Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series

J. A. Pedrosa, S. P. Amstutz, Richard Bihrle, M. J. Mellon

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

INTRODUCTION: The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined.

MATERIALS AND METHODS: Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes.

RESULTS: Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure.

CONCLUSION: Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.

Original languageEnglish (US)
Pages (from-to)1551-1555
Number of pages5
JournalInternational Urology and Nephrology
Volume46
Issue number8
DOIs
StatePublished - Aug 1 2014

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Carcinoma in Situ
Urethra
Squamous Cell Carcinoma
Urethral Diseases
Penis
Dilatation
Transplants
Recurrence
Skin

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra : an updated series. / Pedrosa, J. A.; Amstutz, S. P.; Bihrle, Richard; Mellon, M. J.

In: International Urology and Nephrology, Vol. 46, No. 8, 01.08.2014, p. 1551-1555.

Research output: Contribution to journalArticle

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N2 - INTRODUCTION: The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined.MATERIALS AND METHODS: Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes.RESULTS: Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure.CONCLUSION: Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.

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