Advances in Penile-Preserving Surgical Approaches in the Management of Penile Tumors

Penile-preserving surgery offers a revolutionary alternative to more traditional radical surgery. It offers better sexual, functional, and psychological results and evidence suggests it achieves this without sacrificing oncological outcomes. We examined the evolving nature of such surgeries, addressing controversies such as safe margins and survival outcomes and discussing more conventional techniques, including laser. At our UK center, we treat a high volume of penile cancer and here, based on such experience, we describe our glans resurfacing, glansectomy, and partial penectomy techniques; their application by disease stage; and the limitations of such surgeries.

With reduced tumor-free margins, positive margins are undoubtedly a risk. Those with positive margins require either early re-resection or active surveillance. An as-yet unpublished study of 42 patients with positive margins at our regional penile cancer center showed that only 6 had residual disease. They recommended that patients with contiguous deep margin, delayed graft healing, or extensive positive margins may benefit from early surgical intervention. Others should be closely monitored with a specialist clinic, as studies have demonstrated that local recurrence does not compromise long-term survival because most recurrences are still surgically salvageable.

At our center, we have investigated the role of substitution urethroplasty for distal urethral tumors concluding that it offers both functional and oncologically effective outcomes. To ensure maximal urethral length, initial excision is done using frozen section. Patients are then offered either a synchronous or delayed urethroplasty with buccal graft. In a study of 19 completed surgeries, no patient had suffered local recurrence or urethral strictures at 5 years.

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