Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Surgical technique and outcomes following coronal-sparing glans resurfacing for benign and malignant penile lesions

Abstract

The aim of this study is to describe the outcomes for a modified glans-resurfacing technique for benign and malignant penile conditions in which the uninvolved glans corona is preserved in order to maintain glans erogenous sensation. A total of 13 patients underwent coronal-sparing glans resurfacing (CSGR), with follow-up every 3 months for ≥2 years. Positive surgical margin and local recurrence (LR) rates were evaluated. Surgical complications and cosmetic outcomes were also recorded. Patients were asked to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire starting 12 months after the surgery. The median (interquartile range [IQR]) age and follow-up periods were 63 (53–68) years and 29 (14–38) months, respectively. Eight patients were diagnosed with primary penile squamous cell carcinoma (SCC), three had refractory lichen sclerosus, and two had penile intraepithelial neoplasia (PeIN). No surgical complications were recorded. All patients had a complete graft take and reported satisfactory cosmetic results with preserved erogenous sensation. Two cancer patients developed LR which was managed with further penile preserving surgery. The median (IQR) postoperative IIEF-5 value was 20 (17–23). This modified coronal-sparing technique was suitable for glans lesions that spare the coronal ridge and coronal sulcus. Preservation of the coronal ridge helps maintain sexual function and provides excellent cosmetic outcomes.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Neuroanatomy of the penis.
Fig. 2: Marking of the glans epithelium.
Fig. 3: Coverage of glans with split skin graft.
Fig. 4: Postoperative appearance.

References

  1. 1.

    Christodoulidou M, Sahdev V, Houssein S, Muneer A. Epidemiology of penile cancer. Curr Probl Cancer. 2015;39:126–36.

    Article  Google Scholar 

  2. 2.

    O’Kelly F, Lonergan P, Lundon D, Nason G, Sweeney P, Cullen I, et al. A prospective study of total glans resurfacing for localized penile cancer to maximize oncologic and functional outcomes in a tertiary referral network. J Urol. 2017;197:1258–63. https://doi.org/10.1016/j.juro.2016.12.089.

    Article  PubMed  Google Scholar 

  3. 3.

    Alnajjar HM, Randhawa K, Muneer A. Localized disease: types of reconstruction/plastic surgery techniques after glans resurfacing/glansectomy/partial/total penectomy. Curr Opin Urol. 2020;30:213–7.

    Article  Google Scholar 

  4. 4.

    Garaffa G, Shabbir M, Christopher N, Minhas S, Ralph DJ. The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature. J Sex Med. 2011;8:1246–53.

    Article  Google Scholar 

  5. 5.

    Shim TN, Ali I, Muneer A, Bunker CB. Benign male genital dermatoses. BMJ. 2016;354:1–11.

    Google Scholar 

  6. 6.

    Charlton OA, Smith SD. Balanitis xerotica obliterans: a review of diagnosis and management. Int J Dermatol. 2019;58:777–81.

    Article  Google Scholar 

  7. 7.

    Bunker CB, Shim TN Male genital lichen sclerosus. Indian J Dermatol. 2015;60:111–7.

    Article  Google Scholar 

  8. 8.

    Ashley S, Shanks JH, Oliveira P, Lucky M, Parnham A, Lau M, et al. Human papilloma virus (HPV) status may impact treatment outcomes in patients with pre-cancerous penile lesions (an eUROGEN Study). Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0327-4.

  9. 9.

    Hakenberg OW, Comperat E, Minhas S, Necchi A, Protzel C, Watkin N, et al. EAU guidelines on Penile Cancer. Arnhem, The Netherlands: EAU Guidelines Office; 2020. retrieved from https://uroweb.org/guidelines/.

  10. 10.

    Kravvas G, Shim TN, Doiron PR, Freeman A, Jameson C, Minhas S, et al. The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients. J Eur Acad Dermatol Venereol. 2018;32:91–5.

    CAS  Article  Google Scholar 

  11. 11.

    Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86:459–65.

    CAS  Article  Google Scholar 

  12. 12.

    Shabbir M, Muneer A, Kalsi J, Shukla CJ, Zacharakis E, Garaffa G, et al. Glans resurfacing for the treatment of carcinoma in situ of the penis: surgical technique and outcomes. Eur Urol. 2011;59:142–7. https://doi.org/10.1016/j.eururo.2010.09.039.

    Article  PubMed  Google Scholar 

  13. 13.

    Hadway P, Corbishley CM, Watkin NA. Total glans resurfacing for premalignant lesions of the penis: initial outcome data. BJU Int. 2006;98:532–6.

    Article  Google Scholar 

  14. 14.

    Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. Resurfacing and reconstruction of the glans penis. Eur Urol. 2007;52:893–900.

    Article  Google Scholar 

  15. 15.

    Håkansson U, Kirrander P, Uvelius B, Baseckas G, Torbrand C. Organ-sparing reconstructive surgery in penile cancer: initial experiences at two Swedish referral centres. Scand J Urol. 2015;49:149–54.

    Article  Google Scholar 

  16. 16.

    Ayres BE, Lam W, Alnajjar HM, Corbishley CM, Perry MJA, Watkin NA. Glans resurfacing—a new penile preserving option for superficially invasive penile cancer. Eur Urol Suppl. 2011;10:340.

    Article  Google Scholar 

  17. 17.

    Yang CC, Bradley WE. Neuroanatomy of the penile portion of the human dorsal nerve of the penis. Br J Urol. 1998;82:109–13.

    CAS  Article  Google Scholar 

  18. 18.

    Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 1986;371:205–30.

    CAS  Article  Google Scholar 

  19. 19.

    Sarkarati M, Rossier AB, Fam BA. Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report. J Urol. 1987;138:59–62.

    CAS  Article  Google Scholar 

  20. 20.

    Pryor JL, LeRoy SC, Nagel TC, Hensleigh HC. Vibratory stimulation for treatment of anejaculation in quadriplegic men. Arch Phys Med Rehabil. 1995;76:59–64.

    CAS  Article  Google Scholar 

  21. 21.

    Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M. Validation of the Clavien–Dindo grading system in urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus. 2018;4:608–13.

    Article  Google Scholar 

  22. 22.

    Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peñ BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    CAS  Article  Google Scholar 

  23. 23.

    Baumgarten A, Chipollini J, Yan S, Ottenhof SR, Tang DH, Draeger D, et al. Penile sparing surgery for penile cancer: a multicenter international retrospective cohort. J Urol. 2018;199:V1233–7.

    Article  Google Scholar 

  24. 24.

    Malone PR, Thomas JS, Blick C. A tie-over dressing for graft application in distal penectomy and glans resurfacing: the TODGA technique. BJU Int. 2011;107:836–40.

    Article  Google Scholar 

  25. 25.

    Pappas A, Katafigiotis I, Waterloos M, Spinoit AF, Ploumidis A. Glans resurfacing with skin graft for penile cancer: a step-by-step video presentation of the technique and review of the literature. Biomed Res Int. 2019;2019:1–6.

    Article  Google Scholar 

Download references

Acknowledgements

AM was supported by the NIHR Biomedical Research Centre UCLH.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Asif Muneer.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics statement

This is a retrospective chart review and audit of outcomes. The treatment was in line with our institutional guidelines and operational policy and approved as part of the multidisciplinary team process as part of standard management for penile lesions. All data were anonymized. All participants gave full informed consent for surgery and for the use of their anonymized data in the study. As this was a variation of our standard partial glans-resurfacing technique which is already part of the institution operational policy, this was approved as a retrospective audit to assess surgical outcomes.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cakir, O.O., Schifano, N., Venturino, L. et al. Surgical technique and outcomes following coronal-sparing glans resurfacing for benign and malignant penile lesions. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00452-5

Download citation

Search

Quick links