EUR UROL SUPPL 2022; 40:58-94. [PMID: 35540709 PMCID: PMC9079254 DOI: 10.1016/j.euros.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Context The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh’s micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh’s micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh’s micrographic surgery could be used for smaller lesions.
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Zimmermann EF, Embury-Young Y, Dickerson D, Manjunath A. Sexual and urinary function after organ sparing surgery for penile cancer: A questionnaire study of consecutive patients over a 3-year period in a single region. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function. Method: Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included. Results: A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down. Conclusion: Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.
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Affiliation(s)
| | - Ysabelle Embury-Young
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - David Dickerson
- Department of Urology, North Bristol NHS Trust, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Aditya Manjunath
- Department of Urology, North Bristol NHS Trust, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
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Pang KH, Alnajjar HM, Muneer A. Advances in penile-sparing surgical approaches. Asian J Urol 2022; 9:359-373. [DOI: 10.1016/j.ajur.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
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Falcone M, Preto M, Blecher G, Timpano M, Peretti F, Ferro I, Mangione C, Gontero P. The outcomes of glansectomy and split thickness skin graft reconstruction for invasive penile cancer confined to glans. Urology 2022; 165:250-255. [PMID: 35038491 DOI: 10.1016/j.urology.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report surgical, functional and patient reported outcomes(PROs) of glansectomy(GS) and split-thickness skin graft(STSG) reconstruction in case of locally invasive penile cancer(PC) MATERIALS AND METHODS: : A retrospective analysis from May 2015 to August 2019 was conducted. Inclusion criteria were age<80, a "de novo" malignancy, clinically confined PC (≤T2) with histological confirmation. Complications, recurrence-free(RFS), cancer-free(CFS) and overall survival(OS) were described. Functional outcomes and PRO's were explored using validated questionnaires and "ad hoc" created questionnaire respectively. Kaplan-Meier analysis, t-Student and the Mann-Whitney U test were used to estimate survival and postsurgical functional changes respectively. RESULTS 34 patients were enrolled. Median follow-up was 12(IQR:12-41) months. Positive surgical margins were detected in 2.9% of cases, requiring salvage surgery.Postoperative complications occurred in 29.4%, most commonly being a graft partial loss(17.6%), meatal stenosis(5.8%) or genital wound infection(5.8%). Disease recurrence occurred in 17.6% of cases with a median elapsed time of 16 months(12-41). 12-month RFS was 88.2%, whilst CSS and OS were 91 % at the same time point. Glans sensation was preserved in 91.2% of cases. 88.2% of patients reported to be fully satisfied with the postoperative aesthetic appearance of the penis, 91.2% of patients would recommend the same procedure to someone else. Limitations include retrospective design and the lack of a control group CONCLUSIONS: : GS with STSG minimizes the impact on urinary and sexual functions without jeopardizing oncological control in locally advanced PC.
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Affiliation(s)
- Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy; Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Italy
| | - Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy.
| | - Gideon Blecher
- Adjunct Lecturer, Department of Surgery. Monash University. Melbourne (Australia) Wellington Rd, Clayton VIC 3800, Australia; Urology Consultant. Department of Urology, The Alfred Hospital. Melbourne, (Australia) 55 Commercial Rd, Melbourne VIC 3004, Australia
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Federica Peretti
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Ilaria Ferro
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Carlotta Mangione
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
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Stroie FA, Houlihan MD, Kohler TS. Sexual function in the penile cancer survivor: a narrative review. Transl Androl Urol 2021; 10:2544-2553. [PMID: 34295742 PMCID: PMC8261429 DOI: 10.21037/tau-20-1228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022] Open
Abstract
Squamous cell carcinoma of the penis is a rare malignancy among men in North America and Europe with an incidence of <1 per 100,00 men. Of all genitourinary cancers, penile carcinoma has the potential to jeopardize sexual function the most. The treatment modalities of penile carcinoma span the gamut from organ-sparing treatments such as topical therapy, laser therapy, radiotherapy, glansectomy, wide-local excision and partial or total penectomy. There is a relative paucity of data in the medical literature describing the impact of penile cancer treatment on sexual function. The majority of available studies use retrospective data from small samples utilizing heterogeneous study tools such as patient interviews and non-validated questionnaires. The most commonly used validated instrument to evaluate sexual outcomes is the International Index of Erectile Function Questionnaire (IIEF), but is limited in that it does not assess patients who perform self-stimulation or achieve sexual stimulation by any means other than penetrative intercourse. Though advances in clinical research continue; large, well-designed comparative studies using validated instruments are elusive. The sexual outcomes after penile cancer are reviewed from the available published data to better assist the patient and the treating physician with medical decision making. With a detailed assessment of sexual outcomes, the physician is better equipped in providing patient centered care to achieve outcomes meaningful for each patient.
