Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results?
BACKGROUND
We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer.


METHODS
We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square.


RESULTS
Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004).


CONCLUSIONS
WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.
Department of Urology, University of Turin, Turin, Italy;
Omid
O
Sedigh
Department of Urology, University of Turin, Turin, Italy;
Marco
M
Falcone
Department of Urology, University of Turin, Turin, Italy;
Carlo
C
Ceruti
Department of Urology, University of Turin, Turin, Italy;
Massimiliano
M
Timpano
Department of Urology, University of Turin, Turin, Italy;
Mirko
M
Preto
Department of Urology, University of Turin, Turin, Italy;
Marco
M
Oderda
Medical School of Vienna, Vienna, Austria.
Franklin
F
Kuehhas
Department of Urology, University of Turin, Turin, Italy;
Mattia
M
Sibona
Department of Urology, University of Turin, Turin, Italy;
Arianna
A
Gillo
Department of Urology, University of Turin, Turin, Italy;
Paolo
P
Gontero
Department of Urology, University of Turin, Turin, Italy;
Luigi
L
Rolle
Department of Urology, University of Turin, Turin, Italy;
Bruno
B
Frea