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Organ-sparing penile cancer surgery tied to better patient-reported outcomes

Reuters Health - 03/03/2021 - Men with penile cancer who get a partial or radical glansectomy with reconstruction report satisfaction with urinary function and phallus appearance after surgery, a small study suggests.

Researchers examined results from questionnaires administered to 35 patients (mean age 61 years) who underwent penile reconstruction (mean time from surgery 22 months). Overall, most men (82.4%) said they were satisfied or felt neutral about how their genitals looked, most could urinate from a standing position (85.3%), and with little if any urine spraying (79.4%).

"The take-home message is that organ-sparing surgery for penile cancer can result in satisfactory genital appearance and preservation of penile function in many patients," said lead study author Dr. Stefanie Croghan, a specialist in urology at University Hospital Waterford in Ireland.

"We therefore reiterate the importance of offering phallus preservation strategies, performed by a surgeon with oncoplastic experience, to eligible patients with a diagnosis of penile cancer," Dr. Croghan said by email.

While not all patients are good candidates for organ-sparing surgery, particularly if tumor factors would be better served by a radical penectomy, most patients can undergo these less aggressive procedures and benefit from the improved quality of life afterwards, Dr. Croghan said.

Men in the study submitted a series of questionnaires anonymously, with a response rate of 71.4%.

Partial penectomy patients appeared less satisfied with genital appearance than those who had other procedures. Partial glansectomy patients reported more urine spraying than radical glansectomy patients, but for both results the sample size was too small to determine statistically significant differences.

At least half of the men in each surgery group were sexually active afterward. Every patient who received partial glansectomy and most (81.2%) who underwent radical glansectomy reported some sensation in their reconstructed penis.

Better sexual function was correlated with better quality of life, the researchers report in Urology.

One limitation of the study is that researchers used a previously unpublished questionnaire to assess urinary and sexual outcomes due to the lack of an available validated questionnaire. Another limitation is the potential for recall bias when men were asked to assess their urinary and sexual function before surgery and again several months afterwards.

"It's not a large sample size but then again penile cancer is a rare cancer and often trials are difficult to conduct," said Dr. Asif Muneer, an associate professor at University College London in the UK, who wasn't involved in the study. "Most studies are single center due to the low volume of cases."

Even so, results from the current study offer fresh evidence of the importance of penile preservation, Dr. Muneer, who wasn't involved in the study, said by email.

"The unique thing about penile cancer is that centralization of services into specialist centers means that penile preserving procedures are routine and standard of care," Dr. Muneer said. "However, this study is important for regions where penile preserving procedures are not routinely offered."

SOURCE: https://bit.ly/3sGotvY Urology, online February 16, 2021.

By Lisa Rapaport

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