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Affiliation(s)
- Florian A Stroie
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL, USA
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12
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Preto M, Falcone M, Blecher G, Capece M, Cocci A, Timpano M, Gontero P. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021; 18:1099-1103. [PMID: 37057466 DOI: 10.1016/j.jsxm.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. AIM The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). METHODS From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. OUTCOMES Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. RESULTS 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. CLINICAL IMPLICATIONS TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions STRENGTHS AND LIMITATIONS: Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. CONCLUSION TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions. M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099-1103.
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Affiliation(s)
- Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy.
| | - Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy; Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Italy
| | - Gideon Blecher
- Adjunct Lecturer, Department of Surgery. Monash University. Melbourne (Australia) Wellington Rd, Clayton VIC, Australia; Urology Consultant. Department of Urology, The Alfred Hospital. Melbourne, Melbourne VIC, Australia
| | - Marco Capece
- Urology department, Federico II Hospital, University of Naples, Italy
| | - Andrea Cocci
- Urology department, Careggi Hospital, University of Florence, Florence, Italy
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Italy
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13
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Croghan SM, Compton N, Daniels AE, Fitzgibbon L, Daly PJ, Cullen IM. Phallus Preservation in Penile Cancer Surgery: Patient-reported Aesthetic & Functional Outcomes. Urology 2021; 152:60-66. [PMID: 33600836 DOI: 10.1016/j.urology.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess patient-reported outcomes of oncoplastic penile reconstruction using standardized questionnaires. Whilst organ-preserving penile cancer surgery has evolved, aiming to preserve genital function, reduce psychological morbidity of radical penectomy, and maximise patient quality of life, few studies have evaluated patients' final perceptions. METHODS Following ethical approval, patients post partial/radical glansectomy with reconstruction 2016-2019, under a single surgeon, were identified. Patients were posted a modified Index of Male Genital Image, the IIEF-5, a customised questionnaire exploring outcomes of urinary and sensory function and the EORTC QLQ-C30 to complete and return. Questionnaires were nonidentifiable, however study ID linked responses to the procedure performed. RESULTS A total of 130 questionnaires were received from 35 patients post penile reconstruction, giving a response rate of 71.4% (35/49). Mean time from surgery was 22 months (4-51), and mean age 61 years (31-79). The majority (82.4%, n = 28) were satisfied or felt neutral about the appearance of their genitalia. High satisfaction with postprocedure urinary function was reported; 85.3% (29/34) could void from a standing position and 79.4% (27/34) reported little or no spraying of urine. Nineteen patients (55.89%) were sexually active, with mean IIEF-5 scores of 14.9 (5-25) (partial glansectomy) and 15.8 (5-25) (radical glansectomy). Mean QoL over past week on 7-point EORTC QLQ-C30 scale was 5.88 (3-7). CONCLUSION We report good aesthetic and functional outcomes in a unique study exploring penile cancer surgery patient-reported outcome measures. These results strongly support phallus-preserving phallic-preserving strategies as the standard of care in eligible patients undergoing penile cancer surgery.
