Penile, Urethral, and Scrotal Cancer

Samir S. Taneja, MD, Consulting Editor

Cancer of the male genitalia has historically been of great interest to urologists dating back to early history of the specialty. At the turn of the nineteenth century, Hugh Hampton Young changed the traditional approach to the disease following his observation that the lymphatic drainage of the penis was to the inguinal region and not through the scrotum, as originally thought. After this, the traditional approach of total penectomy, bilateral orchiectomy, and perineal urethrostomy was altered to preserve the scrotal contents and include the inguinal lymph nodes. Young also described preservation of the proximal penis to allow urination over the scrotum. Many of the principles described by Young in his 1931 publication persisted in the evolution of penile cancer surgery to modern day—surgical control of inguinal lymph nodes, wide margin local excision of the tumor, and penile preservation whenever possible. The recognition that penile cancer often has poor outcomes has prompted the use of multimodal approaches to maximize oncologic control.

Penile cancer has fallen out of the daily view of contemporary American urologists, largely owing to the broad implementation of circumcision in American culture, and the improved hygiene of the population that came with industrialization. In many parts of the country, penile cancer is of more historical significance than practical. This is even more true of scrotal cancer, which has become rare in the absence of known risk factors such as direct carcinogen exposure. Nonetheless, penile cancer, and to a lesser extent scrotal cancer, remains prevalent in many geographic regions and is frequently seen in urban areas where diverse ethnic and cultural populations may exist. Urethral cancer, often described as a rare manifestation within the broad context of urothelial cancer, is also something not frequently seen by the urologist in practice. In my view, it is critically important for urologists to be active in seeking out updates on the evolution of disease management for those diseases that they do not see on a daily basis. In this regard, an issue of Urologic Clinics devoted to penile, urethral, and scrotal cancers seemed timely and appropriate to me.

I would like to thank our guest editor, Dr Philippe E. Spiess, for his passionate devotion to the formulation and creation of this issue. He has crafted an extremely valuable resource for the practicing urologist, which includes all aspects of the management of these less-encountered malignancies, including nuances that one might not consider until they are actually confronted with the scenario in clinical practice. I am indebted to each of the authors for their wonderful contributions to the issue. It is my opinion that this issue will serve as the primary reference for American urologists, managing penile and urethral cancer, for years to come.

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