Skip to main content

Advertisement

SpringerLink
Log in

Surgical Reconstruction After Penile Cancer Surgery

  • Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Penile cancer is a rare condition that can have a severe negative impact on the quality of life of affected individuals. Treatment for this malignancy has improved over the years with regard to modalities the oncologic team is able to offer as well as the reconstructive options available thereafter. The purposes of this manuscript are to perform a critical review of the current scientific literature and highlight the reconstructive techniques at the forefront of the urologic arena.

Recent Findings

Reconstructive surgery following penile cancer treatment is dependent on the extent of the defect created from local or radical excision of the tumor. Improvements in surgical reconstructive techniques have enabled physicians to minimize post-operative complications such as urethral stricture formation and flap/graft loss.

Summary

Herein, we summarize the updates and improvements of reconstructive surgery following procedures for penile cancer. Advancements in current techniques, ranging from resurfacing of the glans to complex reconstructive phalloplasty procedures, have enabled surgeons to improve the outcomes of their primary goals: to maintain or restore the urinary and sexual function of the phallus while creating a cosmetically acceptable result.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been Highlighted as: • Of importance •• Of major importance

  1. D’Ancona CA, Botega NJ, De Moraes C, Lavoura NS Jr, Santos JK, Rodrigues Netto N Jr. Quality of life after partial penectomy for penile carcinoma. Urology. 1997;50(4):593–6.

    Article  PubMed  Google Scholar 

  2. Djordjevic ML, Palminteri E, Martins F. Male genital reconstruction for the penile cancer survivor. Curr Opin Urol. 2014;24(4):427–33. https://doi.org/10.1097/MOU.0000000000000068.

    Article  PubMed  Google Scholar 

  3. • Bickell M, Beilan J, Wallen J, Wiegand L, Carrion R. Advances in surgical reconstructive techniques in the management of penile, urethral, and scrotal cancer. Urol Clin North Am. 2016;43(4):545–59. https://doi.org/10.1016/j.ucl.2016.06.015. This paper summarizes recent updates on the reconstructive techniques employed following radical surgery for penile, urethral, and scrotal cancers.

    Article  PubMed  Google Scholar 

  4. Yang J, Chen J, Wu XF, Song NJ, Xu XY, Li Q, et al. Glans preservation contributes to postoperative restoration of male sexual function: a multicenter clinical study of glans preserving surgery. J Urol. 2014;192(5):1410–7. https://doi.org/10.1016/j.juro.2014.04.083.

    Article  PubMed  Google Scholar 

  5. Yang J, Chen J, Wu XF, Song NJ, Li Q, Qiao D, et al. Glans-reconstruction with preputial flap is superior to primary closure for post-surgical restoration of male sexual function in glans-preserving surgery. Andrology. 2014;2(5):729–33. https://doi.org/10.1111/j.2047-2927.2014.00239.x.

    Article  CAS  PubMed  Google Scholar 

  6. Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE, et al. Penile cancer: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2013;11(5):594–615.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Leone A, Inman B, Spiess PE. Need for evidence and consensus on laser treatment for management of select primary penile tumors. Eur Urol. 2017;72(1):4–6. https://doi.org/10.1016/j.eururo.2017.01.024.

    Article  PubMed  Google Scholar 

  8. Horenblas S, van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. 1994;151(5):1239–43.

    Article  CAS  PubMed  Google Scholar 

  9. Minhas S, Kayes O, Hegarty P, Kumar P, Freeman A, Ralph D. What surgical resection margins are required to achieve oncological control in men with primary penile cancer? BJU Int. 2005;96(7):1040–3. https://doi.org/10.1111/j.1464-410X.2005.05769.x.

    Article  PubMed  Google Scholar 

  10. Sharma P, Zargar-Shoshtari K, Spiess PE. Current surgical management of penile cancer. Curr Probl Cancer. 2015;39(3):147–57. https://doi.org/10.1016/j.currproblcancer.2015.03.006.

