Glans preservation contributes to postoperative restoration of male sexual function: a multicenter clinical study of glans preserving surgery.
OBJECTIVE
We evaluated whether glans preserving surgery would be more helpful for patients to regain satisfactory sexual competency postoperatively than conventional partial amputation.


METHODS
From 2004 to 2012 at 4 centers a total of 135 men treated with glans preserving surgery and 36 treated with partial amputation were selected for evaluation from a total of 273 consecutive patients with penile cancer. Subjective evaluation for patient sexual performance was investigated using the IIEF-15. Objective evaluation was done using the audiovisual sexual stimulation test with the RigiScan® Plus. The degree of satisfaction with penile appearance, and patient confidence and partner acceptability for intercourse were evaluated by 5-point scales.


RESULTS
Patients treated with glans preserving surgery had better performance in 4 IIEF-15 domains (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) and 1 RigiScan parameter (tip rigidity) (each p <0.01). They also had significantly higher appearance satisfaction (64.4% vs 13.9%) and intercourse confidence (55.6% vs 5.6%) than men who underwent partial amputation. Sexual partners in the glans preserving group also showed significantly higher appearance satisfaction (51.1% vs 5.6%) and intercourse acceptability (37.8% vs 16.7%) than in the partial amputation group.


CONCLUSIONS
Glans preserving surgery effectively preserves the functional anatomy and cosmetic appearance of the glans penis. Glans preservation contributes to minimizing postoperative erectile dysfunction and negative psychological impediments, and promotes return to satisfactory sexual performance. Patients treated with glans preservation have more advantages in obtaining sexual acceptance from their partners than those who undergo amputation.
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Jie
J
Yang
Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Jing
J
Chen
Institute of Dermatology Surgery, China Academy of Medical Sciences and Peking Union Medical College, Nanjing, People's Republic of China.
Xin-feng
XF
Wu
Department of Dermatology, Shanghai Skin Diseases Hospital, Shanghai, People's Republic of China.
Ning-jing
NJ
Song
Department of Dermatology, Jiangsu Province Official Hospital, Nanjing, People's Republic of China.
Xiao-yun
XY
Xu
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Quan
Q
Li
Department of Urology, Jiangsu Province Official Hospital, Nanjing, People's Republic of China.
Di
D
Qiao
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Jia-yi
JY
Zhang
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Wei
W
Wang
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Huang
H
Su
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Zeng-jun
ZJ
Wang
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Jian-tang
JT
Su
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. Electronic address: yj197912@163.com.
Ning-hong
NH
Song
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000601:surgery*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019529:Sexuality / Q000502:physiology*; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male
erectile dysfunction; organ preservation; penile neoplasms; penis; physiological; sexual dysfunction