The role of penectomy in penile cancer—evolving paradigms

Abstract

Penile cancer is a rare cancer, with the majority treated with penile preserving methods.There remains a role for partial and totally penectomy for advanced and more proximal penile cancers.Significant functional and psychological morbidity can ensue for patients undergoing surgical management.Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3-5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients' oncologic outcomes-however a role still exists for radical surgery in advanced penile malignancy.

Effects of partial penectomy for penile cancer on sexual function: A systematic review

“…Both Romero et al [ 17 ] and Yu et al [ 11 ] reported an incision site which allowed a 2-cm margin of tumour-free tissue. However, more recent research suggests that safe surgical margins can be reduced from 2 cm to 3–5 mm, thus allowing greater preservation of penile lengths [ 43 ]. As such, patients undergoing partial penectomy may now expect to maintain greater penile lengths and sexual function than individuals historically undergoing this operation.…”

Total Penectomy and Perineal Urethrostomy Management of Penile Squamous Cell Carcinoma with Paraffinoma in Single Center Hospital: A Rare Case Report

“…The etiology of penile cancer has not been explained clearly; however, there are conditions associated with penile cancer such as uncircumcised prepuce, chronic inflammatory conditions, and exposure to the human papilloma virus [4]. Poor hygiene, history of smoking, and history of phimosis were also found in 25% of patients with penile cancer [5]. Many cases of sclerofibroma reactions and advanced granulomas occurring after injection of liquid silicone were given to enlarge the penis [6].…”

“…It was concluded that the injection of liquid silicone to enlarge the penis can cause chronic inflammatory reactions. Silicone is a polymer that can be chemically injected into the soft tissue of the penis which forms into liquid silicone in the form of injection in a variety of cosmetic procedures [5]. Mainly done for tissue augmented, for example, lips, chin, breasts, buttocks, and penis.…”

Non-Coding RNA in Penile Cancer

“…Penectomy is still the “gold standard” for the treatment of primary tumors. It can be partial or total, depending on the extension of the lesion ( 6 , 7 ). In some patients, lymphadenectomy is essential for surgical management, although it presents risks of complications and has high morbidity.…”