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Affiliation(s)
- Stefanie M Croghan
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland.
| | - Niall Compton
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland
| | - Anne E Daniels
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland
| | - Linda Fitzgibbon
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland
| | - Pádraig J Daly
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland
| | - Ivor M Cullen
- Department of Urological Surgery & Andrology, University Hospital Waterford, Waterford, Ireland
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14
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Coba G, Patel T. Penile Cancer: Managing Sexual Dysfunction and Improving Quality of Life After Therapy. Curr Urol Rep 2021; 22:8. [PMID: 33420966 DOI: 10.1007/s11934-020-01022-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To review the most current literature on how the treatment for penile cancer can affect quality of life and to discuss current treatment options to overcome sexual dysfunction and ultimately improve patient wellbeing. RECENT FINDINGS Multiple medical and surgical therapies exist to address the high incidence of sexual dysfunction following penile cancer treatment. Advancements and refinements in the neophalloplasty, penile prosthesis, and penile lengthening procedures have opened the door to improved long-term outcomes. Additionally, studies continue to highlight the severe psychological toll that penile cancer treatment can have on patients. We explore the potential options for addressing the inherent psychologic effects of these treatments and highlight the need for further research in this domain. Although rare, it is important for all urologists to be familiar with the treatments and post-treatment sequelae of penile cancer. Penile cancer is associated with dramatic decline in quality of life and sexual function. Multiple medical and surgical therapies exist that addresses these concerns. Additionally, urologists must also be mindful of the psychologic component regarding surgical disfigurement and the decline in sexual function.
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Affiliation(s)
- George Coba
- University of South Florida-Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Trushar Patel
- Department of Urology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, STC6, Tampa, FL, 33606, USA.
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15
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Abstract
Penile cancer is a rare malignancy with a reported incidence of 0.66–1.44 per 100,000 men, and a reported mortality of 0.15–0.37 per 10,000 men. Expert clinical examination and histological diagnosis from biopsy is required to determine the extent and invasion of disease, which is paramount in planning of appropriate treatment. Management of loco-regional penile cancer can be divided into management of primary tumour and management of regional lymph nodes. This review article will focus on the management of the primary penile tumour with particular focus on penile sparing therapies. The aim of primary penile tumour management is to completely remove the tumour whilst preserving as much organ function as possible. Preservation of the penis is important as it allows patients to maintain urinary and sexual function, as well as quality of life. With the majority of penile cancer confined to the glans and foreskin, most penile cancers can be managed with organ-preserving therapy. A wide variety of treatment options are available, and this review aims to describe each of the options including the reported oncological and functional outcome for the different therapies for penile cancer.
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Affiliation(s)
- Henry Han-I Yao
- Department of Urology, Eastern Health, Melbourne, Australia.,Department of Urology, Western Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Justin Chee
- Department of Urology, Western Health, Melbourne, Australia.,Department of Urology, Alfred Health, Melbourne, Australia
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16
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Abstract
Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer.
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Affiliation(s)
- Andrew Fang
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA
| | - James Ferguson
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA.,The University of Alabama, Birmingham School of Medicine- O'Neal Comprehensive Cancer Center , Birmingham, AL, USA
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17
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Falcone M, Preto M, Oderda M, Timpano M, Russo GI, Capogrosso P, Cocci A, Fode M, Gontero P. Total Glans Resurfacing for the Management of Superficial Penile Cancer: A Retrospective Cohort Analysis in a Tertiary Referral Center. Urology 2020; 145:281-286. [DOI: 10.1016/j.urology.2020.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
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18
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Beech BB, Chapman DW, Rourke KF. Clinical outcomes of glansectomy with split-thickness skin graft reconstruction for localized penile cancer. Can Urol Assoc J 2020; 14:E482-E486. [PMID: 32432538 DOI: 10.5489/cuaj.6277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penectomy as the traditional surgical treatment of penile cancer has substantial adverse functional and psychological impact. Glansectomy with split-thickness skin graft (STSG) reconstruction aims to provide curative resection while maximizing functional outcomes and minimizing psychological harm. We describe our outcomes of glansectomy with STSG reconstruction for penile cancer in a Canadian setting. METHODS We identified patients undergoing glansectomy with STSG genital reconstruction for squamous cell carcinoma of the penis from July 2006 to July 2019 at a single center. Patients undergoing glansectomy for reasons other than penile cancer were excluded. We collected clinical and pathological data, including patient demographics, 90-day complications, positive margin rate, local recurrence rate, disease-specific survival, and functional outcomes. Descriptive statistics were used to characterize our cohort and to examine outcomes. RESULTS Twelve men met study criteria with a median age of 62 years. Seven patients had failed prior treatment. The 90-day complication rate (Clavien >2) was 0% and graft take was excellent in all cases. The positive margins rate was 16.7% (n=2). Local recurrence occurred in two patients (16.7%), one of whom underwent a repeat organ-sparing surgery for salvage, while the other underwent radical penectomy for high-risk pathological features. Disease-free survival at a median followup of 14 months was 91.7% (11/12). Standing voiding and erectile function, as well as satisfactory cosmesis, were preserved in all patients. CONCLUSIONS Glansectomy with STSG reconstruction is a safe and effective treatment for men with localized penile cancer with simultaneous preservation of cosmesis, as well as urinary and sexual function.
