Glansectomy with neoglans construction surgery step by step
Ramos, R1; Santos, JC2; Jorge da Silva, JP1; Tavares, J2; Margalho, AF1; Silva, E1
1: Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Portugal; 2: Hospital Egas Moniz, Portugal
Objectives: Penile cancer is a rare disease representing 1% of all cancers diagnosed. Surgery is the mainstay of treatment for non-superficial lesions. Thus, urologists should strive for minimal penile ablation while maintaining oncological safety. For glandular lesions multiple techiques have been described for the glansectomy. The objective of this presentation is to describe the glansectomy procedure with preservation of the corpora cavernosa and construction of the neoglans.
Methods: Description with iconography the surgical steps for the technique of glansectomy and neoglans construction performed in two patients with cT2 and cT3 penile cancer at an oncology devoted institution in southern Europe.
Results: Between 2009 and 2016, 72 patients received surgical treatment for penile cancer at our institution: local and inguinal lymphadenectomy. Ninety percent of the patients had tumour involving the glans and thirty one percent were considered for glansectomy. Neoglans construction was performed for the first time in 2016. Patients were able to maintain erection with minimal body image alteration aside from penile shortening.
Main surgical steps: 1 – circumcision; 2 – close corpora cavernosa dissection under erection; 3 – frozen section evaluation; 4 - urethra reconstruction; 5 – skin transplantation and neoglans construction. Post-operative care is essential for the success of the procedure. With a mean follow-up of 11.5 months both patients are disease free and with rigid fulfilling erections.
Conclusions: Although not suitable for every patient, glansectomy with corpora cavernosa preservation and neoglans construction should be considered for patients with apparently glans localized penile cancer. This procedure provides patients a high level of satisfaction with aesthetic and erectile function preservation while maintaining oncological safety.
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