Erectile function after partial penectomy for penile cancer

Abstract

Purpose: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. Materials and Methods: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. Results: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. Conclusion: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.

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

“…All 16 NRCSs were retrospective studies, 12 comparing penile-sparing surgery with amputative surgery [11] , [12] , [13] , [14] , [15] , [16] , [17] , [20] , [21] , [22] , [24] , [25] and four comparing radiotherapy with penile surgery [10] , [18] , [19] , [23] . All 72 CSs were retrospective, with 39 studies addressing penile surgery [6] , [7] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , 20 reporting on radiotherapy [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , ...…”

“…case series 38 T1G2: 38/38 (100%) PP: 11/38 (28.9%) Tumor excision: 5/38 (13.16%) Laser therapy (Nd:YAG laser): 22/38 (57.9%) PP: 9/11(81.82%) Circumcision: 4/5 (80%) Laser: 13/22 (59.09%) NR NR NR NR NR 16/22 (72.73%; laser only) High risk Yu et al (2016) [71] Prospective case series 43 T status NR PP ± lap bilateral or unilateral LND PP alone: 8/43 (18.6%) PP plus LND: 35/43 (81.4%) 95.35% (41/43) NR NR IIEF-15 score at regular FU postop: the results is for the whole group Erectile function: preop 26.0 (3.07), postop 17.8 (10.66), p < 0.01 Orgasmic function: preop 8.44 (1.16), postop 5.81 (3.35), p < 0.01 Sexual desire: preop 8.33 (1.27), postop 6.28 (2.16), p < 0.01 Intercourse satisfaction: preop 12.3 (2.21), postop 7.07 (4.56), p < 0.01 Overall satisfaction: preop 8.0 (1.19), postop 5.91 (2.01) SAS score: preop 46.3 (8.73), postop 54.72 (11.74), p = 0.01 SDS score: preop 43.6 (8.32), postop 51.26 (10.7), p = 0.04 NR NR High risk Minhas et al (2005) [72] Retrosp. case series 48(51) Tx: 3/51 (5.9%) T1: 20/48 (41.67%) T2: 26/48 (54.17%) T3: 2/48 (4.17%) PSS (WLE, partial or total glansectomy) NR At 1 yr: 95.8% (46/48) T1: 19/20 (95%) T2: 25/26 (96.16%) NR NR NR NR 95.8% (46/48) 1st year data only Low risk Monteiro et al (2021) [73] Retrosp. case series 79 (81) Tis: 2/81 (2.5%) T1: 42/79 (53.1%) T2: 35/79 (44.3%) T3: 2/79 (2.5%) Amputative surgery: partial penectomy 92% (72/79) NR NR Total IIEF score: preop 100% satisfactory erections, postop: 16.18 ± 7.08 ( p < 0.05) Postop 61.7% had ED (9/50 [11.2%] mild ED, 17/50 [21%] mild-to-moderate ED, 9/50 [11.2%] moderate ED, and 15/50 [18.3%] severe ED) NR NR NA High risk …”

“…The outcomes of 7841 men who underwent any type of surgery for their primary tumor are reported herein [6] , [7] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] . The overall 5-yr recurrence-free rates ranged between 33.3% and 98.2%.…”

“…Amputative surgery is reserved for more advanced disease. Five trials reported on 243 men; 71.6% were staged as T1-T2, who underwent partial or total penectomy [61] , [64] , [68] , [71] , [73] . The cumulative mean 5-yr recurrence-free rate was 83.9% (204/243; range 75.8–95.4%).…”

Living in a rural area as a risk factor for worst outcomes in penile cancer

“…In conclusion, penile cancer is a rare genitourinary malignancy with high morbimortality. There is an urge for preventive programs (40), timely diagnosis, and treatment with no delays since it brings functional loss (41), negatively impacting quality of life and survival. Belonging to a rural population with high poverty indices and low access to education and health care enhances the risk of worse outcomes because of the retard in the diagnosis and treatment, culminating with disease progression and spreading (42).…”