    Article  PubMed  Google Scholar 

  11. •• Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, et al. Primary penile cancer organ sparing treatment. Cent European J Urol. 2016;69(4):377–83. https://doi.org/10.5173/ceju.2016.890. This paper analyzes organ-sparing techniques in the treatment of penile cancer and includes a concise review on glans resurfacing and glansectomy.

    PubMed  PubMed Central  Google Scholar 

  12. Jordan GH MK. In: Elsevier, editor. Campbell-Walsh Urology. 10 ed., 2012. p. 956–1000.

  13. • Chipollini J, Yan S, Ottenhof SR, Zhu Y, Draeger D, Baumgarten AS, Tang DH, Protzel C, Ye DW, Hakenberg OW, Horenblas S Watkin NA, Spiess PE. Surgical management of penile carcinoma in situ: results from an international collaborative study and review of the literature. BJU International. 2017;XX(XX):XX. This study demonstrates penile-sparing approaches that can be successfully employed in the treatment of penile CIS, with durable response rates at intermediate to long-term follow-up.

  14. •• O’Kelly F, Lonergan P, Lundon D, Nason G, Sweeney P, Cullen I, et al. A prospective study of total glans resurfacing for localized penile cancer to maximize oncologic and functional outcomes in a tertiary referral network. J Urol. 2017;197(5):1258–63. https://doi.org/10.1016/j.juro.2016.12.089. This study follows 19 prospectively enrolled patients who underwent total glans resurfacing, with detailed functional and oncologic outcomes.

    Article  PubMed  Google Scholar 

  15. Hakansson U, Kirrander P, Uvelius B, Baseckas G, Torbrand C. Organ-sparing reconstructive surgery in penile cancer: initial experiences at two Swedish referral centres. Scand J Urol. 2015;49(2):149–54. https://doi.org/10.3109/21681805.2014.955822.

    Article  PubMed  Google Scholar 

  16. Perez-Nino J, Fernandez N, Sarmiento G. Partial penectomy and penile reconstruction. Initial surgical management of localized penile cancer. Actas Urol Esp. 2014;38(1):62–5. https://doi.org/10.1016/j.acuro.2013.04.005.

    Article  CAS  PubMed  Google Scholar 

  17. Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term follow-up. J Urol. 2007;178(5):1980–5. https://doi.org/10.1016/j.juro.2007.07.039.

    Article  PubMed  Google Scholar 

  18. Machan M, Brodland D, Zitelli J. Penile squamous cell carcinoma: penis-preserving treatment with Mohs micrographic surgery. Dermatol Surg. 2016;42(8):936–44. https://doi.org/10.1097/DSS.0000000000000795.

    Article  CAS  PubMed  Google Scholar 

  19. •• Kamel MH, Bissada N, Warford R, Farias J, Davis R. Organ sparing surgery in penile cancer: a systematic review. J Urol. 2017; https://doi.org/10.1016/j.juro.2017.01.088. This systematic review outlines current oncologic and reconstruction techniques, with excellent figures/images to supplement a detailed discussion.

  20. Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol. 2009;9:8. https://doi.org/10.1186/1471–2490–9-8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. Resurfacing and reconstruction of the glans penis. Eur Urol. 2007;52(3):893–8. https://doi.org/10.1016/j.eururo.2007.01.047.

    Article  PubMed  Google Scholar 

  22. Belinky JJ, Cheliz GM, Graziano CA, Rey HM. Glanuloplasty with urethral flap after partial penectomy. J Urol. 2011;185(1):204–6. https://doi.org/10.1016/j.juro.2010.09.010.

    Article  PubMed  Google Scholar 

  23. Parnham AS, Albersen M, Sahdev V, Christodoulidou M, Nigam R, Malone P, et al. Glansectomy and split-thickness skin graft for penile cancer. Eur Urol. 2016; https://doi.org/10.1016/j.eururo.2016.09.048.