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Affiliation(s)
- Ben B Beech
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W Chapman
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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19
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Pérez J, Chavarriaga J, Ortiz A, Orrego P, Rueda S, Quiroga W, Fernandez N, Patiño G, Tobar V, Villareal N, Prada J, Barco C, Sarmiento G. Oncological and Functional Outcomes After Organ-Sparing Plastic Reconstructive Surgery for Penile Cancer. Urology 2020; 142:161-165.e1. [PMID: 32380155 DOI: 10.1016/j.urology.2020.03.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe oncological and functional outcomes in patients treated with reconstructive organ-sparing surgery (OSS) for squamous cell carcinoma of the penis. Plastic reconstructive OSS of the penis with a split thickness skin graft has been proposed as a treatment option for penile cancer, with the objective being preservation of physiological voiding and sexual function without comprising oncological control. MATERIALS AND METHODS Multicenter study reporting clinicopathological data of 57 patients with malignant lesions of the penis treated with OSS and plastic reconstructive surgery with split thickness skin graft from 2007 to 2019. Health related quality of life (HRQoL) was assessed with EuroQoL-5D-3L, urinary symptoms with the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms, and erectile function with the International Index of erectile function (IIEF)-5. RESULTS Fifty-seven patients underwent OSS reconstructive surgery. Twenty underwent glans resurfacing, 23 partial penectomy, and 14 glansectomy. Median age was 55.1 years (interquartile range [IQR] 29-90), median follow-up 55.7 months (3-149). At the time of data analysis, 6 patients had died of Squamous Cell Carcinoma (SCC) (12.5%) and 10 (17.8%) had progressed. Kaplan-Meier estimates showed a 5-year survival rate of 87.5% and a 5-year progression-free survival of 83%. We assessed HRQoL and functional outcomes in 32 patients. EuroQol 5D-3L showed a mean health status of 82.5%, median Voiding score of the ICIQ-MLTUS was 4 (IQR 1-15), and median IIEF-5 19 (IQR 10.75-25). CONCLUSION OSS of the penis remains a safe and viable option for the treatment of SCC, ensuring a favorable appearance of the penis, preserving urinary and sexual function, with good HRQoL and without comprising oncological safety in selected cases.
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Affiliation(s)
- Jaime Pérez
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | - Julián Chavarriaga
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Ana Ortiz
- Division of Urology, Fundación Oftalmológica de Santander Clínica Ardila Lulle (FOSCAL), Universidad Autonoma de Bucaramanga, Colombia
| | - Paola Orrego
- Division of Urology, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Sandra Rueda
- Division of Urology, Fundación Oftalmológica de Santander Clínica Ardila Lulle (FOSCAL), Universidad Autonoma de Bucaramanga, Colombia
| | - William Quiroga
- Division of Urology, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Nicolás Fernandez
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Urology, Fundación Santa Fe de Bogotá, Colombia; Division of Urology, Hospital for SickKids, University of Toronto, Toronto, Canada
| | - German Patiño
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Verónica Tobar
- Division of Urology, Fundación Oftalmológica de Santander Clínica Ardila Lulle (FOSCAL), Universidad Autonoma de Bucaramanga, Colombia
| | - Nicolás Villareal
- Division of Urology, Fundación Oftalmológica de Santander Clínica Ardila Lulle (FOSCAL), Universidad Autonoma de Bucaramanga, Colombia
| | - Juan Prada
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Catalina Barco
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | - Guillermo Sarmiento
- Division of Urology, Fundación Oftalmológica de Santander Clínica Ardila Lulle (FOSCAL), Universidad Autonoma de Bucaramanga, Colombia
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20
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Kristinsson S, Johnson M, Ralph D. Review of penile reconstructive techniques. Int J Impot Res 2020; 33:243-250. [PMID: 32152468 DOI: 10.1038/s41443-020-0246-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/08/2020] [Accepted: 02/26/2020] [Indexed: 11/09/2022]
Abstract
Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: 'penile trauma', 'penile cancer', 'lichen sclerosus', 'glansectomy', 'glans resurfacing', 'penile-sparing surgery', 'micropenis', 'aphallia', 'female-to-male sex reassignment surgery', 'scrotal flap' and 'genital lymphoedema'. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0-10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.
