RESUMO
Context: The primary lesion in penile cancer is managed by surgery or radiation. Surgical options include penile-sparing surgery, amputative surgery, laser excision, and Moh's micrographic surgery. Radiation is applied as external beam radiotherapy (EBRT) and brachytherapy. The treatment aims to completely remove the primary lesion and preserve a sufficient functional penile stump. Objective: To assess whether the 5-yr recurrence-free rate and other outcomes, such as sexual function, quality of life, urination, and penile preserving length, vary between various treatment options. Evidence acquisition: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane HTA, DARE, HEED), Google Scholar, and ClinicalTrials.gov were searched for publications from 1990 through May 2021. Randomized controlled trials, nonrandomized comparative studies (NRCSs), and case series (CSs) were included. Evidence synthesis: The systematic review included 88 studies, involving 9578 men from 16 NRCSs and 72 CSs. The cumulative mean 5-yr recurrence-free rates were 82.0% for penile-sparing surgery, 83.9% for amputative surgery, 78.6% for brachytherapy, 55.2% for EBRT, 69.4% for lasers, and 88.2% for Moh's micrographic surgery, as reported from CSs, and 76.7% for penile-sparing surgery and 93.3% for amputative surgery, as reported from NRCSs. Penile surgery affects sexual function, but amputative surgery causes more appearance concerns. After brachytherapy, 25% of patients reported sexual dysfunction. Both penile-sparing surgery and amputative surgery affect all aspects of psychosocial well-being. Conclusions: Despite the poor quality of evidence, data suggest that penile-sparing surgery is not inferior to amputative surgery in terms of recurrence rates in selected patients. Based on the available information, however, broadly applicable recommendations cannot be made; appropriate patient selection accounts for the relative success of all the available methods. Patient summary: We reviewed the evidence of various techniques to treat penile tumor and assessed their effectiveness in oncologic control and their functional outcomes. Penile-sparing as well as amputative surgery is an effective treatment option, but amputative surgery has a negative impact on sexual function. Penile-sparing surgery and radiotherapy are associated with a higher risk of local recurrence, but preserve sexual function and quality of life better. Laser and Moh's micrographic surgery could be used for smaller lesions.
RESUMO
La rápida propagación mundial de la infección por SARS-CoV-2 (COVID-19) ha generado una crisis de salud de gran magnitud.[1] [2] El enfoque ha sido el uso de los recursos sanitarios a la atención de pacientes COVID-19 en el escenario de urgencias, hospitalización y cuidado intensivo.[3] De otro lado, se han cancelado las consultas presenciales y los procedimientos electivos en la gran mayoría de las instituciones hospitalarias generando un impacto en la atención de los pacientes.[4] Con excepción de las cirugías de oncología urológica, la mayoría de las cirugías electivas en urología pueden retrasarse sin un impacto negativo para el paciente.
The rapid global spread of SARS-CoV-2 (COVID-19) infection has created a major health crisis.[1] [2] The focus has been on the use of healthcare resources to care for COVID-19 patients in the emergency, inpatient and intensive care setting.[3] On the other hand, face-to-face consultations and elective procedures have been cancelled in the vast majority of hospital institutions, impacting patient care.[4] With the exception of urologic oncology surgeries, most elective surgeries in urology can be delayed without negative impact on patient care.[5] The majority of elective surgeries in urology, with the exception of urologic oncology surgeries, can be delayed without negative patient impact. With the exception of urologic oncology surgeries, most elective surgeries in urology can be delayed without a negative impact on the patient.