  24. Sedigh O, Falcone M, Ceruti C, Timpano M, Preto M, Oderda M, et al. Sexual function after surgical treatment for penile cancer: which organ-sparing approach gives the best results? Can Urol Assoc J. 2015;9(7–8):E423–7. https://doi.org/10.5489/cuaj.2801.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wallen JJ, Baumgarten AS, Kim T, Hakky TS, Carrion RE, Spiess PE. Optimizing penile length in patients undergoing partial penectomy for penile cancer: novel application of the ventral phalloplasty oncoplastic technique. Int Braz J Urol. 2014;40(5):708–9. https://doi.org/10.1590/S1677-5538.IBJU.2014.05.18.

    Article  PubMed  Google Scholar 

  26. Hakky TS, Rodriguez AR, Parker J, Lockhart JL, Honeymeyer Iii J, Carrion RE. Ventral phalloplasty. Int Braz J Urol. 2012;38(4):565–6.

    Article  PubMed  Google Scholar 

  27. Parkash S, Ananthakrishnan N, Roy P. Refashioning of phallus stumps and phalloplasty in the treatment of carcinoma of the penis. Br J Surg. 1986;73(11):902–5.

    Article  CAS  PubMed  Google Scholar 

  28. Mortensen GL, Jakobsen JK. Patient perspectives on quality of life after penile cancer. Dan Med J. 2013;60(7):A4655.

    PubMed  Google Scholar 

  29. Garaffa G, Christopher NA, Ralph DJ. Total phallic reconstruction in female-to-male transsexuals. Eur Urol. 2010;57(4):715–22. https://doi.org/10.1016/j.eururo.2009.05.018.

    Article  PubMed  Google Scholar 

  30. Schultheiss D, Gabouev AI, Jonas U, Nikolaj A. Bogoraz (1874–1952): pioneer of phalloplasty and penile implant surgery. J Sex Med. 2005;2(1):139–46. https://doi.org/10.1111/j.1743-6109.2005.20114.x.

    Article  PubMed  Google Scholar 

  31. Song R, Gao Y, Song Y, Yu Y, Song Y. The forearm flap. Clin Plast Surg. 1982;9(1):21–6.

    CAS  PubMed  Google Scholar 

  32. Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74(2):251–8.

    Article  CAS  PubMed  Google Scholar 

  33. •• Sopko NA, Tuffaha SH, Lough D, Brandacher G, Lee WPA, Bivalacqua TJ, et al. Penile allotransplantation for complex genitourinary reconstruction. J Urol. 2017; https://doi.org/10.1016/j.juro.2016.10.134. This study reviews the three reported cases of penile transplant and includes a relevant discussion regarding the conversersies surrounding this procedure.

  34. Garaffa G, Antonini G, Gentile V, Ralph DJ. Phalloplasty for the genetic male. Transl Androl Urol. 2012;1(2):103–8. https://doi.org/10.3978/j.issn.2223-4683.2012.05.05.

    PubMed  PubMed Central  Google Scholar 

  35. Hage JJ, Bloem JJ, Suliman HM. Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals. J Urol. 1993;150(4):1093–8.

    Article  CAS  PubMed  Google Scholar 

  36. Hage JJ, De Graaf FH. Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery. 1993;14(9):592–8.

    Article  CAS  PubMed  Google Scholar 

  37. Dabernig J, Shelley OP, Cuccia G, Schaff J. Urethral reconstruction using the radial forearm free flap: experience in oncologic cases and gender reassignment. Eur Urol. 2007;52(2):547–53. https://doi.org/10.1016/j.eururo.2007.01.004.

    Article  PubMed  Google Scholar 

  38. Garaffa G, Raheem AA, Christopher NA, Ralph DJ. Total phallic reconstruction after penile amputation for carcinoma. BJU Int. 2009;104(6):852–6. https://doi.org/10.1111/j.1464-410X.2009.08424.x.

