The majority of penile cancers are located on the distal aspect of the penis- the glans, the coronal sulcus or the prepuce. This lends penile cancer well towards an organ sparing approach. Traditionally a diagnosis of penile cancer resulted in a radical excision with greater than 2 cm surgical margin- this resulted in satisfactory oncological outcomes but significant morbidity to the patient particularly from a urinary, sexual and psychological perspective.
Numerous techniques have been described for organ preserving surgery in penile cancer- laser therapy, Mohs’ microsurgery, glans resurfacing, wide local excision, partial glansectomy, glansectomy, partial penectomy and finally as a radical penectomy after all organ sparing approaches have been exhausted. Organ preserving surgery has been shown to be oncologically safe and associated with improved functional outcomes.
Patients with penile cancer and especially those with an organ preserving approach require close follow up of their primary disease as well as inguinal and pelvic lymph nodes. Penile cancer is a rare disease and benefits from centralization to a dedicated penile cancer centre with a multidisciplinary approach.
Lichen sclerosis, or balanitis xerotica obliterans, is a chronic inflammatory process of unknown aetiology affecting the glans penis, prepuce and urethra. Lichen sclerosis affects primarily the glans penis and prepuce of uncircumcised men and presents as pale, atrophic plaques, which may coalesce and sclerose, causing phimosis and meatal stenosis.
Primarily, patients with lichen sclerosis can be treated with topical agents and circumcision. Topical steroids have been shown to reduce the need for circumcision by up to 35%. Patients with persistent scaring lichen sclerosis should be referred for specialist opinion. In such patients who have extensive recurrent lichen sclerosis- organ preserving surgery such as removal of the glans epithelium (glans resurfacing) has been proven to be effective both cosmetically and functionally.
Penile cancer Lichen sclerosis Organ-sparing Organ-preserving Partial Penectomy
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