The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41–61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39–51.39], with the change being statistically significant (mean difference: –10.52, (–19.15), p < 0.001). During the 0–12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: –12.955, –24.14%, [95% CI: –21.52, –4.38], p = 0.002; WLE: –14.1, –22.92%, [95% CI: –26.8, –1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (–3.083, –5.97%, CI: [–14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.
Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions
Falcone, Marco;Preto, Mirko;Scavone, Martina;Cirigliano, Lorenzo;Ferro, Ilaria;Plamadeala, Natalia;Gontero, Paolo
2024-01-01
Abstract
The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41–61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39–51.39], with the change being statistically significant (mean difference: –10.52, (–19.15), p < 0.001). During the 0–12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: –12.955, –24.14%, [95% CI: –21.52, –4.38], p = 0.002; WLE: –14.1, –22.92%, [95% CI: –26.8, –1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (–3.083, –5.97%, CI: [–14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.
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