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Functional and Patient Reported Outcomes Following Total Glans Resurfacing - Beyond the Abstract

In Wester Word, penile cancer (PC) is a rare condition (incidence less than 1/100000/year) but with severe consequences on patients’ functions and quality of life.

In the past, PC surgery was based on demolitive approaches with 2cm surgical margins that guaranteed good oncological radicality and disease control but did not take into account the functional drawbacks in terms of sexual and urinary functions neither cosmetic appearance.1-2

Based on these findings, organ sparing surgery (OSS) has started to gain ground among reconstructive surgeons following the concept of minimally invasive approaches in the treatment of localized and superficial PC lesions while maintaining a few millimeters (up to 5mm) surgical margin.3-4

Literature evidence has already proven that OSS does not affect survival outcomes, offering adequate oncologic radicality even if a higher local recurrence (LR) rate has been detected. In the case of LR, diagnosis is usually rapid and the recurrence is easily managed with revision surgery without a negative impact on patients’ overall survival.5-6

Different OSS techniques have been developed over time, a “gold-standard” procedure has not been identified yet. Total glans resurfacing (TGR) with split-thickness skin graft (STSG), harvested from the thigh, represents an excellent option for managing superficial PC with satisfactory oncological and functional outcomes.8-10

Before our series, functional outcomes were partially reported, non-validated tools and not completely reproducible methods were used. All this resulted in a positive trend but no definitive conclusions, regarding TGR functional outcomes, could be defined.8-10

Data collection through the use of validated questionnaires such as the International Prostate Symptoms Score (IPSS) and the International Index of Erectile Function (IIEF), for urinary and sexual function respectively, allowed us to obtain reliable and reproducible results. This study also focused on patient-reported satisfaction outcomes (PRO's) in the postoperative period through the creation of a 5-items “ad hoc” questionnaire. All these tools allowed to obtain reproducible and objective data which also confirmed the preliminary trends previously published about TGR.8-10

The high satisfaction rate with regard to functional results is a consequence of the preservation of penile anatomical structures that allow to obtain an adequate erection for penetrative intercourse and an optimal sensitivity of the glans for reaching orgasm. These outcomes result in an improvement in overall quality of life in 84.4% of patients.11

We strongly believe that the surgical treatment of superficial PC should be based on the use of organ-sparing techniques, in order to guarantee the best surgical and oncological results, but at the same time preserving both urinary, sexual functions and cosmetic appearance.

Written by: Federica Peretti,1 Mirko Preto,1 Marco Falcone1,2

  1. Department of Urology, A.O.U. Città della Salute e della Scienza di Torino – Molinette Hospital, Turin, Italy
  2. Department of Neurourology, A.O.U. Città della Salute e della Scienza di Torino - Unità Spinale Unipolare, Turin, Italy

References:

  1. Kieffer JM, Djajadiningrat RS, van Muilekom EA, et al. Quality of life in patients treated for penile cancer. J Urol 2014;192:1105-10.
  2. D’Ancona CA, Botega NJ, De Moraes C et al. Quality of life after partial penectomy for penile carcinoma. Urology 1997;50:593-6.
  3. Sedigh O, Falcone M, Ceruti C, Timpano M, Preto M, Oderda M, Kuehhas F, Sibona M, Gillo A, Gontero P, Rolle L, Frea B. Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results? Can Urol Assoc J. 2015 Jul-Aug;9(7-8):E423-7
  4. Parnham AS, Albersen M, Sahdev V, Christodoulidou M, Nigam R, Malone P, Freeman A, Muneer A. Glansectomy and Split-thickness Skin Graft for Penile Cancer. Eur Urol. 2018 Feb;73(2):284-289.
  5. Hoffman MA, Renshaw AA, Loughlin KR. Squamous cell carcinoma of the penis and microscopic pathologic margins: How much margin is needed for local cure? Cancer 1999;85:1565-8.
  6. Bracka A. Glans resection and plastic repair. BJU Int 2009;105:136–144.
  7. Parnham AS; Aalbersen M, Sahdev V, et al. Surgery in motion glansectomy and split –thickness skin graft for penile cancer. Eur Urol 2018
  8. Palminteri E, Fusco F, Berdondini E, et al. Aesthetic neo-glans reconstruction after panis sparing surgery for benign, premalignant or malignant penile lesions. Arab J Urol 2011.
  9. O’Kelly F, Lonergan P, Lundon D, et al. A prospective study of total glans resurfacing for localized penile cancer to maximixe oncologic and functional outcomes in a tertiary referral network.
  10. Hadway P, Corbishley CM,Watkin NA. Total glans resurfacing for premalignant lesions of the penis: Initial outcome data. BJU Int. 2006;98:532–536.
  11. Preto M, Falcone M, Blecher G, et al. Functional and Patinet Reported Outcomes Following Total Glans Resurfacing. Sexual J 2021

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