    Article  PubMed  Google Scholar 

  39. • Frey JD, Poudrier G, Chiodo MV, Hazen A. An update on genital reconstruction options for the female-to-male transgender patient: a review of the literature. Plast Reconstr Surg. 2017;139(3):728–37. https://doi.org/10.1097/PRS.0000000000003062. This review outlines techniques used in transgender surgeries, many of which can be applied to penile cancer patients.

    Article  CAS  PubMed  Google Scholar 

  40. Lumen N, Monstrey S, Selvaggi G, Ceulemans P, De Cuypere G, Van Laecke E, et al. Phalloplasty: a valuable treatment for males with penile insufficiency. Urology. 2008;71(2):272–276; discussion 6–7. https://doi.org/10.1016/j.urology.2007.08.066.

    Article  PubMed  Google Scholar 

  41. Selvaggi G, Monstrey S, Hoebeke P, Ceulemans P, Van Landuyt K, Hamdi M, et al. Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg. 2006;118(5):1171–7. https://doi.org/10.1097/01.prs.0000221110.43002.a0.

    Article  CAS  PubMed  Google Scholar 

  42. Kim SK, Lee KC, Kwon YS, Cha BH. Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals. J Plast Reconstr Aesthet Surg. 2009;62(3):309–17. https://doi.org/10.1016/j.bjps.2007.11.011.

    Article  PubMed  Google Scholar 

  43. Monstrey S, Hoebeke P, Selvaggi G, Ceulemans P, Van Landuyt K, Blondeel P, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg. 2009;124(2):510–8. https://doi.org/10.1097/PRS.0b013e3181aeeb06.

    Article  CAS  PubMed  Google Scholar 

  44. Kim SK, Kim TH, Yang JI, Kim MH, Kim MS, Lee KC. The etiology and treatment of the softened phallus after the radial forearm osteocutaneous free flap phalloplasty. Arch Plast Surg. 2012;39(4):390–6. https://doi.org/10.5999/aps.2012.39.4.390.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int. 2007;100(4):899–905; discussion. https://doi.org/10.1111/j.1464-410X.2007.07084.x.

    Article  PubMed  Google Scholar 

  46. Descamps MJ, Hayes PM, Hudson DA. Phalloplasty in complete aphallia: pedicled anterolateral thigh flap. J Plast Reconstr Aesthet Surg. 2009;62(3):e51–4. https://doi.org/10.1016/j.bjps.2007.04.014.

    Article  CAS  PubMed  Google Scholar 

  47. Felici N, Felici AA. new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg. 2006;59(2):153–7.

    Article  CAS  PubMed  Google Scholar 

  48. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219–26. discussion 27–30

    Article  PubMed  Google Scholar 

  49. Selvaggi G, Monstrey S, Ceulemans P, T’Sjoen G, De Cuypere G, Hoebeke P. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58(4):427–33. https://doi.org/10.1097/01.sap.0000238428.91834.be.

    Article  CAS  PubMed  Google Scholar 

  50. De Fontaine S, Lorea P, Wespes E, Schulman C, Goldschmidt D. Complete phalloplasty using the free radial forearm flap for correcting micropenis associated with vesical exstrophy. J Urol. 2001;166(2):597–9.

    Article  PubMed  Google Scholar 

  51. Zuckerman JM, Smentkowski K, Gilbert D, Storme O, Jordan G, Virasoro R, et al. Penile prosthesis implantation in patients with a history of total phallic construction. J Sex Med. 2015;12(12):2485–91. https://doi.org/10.1111/jsm.13067.

    Article  PubMed  Google Scholar 

  52. Hoebeke PB, Decaestecker K, Beysens M, Opdenakker Y, Lumen N, Monstrey SM. Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57(2):334–40. https://doi.org/10.1016/j.eururo.2009.03.013.

    Article  PubMed  Google Scholar 

  53. Mason C, Dunnill P. A brief definition of regenerative medicine. Regen Med. 2008;3(1):1–5. https://doi.org/10.2217/17460751.3.1.1.

