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Outcomes of Perineal Urethrostomy for Penile Cancer: A 20-Year International Multicenter Experience - Beyond the Abstract

While surgical margins can be minimal (3-5 mm) in penile cancer (PC) there is still a substantial group of patients with locally advanced or anatomically unfavorable PC in whom aggressive surgical intervention is necessary.1 In cases with bulky primary tumors total penectomy is indicated. In these patients, perineal urethrostomy is often the definitive form of urinary diversion. Perineal urethrostomy has been described quite thoroughly for benign urethral disease. However, the combination with penectomy has 2 major differences. First of all, the surgery is lengthier and causes increased surgical trauma. Secondly, the urethra is completely transected in the case of a total penectomy. These two differences make it difficult to extrapolate the post-operative complications and outcomes of the benign perineal urethrostomy to a total penectomy with perineal urethrostomy. Therefore, this study aimed to describe the complications and outcomes of this procedure.


After a thorough retrospective chart review in our international penile cancer collaboration, we had complete 30-day post-operative complications data of 299 patients who underwent total penectomy with perineal urethrostomy.2 Of these patients, 19% had a 30-day post-operative complication. Most of these complications were minor 45/58 (79%; Clavien-Dindo grade I and II). Wound infections and dehiscence occurred most often (11% and 4% respectively). 79% of patients with wound infections could be treated with oral antibiotics.

Stenosis of the perineal urethrostomy was recorded without time-limit. A total of 35 patients (12%) developed stenosis. 26 of the 35 patients with stenosis needed surgical revision with a median time to revision of 6.1 months. The probability of stenosis revision after one year was 9.3%. In almost all patients the stenosis was located at the neo-meatus, which could indicate poor vasculature in the urethra at the neo-meatus.

This study could not have been performed without the successful collaboration between seven international penile cancer expert centers located on four different continents. As penile cancer is a rare disease, this type of collaborative research is necessary to advance the field. While this is a retrospective study we believe that these types of retrospective analyses could and should lead to prospective international evaluations.

Written by: Hielke-Martijn, MD1 Philippe Spiess, MD, MS, FRCS(C), FACS2 and Oscar Brouwer, MD, PhD1

  1. Department of Urology, The Netherlands Cancer Institute, Amsterdam, Netherlands
  2. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL


References:

  1. O.W. Hakenberg, E. Comperat, S. Minhas, A. Necchi, C. Protzel NW. EAU Guidelines Penile Cancer. 2020.
  2. de Vries HM, Chipollini J, Slongo J, et al. Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience. Urol Oncol. June 2021.

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