Ces Urol 2011, 15(1):15-23 | DOI: 10.48095/cccu2011004

Role of a glansectomy in treatment of penile cancer

Milan Hora¹, Karel Pizinger², Vlastimil Bursa³, Michal Sviták³, Petr Stránský¹, Viktor Eret¹, Ondřej Hes⁴, Denisa Kacerovská⁴, Dmitry Kazakov⁴, Jiří Ferda⁵, Boris Kreuzberg⁵

¹ Urologická klinika LF UK a FN, Plzeň

² Dermatovenerologická klinika LF UK a FN, Plzeň

³ Oddělení plastické chirurgie LF UK a FN, Plzeň

⁴ Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň

⁵ Klinika zobrazovacích metod LF UK a FN, Plzeň

Aim:
Some lower categories of penile cancer are unnecessarily treated with a mutilated partial amputation of the penis. We present a more suitable alternative - a glansectomy.

Material and methods:
From 8/2006 to 8/2010, 28 men with penile tumours were surgically treated at the University Hospital Plzeň, CZ. Seven underwent a partial amputation, two total amputation, 7 circumcision, three an excision of the lesion (including one partial glansectomy). Nine (32%) underwent glansectomy. These cases are retrospectively evaluated, but the data was collected prospectively.

Results:
The mean age was 69.0 ?8.1 years (59.0-80.9). The tumour was verified histologically preoperatively in 5 cases, once preoperatively and 3 tumours were indicated only by macroscopically viewing them with the consideration of a possible future variant of treatment. A definitive histology of squamous carcinoma (2 times its verrucous variant) was in all cases, pT category 2x CIS, 6x pT1 (one from preoperative biopsy, definitive histology was CIS only) and 1 x pT2. Grading was 6x 1 (including 3 CIS), 3x2. Three times there was corpora cavernosa covered with a skin graft, 6x with the skin of the shaft of the penis only (in men without interest in sexual activity). In one case of a skin graft, the abscess of the wound was treated. The mean follow-up was 28 months without local recurrence. Once glansectomy was combined with bilateral inguinal lymphadenectomy, this patient had a recurrence 9 months later in the left groin.

Conclusion:
Glansectomy affords better cosmetic and psychological effect in comparison with partial amputation, preserving the maximal length of the penis, sex life and micturition. And good oncological results are saved. Covering of the corpora cavernosa with a skin graft is more aesthetic, but surgery and postoperative care is more complicated than only using the skin of the shaft of the penis.

Keywords: penile tumours, glansectomy, split-thickness, sexual dysfunction

Received: September 21, 2010; Accepted: November 11, 2010; Published: January 1, 2011