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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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 27,
2022
Received:
November 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
