Abstract
Objective:
The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function.
Method:
Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included.
Results:
A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down.
Conclusion:
Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.
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