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Penile preserving and reconstructive surgery in the management of penile cancer

Nature Reviews Urology volume 13, pages 249–257 (2016)Cite this article

Subjects

Key Points

  • Organ-preserving surgery is a reasonable approach in managing early-stage penile cancer when oncologically feasible to retain quality of life and maximize sexual function

  • Conservative treatment decisions for penile cancer are critically based on clinical and pathological information that defines prognostic disease risk

  • Conservative strategies for penile cancer treatment are supported by analyses indicating that long-term survival is maintained despite the possibility of localized disease recurrence

  • The surgical plan for conservative penile cancer treatment combines extirpative and reconstructive procedures with the latter aspect dictated by the features of the surgical defect

  • Patient education and adherence to surveillance protocols are recommended when implementing conservative penile cancer treatment strategies

Abstract

A major paradigm shift has occurred in the clinical management of penile cancer: the adoption of alternative, less-invasive surgical strategies to address the primary tumour. Such penile-preserving approaches aim to retain aspects of penile function and improve quality of life outcomes by reducing penile alterations and sexual dysfunction incurred by historical surgical approaches without compromising oncological control. Novel options include wide local excision, glansectomy, and glans resurfacing, and these strategies are now included in the spectrum of interventions available to treat penile cancer. Surgical reconstructive techniques have also advanced to include primary closure, closure using skin flaps and grafts, penile lengthening and/or enhancement, and neophalloplasty. All of these options can be readily applied in the risk-informed patient after establishing disease-risk variables and instituting protocols for close surveillance and prompt action for possible disease recurrence.

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Figure 1: Surgical technique for partial penectomy with neomeatus construction.
Figure 2: Wide local excision of a lesion involving the preputial or penile shaft skin.
Figure 3: Surgical technique for distal urethrectomy.
Figure 4: Surgical technique for glans resurfacing.
Figure 5: Surgical technique for partial glansectomy.
Figure 6: Schematic for penile lengthening.
Figure 7: Neophalloplasty.

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Authors and Affiliations

  1. Department of Urology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, 21287, Maryland, USA

    Arthur L. Burnett

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Correspondence to Arthur L. Burnett.

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Burnett, A. Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 13, 249–257 (2016). https://doi.org/10.1038/nrurol.2016.54

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