    Article  PubMed  Google Scholar 

  54. Zhang C, Murphy SV, Atala A. Regenerative medicine in urology. Semin Pediatr Surg. 2014;23(3):106–11. https://doi.org/10.1053/j.sempedsurg.2014.05.002.

    Article  PubMed  Google Scholar 

  55. Chen KL, Eberli D, Yoo JJ, Atala A. Bioengineered corporal tissue for structural and functional restoration of the penis. Proc Natl Acad Sci U S A. 2010;107(8):3346–50. https://doi.org/10.1073/pnas.0909367106.

    Article  CAS  PubMed  Google Scholar 

  56. Kwon TG, Yoo JJ, Atala A. Autologous penile corpora cavernosa replacement using tissue engineering techniques. J Urol. 2002;168(4 Pt 2):1754–8. https://doi.org/10.1097/01.ju.0000030103.53181.7d.

    Article  CAS  PubMed  Google Scholar 

  57. Patel MN, Atala A. Tissue engineering of the penis. ScientificWorldJournal. 2011;11:2567–78. https://doi.org/10.1100/2011/323989.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Li Y, Wu J, Feng F, Men C, Yang D, Gao Z, et al. A preclinical study of cell-seeded tubularized scaffolds specially secreting LL37 for reconstruction of long urethral defects. Anticancer Res. 2017;37(8):4295–301.

    PubMed  Google Scholar 

  59. Zhou S, Yang R, Zou Q, Zhang K, Yin T, Zhao W, et al. Fabrication of tissue-engineered bionic urethra using cell sheet technology and labeling by ultrasmall superparamagnetic iron oxide for full-thickness urethral reconstruction. Theranostics. 2017;7(9):2509–23. https://doi.org/10.7150/thno.18833.

    Article  PubMed  PubMed Central  Google Scholar 

  60. de Vocht D, de Kemp V, Iljas JD, Ruud Bosch JLH, de Kort LMO, de Graaf P. A systematic review on cell seeded tissue engineering of penile corpora. J Tissue Eng Regen Med. 2017; https://doi.org/10.1002/term.2487.

  61. Hu W, Lu J, Zhang L, Wu W, Nie H, Zhu Y, et al. A preliminary report of penile transplantation. Eur Urol. 2006;50(4):851–3. https://doi.org/10.1016/j.eururo.2006.07.026.

    Article  PubMed  Google Scholar 

  62. • Cetrulo CL Jr, Li K, Salinas HM, Treiser MD, Schol I, Barrisford GW, et al. Penis transplantation: first US experience. Ann Surg. 2017; https://doi.org/10.1097/SLA.0000000000002241. This study describes the first vascularized composite allotransplantation of the penis performed in the USA.

  63. van der Merwe A, Graewe F, Zuhlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, et al. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet. 2017;390(10099):1038–47. https://doi.org/10.1016/S0140-6736(17)31807-X.

    Article  PubMed  Google Scholar 

  64. Tuffaha SH, Cooney DS, Sopko NA, Bivalacqua TJ, Lough DM, Cooney CM, et al. Penile transplantation: an emerging option for genitourinary reconstruction. Transpl Int. 2017;30(5):441–50. https://doi.org/10.1111/tri.12928.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, USF Health Morsani College of Medicine, 2 Tampa General Circle, STC 6, Tampa, FL, 33606, USA

    Jonathan A. Beilan, Neil J. Manimala, Julio Slongo, Aram Loeb & Rafael E. Carrion

  2. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA

    Philippe E. Spiess

Authors
  1. Jonathan A. Beilan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neil J. Manimala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julio Slongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aram Loeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philippe E. Spiess
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rafael E. Carrion
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan A. Beilan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

This article is part of the Topical Collection on Male and Female Surgical Interventions

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beilan, J.A., Manimala, N.J., Slongo, J. et al. Surgical Reconstruction After Penile Cancer Surgery. Curr Sex Health Rep 9, 224–231 (2017). https://doi.org/10.1007/s11930-017-0134-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-017-0134-1

Keywords

Search

Navigation