Glandectomy with preservation of corpora cavernosa in the treatment of penile carcinoma

Abstract

Introduction: The objective of this work is to describe a conservative surgical technique as an alternative to classic penile amputations, aiming the local control of the disease, in addition to trying to preserve the patient's sexual function.Surgical technique: After a circular incision of the skin around the penis, the subfascial plane is developed until the base of the organ. The dorsal neurovascular bundle and the urethra are isolated in their distal extremities. The neurovascular bundle is sectioned distally. A retrocoronal dissection plane is developed between the glans and the corpora cavernosa. When this stage is complete, the glans is fixed only to the urethra, which is distally sectioned as well. The neurovascular bundle is fixed to the dorsal albuginea. Following the spatulation of the urethra, a neomeatus is created using the overlay skin of the penis. Between January 2001 and July 2002, we employed this technique in 6 patients who had epidermoid carcinoma of the penis, which were limited to the glans, superficial, well or moderately differentiated and measuring up to 3 cm.Comments: Several conservative surgical methods for treatment of carcinoma of the penis aim the organ's preservation, in an attempt of improving the quality of life of patients, however the indexes of local recurrence and failure in disease control are significant. The described technique showed to be safe and effective for disease control, in addition to preserving sexual function in all patients who were treated, representing, thus, a quite appealing conservative surgical alternative in selected cases.

Aesthetic neo-glans reconstruction after penis-sparing surgery for benign, premalignant or malignant penile lesions

“…Moreover, pre-cancerous lesions often show recalcitrance after conservative treatments, with final development of SCC in 5–33% of cases [4,9,11–13] . Recently, plastic and reconstructive surgical techniques have been developed to reduce the functional and psychological morbidity in patients who have undergone mutilating penile surgery [1–3,9,14–17] . In selected patients, the use of these relatively new plastic approaches with total glans reconstruction provided a satisfactory aesthetic and functional outcome, without sacrificing rigorous cancer control [1–3] .…”

Penis-Sparing Surgery with Neo-Glans Reconstruction for Benign, Premalignant or Malignant Penile Lesions

“…Moreover, precancerous lesions often show recalcitrance after conservative treatments, with final evolution to a SCC in 5 to 33% of the cases [4,9,[15][16][17]. Recently, plastic and reconstructive surgical techniques have been developed to reduce the functional and psychological morbidity in patients who have undergone mutilating penile surgery [1][2][3]9,[11][12][13][14]. In selected patients, the use of these relatively-new plastic and reconstructive approaches provided a satisfactory aesthetic and functional outcome, without sacrificing a rigorous cancer control [1][2][3].…”

Update in the management of penile cancer

“…With extended follow-up, the results have been promising (39). Glansectomy has been reported with no local recurrences in select cases (38,40,41). Others have performed partial glansectomy and partial penectomy with reconstruction of the glans (38,41,42).…”