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Affiliation(s)
- Sverrir Kristinsson
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK
| | - Mark Johnson
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK
| | - David Ralph
- St. Peter's Andrology Centre and UCLH, 145 Harley Street, London, W1G 6BJ, UK.
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21
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Lindner AK, Schachtner G, Steiner E, Kroiss A, Uprimny C, Steinkohl F, Horninger W, Heidegger I, Madersbacher S, Pichler R. Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival. World J Urol 2020; 38:417-424. [PMID: 31062123 PMCID: PMC6994547 DOI: 10.1007/s00345-019-02793-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/26/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To 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. METHODS This 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. RESULTS 55 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. CONCLUSIONS OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.
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Affiliation(s)
| | - Gert Schachtner
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Eberhard Steiner
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Alexander Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stephan Madersbacher
- Department of Urology, Kaiser Franz Josef Hospital, Sigmund Freud Private University, Vienna, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5219048. [PMID: 31312658 PMCID: PMC6595175 DOI: 10.1155/2019/5219048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
Introduction Glans resurfacing has been suggested as a treatment option for the surgical management of superficial penile cancer (Tis, Ta, T1aG1, T1aG2). In this article we describe in detail the glans resurfacing technique with skin graft for penile cancer in a video presentation and we review the current knowledge of the literature. Material and Methods The procedure is described in a stepwise fashion. Initially the patient is circumcised. The glans is marked in quadrants and completely stripped by dissecting and removing the epithelium and subepithelium layer of the glans. Deep spongiosal biopsies are taken to exclude invasion. Each quadrant is sent separately for biopsy. The surface of the graft size needed is estimated. A partial thickness skin graft is harvested from the thigh with a dermatome. The skin graft is then fenestrated. The graft is rolled over the glans and quilted with multiple sutures. A silicone 16F Foley catheter and a suprapubic catheter are placed. The penis is dressed with multiple gauzes and compressed with an elastic band. Results The patient is discharged the next day. The dressing and Foley catheter are removed in 7 days. The patient continues to use the suprapubic catheter for 7 more days. The patient refrains from any sexual activity for 6 weeks and is closely followed. Conclusions Glans resurfacing is an emerging new appealing surgical technique that is already a recommendation in the EAU guidelines for the treatment of premalignant and superficial penile lesions. The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer.
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Sosnowski R, Wolski JK, Kulpa M, Ziętalewicz U, Kosowicz M, Kalinowski T, Demkow T. Assessment of quality of life in patients surgically treated for penile cancer: Impact of aggressiveness in surgery. Eur J Oncol Nurs 2017; 31:1-5. [DOI: 10.1016/j.ejon.2017.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022]
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24
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Beilan JA, Manimala NJ, Slongo J, Loeb A, Spiess PE, Carrion RE. Surgical Reconstruction After Penile Cancer Surgery. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Kamel MH, Bissada N, Warford R, Farias J, Davis R. Organ Sparing Surgery for Penile Cancer: A Systematic Review. J Urol 2017; 198:770-779. [DOI: 10.1016/j.juro.2017.01.088] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Mohamed H. Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Nabil Bissada
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Renee Warford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Judy Farias
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Urology, Baylor School of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas (NB)
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Organ Preservation Surgery for Carcinoma Penis. Indian J Surg Oncol 2017; 8:59-63. [PMID: 28127184 DOI: 10.1007/s13193-016-0573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022] Open
Abstract
Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.
