M Sohn1, M Dietrich2, A Wirthmann3, U M Rieger3. 1. Klinik für Urologie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland. urologie.mk@fdk.info. 2. Klinik für Urologie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland. 3. Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Deutschland.
Abstract
BACKGROUND: Due to the rising incidence of penile cancer and increasing life expectancy in western nations, the current international guidelines recommend a less aggressive surgical approach with reduced safety margins and preferably with organ preservation. OBJECTIVES: The goal of this review is to review the current data on stage-dependent reconstructive surgical techniques and their oncological and functional results. MATERIALS AND METHODS: Five recently published reviews and several single studies and publications on the topic of organ-sparing surgical techniques and penile reconstruction were evaluated to draw conclusions for surgery in penile cancer. RESULTS: Due to the rare incidence of penile cancer and the absence of comparative, prospective studies in the literature, evidence levels of the actual statements and conclusions are low. CONCLUSIONS: Organ-sparing techniques in penile cancer lead to slightly elevated local recurrence rates compared with traditional partial or total penile amputation. Thus, sufficient patient compliance is mandatory and an intensified follow-up for more than the usual 5 years postoperatively is required. On the other hand, these techniques enable the surgeon to offer improved functional and esthetic outcomes to the patient, maintaining erectile capacity and sensitivity. After extended partial or total penile amputation, penile reconstruction using free radial forearm flaps with later prosthetic implantation may be offered to younger and sexually active patients in cooperation with experienced plastic surgeons, even if the previously published case numbers do not permit standardization of these procedures.
BACKGROUND: Due to the rising incidence of penile cancer and increasing life expectancy in western nations, the current international guidelines recommend a less aggressive surgical approach with reduced safety margins and preferably with organ preservation. OBJECTIVES: The goal of this review is to review the current data on stage-dependent reconstructive surgical techniques and their oncological and functional results. MATERIALS AND METHODS: Five recently published reviews and several single studies and publications on the topic of organ-sparing surgical techniques and penile reconstruction were evaluated to draw conclusions for surgery in penile cancer. RESULTS: Due to the rare incidence of penile cancer and the absence of comparative, prospective studies in the literature, evidence levels of the actual statements and conclusions are low. CONCLUSIONS: Organ-sparing techniques in penile cancer lead to slightly elevated local recurrence rates compared with traditional partial or total penile amputation. Thus, sufficient patient compliance is mandatory and an intensified follow-up for more than the usual 5 years postoperatively is required. On the other hand, these techniques enable the surgeon to offer improved functional and esthetic outcomes to the patient, maintaining erectile capacity and sensitivity. After extended partial or total penile amputation, penile reconstruction using free radial forearm flaps with later prosthetic implantation may be offered to younger and sexually active patients in cooperation with experienced plastic surgeons, even if the previously published case numbers do not permit standardization of these procedures.
Entities:
Keywords:
Carcinoma in situ; Excision, local; Glans; Organ preservation surgery; Penile prosthesis; Recurrence
Authors: Jacobien M Kieffer; Rosa S Djajadiningrat; Erik A M van Muilekom; Niels M Graafland; Simon Horenblas; Neil K Aaronson Journal: J Urol Date: 2014-04-18 Impact factor: 7.450