Penile and Urethral Preservation Surgery

Penile and urethral cancers are very rare and potentially disfiguring diseases. There are various treatment options for primary penile lesions. Treatment for such cancers typically involves the removal of part or all of the urethra or penis. Penile sparing approaches provide several quality-of-life benefits without detrimental oncologic outcomes. Such surgeries, while they prolong life, might also be devastating psychologically.

Penile and urethral preservation surgery limit the amount of tissue removed and increases penile tissue preservation without compromising cancer control. The main goal of penile sparing surgery is to preserve sufficient tissue to allow voiding while standing up and/or sexual performance.

The side effects of the penis and urethral removal surgery are disfigurement and profound negative quality of life, the aim is to avoid these effects too.

A painless lesion is the most common symptom of cancer, it may be associated with a rash, pain, discharge, bleeding, or a foul odor.

The disease is most common in men aged 50- to 70-year-old, with the most important risk factor being the presence of an intact foreskin.

Other factors for the development of penile cancer are

• smoking
• balanitis, number of sexual partners, and human papillomavirus (HPV).

Studies have shown that premalignant lesions such as bowenoid papulosis (BP), erythroplasia de Queyrat (EQ), Bowen’s disease (BD), lichen sclerosus (LS), balanitis xerotica obliterans (BXO), penile horn, leukoplakia, subtypes of balanitis, and malignant giant condylomata acuminata are linked with an increased risk of penile carcinoma

Additionally, patients undergoing psoralen and ultraviolet A (PUVA) photochemotherapy for psoriasis are at an increased risk of developing penile cancer.

Multiple innovative methods are now available to aid in the diagnosis of penile cancer and to assist in determining the best treatment option for each patient.

• Physical examination, careful assessments are made concerning to size, location, fixation, and involvement of corporal bodies, a thorough inspection of the base of the penis and scrotum.
• Rectal and bimanual examinations,
• MRI,
• ultrasound

With appropriate diagnostic evaluation and staging, penile sparing techniques will provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment method, a close follow-up is a must for all treatment considerations.

For lower stage and grade cancers, penile preservation procedures include-

• circumcision (lesion confined to foreskin)
• topical chemotherapy (only for superficial cancers)
• laser ablation
• radiation

Penile preservation surgical methods are:

• glans (head of the) penis resurfacing
• partial removal of the glans penis (head)
• removal of the entire glans penis and reconstruction
• Mohs micrographic surgery and reconstruction
• reconstruction of the penis stump