Penile preserving surgery and surgical strategies to maximize penile form and function in penile cancer: recommendations from the United Kingdom experience.

OBJECTIVES: The diagnosis of penile cancer can be devastating for a man and his partner. The fear of cancer is heightened by the prospect of penile amputation. While conventional radical surgery continues to be an effective approach to management, the emasculating nature of this treatment has serious psychological and sexual morbidity. Recent studies have challenged the traditional belief that a 2 cm margin was required for adequate oncological control. METHODS: We review the current options and status of such penile preserving techniques in the modern day management of penile cancer, and assess the use of the different techniques according to the stage and grade of disease based upon the combined experience of two superregional centres in the United Kingdom. RESULTS: A range of organ preserving procedures matches the clinical spectrum of patients presenting with penile cancer. These demonstrate excellent oncological control whilst maximizing penile function and form. CONCLUSION: Innovative surgical techniques can now preserve as much penile tissue and functional integrity as possible, without compromising oncological control. This minimizes the impact of disease and its treatment on the quality of life of the patient.

A Simplified Adult Acquired Buried Penis Repair Classification System With an Analysis of Perioperative Complications and Urethral Stricture Disease.

OBJECTIVE: To propose a simple classification system for buried penis repairs and present an analysis of perioperative data based on category. METHODS: Patients undergoing buried penis repair at a single institution were examined. Classification was as follows: Category I-penile unburying with local flap; II-skin graft; III-scrotal surgery; IV-escutcheonectomy; V-abdominal panniculectomy. Complex repairs were Category III or above. Success was defined as an unburied penis without additional unburying surgery. RESULTS: Between 2007 and 2017, 64 patients underwent repair with 44 (69%) considered complex. Patients undergoing complex repairs had a higher body mass index (median 48 vs 36 kg/m2, P < .01). A total of 30 patients (47%) had urethral strictures, with no association to buried penis complexity (P = .43). High-grade complications (Clavien ≥ 3) occurred in 10 patients (23%) in the high-complexity group with none in the low-complexity group (P = .02). Seven of 10 (70%) of high-grade complications were wound related. Successful unburying was seen in 58 patients (91%). All failures occurred in the high-complexity group. Median follow-up was 209 days. CONCLUSION: Buried penis repairs are highly successful. We propose a classification based on surgical complexity. Patients requiring complex repairs have higher body mass index and increased risk of high-grade complications. While urethral strictures are found in nearly half of patients, there is no association with the severity of disease. Ongoing modifications of technique and perioperative care may improve outcomes.