OBJECTIVE To prospectively assess the outcome of patients treated according to the European Association of Urology (EAU) guidelines on the management of penile cancer, a system originally based on retrospective series. PATIENTS AND METHODS Between 2002 and 2005, 100 consecutive patients (median age 62 years) with penile cancer were treated at one institution; all were categorized and treated according to EAU guidelines. Data were analysed using the z‐test, with significance defined as P < 0.05. RESULTS Survival curves were limited to those with >12 months of follow‐up (mean 29); the survival of the whole group was 92%. Of men with palpable nodes, 72% had lymph node involvement, whereas 18% of those with impalpable nodes who had lymphadenectomy according to the guidelines had lymph node disease. The grade of the primary tumour was more predictive than T stage for lymph node involvement and survival. The 3‐year disease‐specific survival for N0, N1 and N2 disease was 100%, 100% and 73%, respectively, and survival at 12 months for N3 disease was 67%. The median survival for those with metastases was 3 months. CONCLUSION The overall survival of men with penile cancer is high, with a clear benefit for early lymphadenectomy in men with positive nodal disease. However, the current EAU guidelines are limited in predicting those patients with micrometastatic disease, with the result that 82% of patients undergo unnecessary prophylactic lymphadenectomy. There is a need to identify more accurate molecular markers for predicting lymph node disease, or the role of novel staging techniques must be assessed.

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Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVE To assess plaque incision and venous grafting (the Lue procedure) to correct the deformity associated with Peyronie's disease and to maintain penile length, evaluating the results over an 8‐year period. PATIENTS AND METHODS The penile deformity of 113 patients (mean age 45 years, range 17–71) with Peyronie's disease was corrected by plaque incision and saphenous vein grafting. All patients had stable Peyronie's disease and had a mean (range) penile deformity of 64.5 (20–180)°; the mean follow‐up was 12 months. RESULTS The result was excellent or satisfactory in 105 patients (93%), and the penis completely straightened in 97 (86%). Erectile dysfunction after surgery developed in 10 of 68 potent patients (15%) although they had arterial risk factors of diabetes, hypertension or cardiac disease that may also have contributed. There was penile shortening of >1 cm in 29 men (25%) but this only prevented intercourse in two. Of the 51 patients with ≥ 5 years of follow‐up, the penis remained completely straight in 80% but the incidence of erectile dysfunction increased to 22.5% and penile shortening of >1 cm to 35%. CONCLUSION The Lue procedure is an effective long‐term option in the surgical management of Peyronie's disease, but penile shortening after surgery remains a risk, and patients with vascular risk factors must be warned of the possibility of later erectile dysfunction.

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To assess the efficacy of vacuum therapy in mechanically straightening the penile curvature of Peyronie’s disease (PD). PATIENTS AND METHODS Modelling of the tunica albuginea has been shown to be possible during penile implant surgery and this principle has been applied as an alternative conservative therapy. In all, 31 patients with PD (mean duration 9.9 months; mean age 51 years, range 24–71) completed the study. Over a 12‐week period, the patients used a vacuum device (Osbon ErecAid®, MediPlus, High Wycombe, UK) for 10 min twice daily. The assessment at study entry and at completion after 12 weeks included the International Index of Erectile Function questionnaire, a perceived pain intensity score, stretched penile length measurement and the angle of penile deformity after an intracavernous injection with prostaglandin E1. RESULTS There was a clinically and statistically significant improvement in penile length, angle of curvature and pain after 12 weeks of using the vacuum pump. Of the 31 patients, 21 had a reduction in the angle of curvature by 5–25°, three had worsening of the curvature and there was no change in the remaining seven. The curvature was corrected surgically in 15 patients while the remaining 16 (51%) were satisfied with the outcome. CONCLUSION Vacuum therapy can improve or stabilize the curvature of PD, is safe to use in all stages of the disease, and might reduce the number of patients going on to surgery.