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Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, Wysock JS, Pęczkowski P, Protzel C, Demkow T. Primary penile cancer organ sparing treatment. Cent European J Urol 2016; 69:377-383. [PMID: 28127454 PMCID: PMC5260461 DOI: 10.5173/ceju.2016.890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marcin Kuligowski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Olga Kuczkiewicz
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Moskal
- The Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jan Karol Wolski
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Marc A. Bjurlin
- Division of Urology, NYU Lutheran Medical Center, NYU Langone Health System, NYU School of Medicine, New York, USA
| | - James S. Wysock
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, New York USA
| | - Piotr Pęczkowski
- Department of Radiotheraphy, Maria Sklodowska-Curie, Memorial Cancer Hospital, Warsaw, Poland
| | - Chris Protzel
- Department of Urology, University of Rostock, Germany
| | - Tomasz Demkow
- Urooncology Department, Maria Sklodowska Curie, Memorial Cancer Hospital, Warsaw, Poland
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28
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Bhat GS, Nelivigi G, Barude V, Shastry A. Sexuality in Surgically Treated Carcinoma Penis Patients and Their Partners. Indian J Surg 2016; 80:19-23. [PMID: 29581680 DOI: 10.1007/s12262-016-1543-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022] Open
Abstract
Most common treatment offered to carcinoma penis patients is surgery. This results in not only mutilation of the genitals but also affects their sexuality. The treating physician fails to address the issue due to the paucity of the data in this regard. Hence, we decided to evaluate sexuality in these patients after surgical treatment for penile cancer. Most of the times, their partners also face problems of sex and sexuality, regarding which there is no literature. Hence, we decided to include their partners also in the study. We retrieved records of the patients who underwent surgical treatment for carcinoma penis at our institute. After obtaining ethical committee approval, they were invited along with their partners for personal interview. After obtaining written informed consent from each of them, they were administered sexual functioning questionnaire (SFQ). Sexuality was evaluated based on the scores obtained. Performance anxiety was reported by majority of these patients. Their sexual interest, arousal and desire remained almost intact with reduction in satisfaction more so in total penectomised patients. Though the partners had accepted the global reduction in sexuality as their fate, their interpersonal relationship remained little disturbed. The study reveals that sexuality is more than the sexual intercourse alone. Proper pre-operative counselling of these patients and their partners by the treating urologist helps better post-treatment adjustment with regards to sexuality in these patients as well as their partners.
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Affiliation(s)
- Gajanan S Bhat
- General Hospital, Honavar, Uttara Kannada District, Karnataka State 581334 India
| | | | - Vijayakumar Barude
- TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada, Karnataka India
| | - Anuradha Shastry
- TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada, Karnataka India
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Katz A, Dizon DS. Sexuality After Cancer: A Model for Male Survivors. J Sex Med 2016; 13:70-8. [PMID: 26755089 DOI: 10.1016/j.jsxm.2015.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION For men with cancer, sexual dysfunction is a common issue and has a negative impact on quality of life, regardless of whether he has a partner. In general, sexuality encompasses much more than intercourse; it involves body image, identity, romantic and sexual attraction, and sexual thoughts and fantasies. AIM Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. METHODS An in-depth review of the literature describing alterations to sexual functioning in men with cancer was undertaken. Based on this and the clinical expertise of the authors, a new model was created and is presented. RESULTS This biopsychosocial model is intended to expand the understanding of male sexuality beyond a purely biomedical model that addresses dysfunction as distinct from the context of a man's life and sexual identity. CONCLUSION Most data on sexual dysfunction in men with cancer are derived from those with a history of prostate cancer, although other data suggest that men with other types of malignancies are similarly affected. Unfortunately, male sexuality is often reduced to aspects of erection and performance. Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. This biopsychosocial model might form the basis for interventions for sexual problems after cancer that includes a man and his partner as a complex whole.
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Affiliation(s)
- Anne Katz
- Manitoba Prostate Centre, CancerCare Manitoba, Winnipeg, MB, Canada.
| | - Don S Dizon
- Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA
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