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Phallus Preservation for Locally Advanced Proximal Primary Urethral Carcinoma: Technique and Outcomes

  • Brayden March
    Affiliations
    Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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  • Catalina A. Palma
    Affiliations
    Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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  • Scott Leslie
    Affiliations
    Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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  • Geoffrey Watson
    Affiliations
    Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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  • Peter Lee
    Affiliations
    Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
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  • Kirk KS Austin
    Affiliations
    Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
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  • Michael Solomon
    Affiliations
    Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia

    Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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  • Nicola Jeffery
    Correspondence
    Address correspondence to: Nicola Jeffery, BSc (Med) MB BS FRACS (Urol), Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
    Affiliations
    Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Published:January 13, 2023DOI:https://doi.org/10.1016/j.urology.2022.12.034

      INTRODUCTION

      To describe a novel method of penile sparing perineal urethrectomy for locally advanced proximal primary urethral cancers (PUC).

      TECHNICAL CONSIDERATIONS

      In mid-2021, 2 cases underwent pelvic exenterative surgery for pT3 and pT4 PUC. The procedure comprised of a complete urethrectomy, proximal penectomy, en bloc pubectomy and excision of pelvic diaphragm in both cases. One case included a wide excision of scrotum, whilst the other required a prostatectomy and abdominoperineal resection of the rectum to achieve complete tumor resection. A complete R0 resection was achieved in both cases. At 6 months follow up, there is no evidence of ischemic necrosis of the penis and cosmesis is satisfactory to both patients. We provide a comprehensive operative description of both cases, together with illustrations, and discuss the underlying principles of penile preservation in the surgical treatment of locally advanced proximal PUC.

      CONCLUSION

      Complete perineal urethrectomy with phallic preservation is feasible in men with locally advanced proximal bulbar urethral cancer in the absence of tumor invasion of the penile shaft. The remnant penis survives off arterial supply from the superficial penile arteries arising from the external pudendal arteries. Phallic preservation may benefit patient's psychological quality of life post-procedure.
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      References

        • Gheiler EL
        • Tefilli MV
        • Tiguert R
        • de Oliveira JG
        • Pontes JE
        • Wood Jr., DP
        Management of primary urethral cancer.
        Urology. 1998; 52: 487-493https://doi.org/10.1016/s0090-4295(98)00199-x
        • Janisch F
        • Abufaraj M
        • Fajkovic H
        • et al.
        Current disease management of primary urethral carcinoma.
        Eur Urol Focus. 2019; 5: 722-734https://doi.org/10.1016/j.euf.2019.07.001
        • Bird E
        • Coburn M
        Phallus preservation for urethral cancer: subcutaneous penectomy.
        J Urol. 1997; 158: 2146-2148https://doi.org/10.1016/s0022-5347(01)68182-5
        • Ishii T
        • Hiratsuka Y
        • Abe H
        • Ikeda M
        • Ariyoshi A
        Subcutaneous penectomy and phalloplasty using a testicle for invasive urethral carcinoma.
        J Urol. 2002; 167: 248
        • McDougal WS
        • Koch MO
        Phallic reconstruction during exenterative surgery for invasive urethral carcinoma.
        J Urol. 1989; 141: 1201-1203https://doi.org/10.1016/s0022-5347(17)41214-6
        • Taguchi H
        • Saito K
        • Yamada T
        A simple method of total reconstruction of the penis. Case reports.
        Plastic and reconstructive surgery. Sep 1977; 60: 454-456
        • Dalbagni G
        • Zhang ZF
        • Lacombe L
        • Herr HW
        Male urethral carcinoma: analysis of treatment outcome.
        Urology. 1999; 53: 1126-1132https://doi.org/10.1016/s0090-4295(98)00659-1
        • Visser O
        • Adolfsson J
        • Rossi S
        • et al.
        Incidence and survival of rare urogenital cancers in Europe.
        Eur J Cancer. 2012; 48: 456-464https://doi.org/10.1016/j.ejca.2011.10.031
        • Aleksic I
        • Rais-Bahrami S
        • Daugherty M
        • Agarwal PK
        • Vourganti S
        • Bratslavsky G
        Primary urethral carcinoma: a surveillance, epidemiology, and end results data analysis identifying predictors of cancer-specific survival.
        Urol Ann. 2018; 10: 170-174https://doi.org/10.4103/UA.UA_136_17
        • Dayyani F
        • Hoffman K
        • Eifel P
        • et al.
        Management of advanced primary urethral carcinomas.
        BJU Int. 2014; 114: 25-31https://doi.org/10.1111/bju.12630
        • Dinney CPN
        • Johnson DE
        • Swanson DA
        • Babaian RJ
        • Von Eschenbach AC
        Therapy and prognosis for male anterior urethral carcinoma: an update.
        Urology. 1994; 43: 506-514https://doi.org/10.1016/0090-4295(94)90242-9
        • Son CH
        • Liauw SL
        • Hasan Y
        • Solanki AA
        Optimizing the role of surgery and radiation therapy in urethral cancer based on histology and disease extent.
        Int J Radiat Oncol Biol Phys. 2018; 102: 304-313https://doi.org/10.1016/j.ijrobp.2018.06.007
        • Wang M
        • Yang M
        • Wu P
        • et al.
        Transperineal-incision urethrectomy combined with laparoscopic prostatectomy for a male patient with squamous cell carcinoma involving distal plus proximal urethra and untypical symptoms-a case report.
        Transl Androl Urol. 2021; 10: 976-982https://doi.org/10.21037/tau-20-984
        • Kent M
        • Zinman L
        • Girshovich L
        • Sands J
        • Vanni A
        Combined chemoradiation as primary treatment for invasive male urethral cancer.
        J Urol. 2015; 193: 532-537https://doi.org/10.1016/j.juro.2014.07.105
        • Cohen MS
        • Triaca V
        • Billmeyer B
        • et al.
        Coordinated chemoradiation therapy with genital preservation for the treatment of primary invasive carcinoma of the male urethra.
        J Urol. 2008; 179 (discussion 541): 536-541https://doi.org/10.1016/j.juro.2007.09.068
        • Singh T
        • Li QK
        • Song DY
        Pathologic complete response after chemoradiation of a massive primary urethral carcinoma.
        Adv Radiat Oncol. 2019; 4: 487-491https://doi.org/10.1016/j.adro.2019.02.005