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Objective: The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function. Method: Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included. Results: A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down. Conclusion: Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery. [ABSTRACT FROM AUTHOR]

Le cancer du pénis est une maladie rare mais ayant un des plus hauts potentiels de mise en péril de la sexualité parmi les cancers génito-urinaires. Il touche des hommes âgés, souvent actif sexuellement. Sa prise en charge varie selon la gravité de l'atteinte : crèmes cytotoxiques, resurfaçage, curiethérapie, biopsie-exérèse, glansectomie, amputation partielle ou totale. L'impact négatif sur le bien-être et la sexualité est d'autant plus important que la chirurgie est mutilante. Le traitement doit ainsi être le plus conservateur possible, sans compromis oncologique. La prise en charge de la sexualité doit comprendre une information éclairée sur les modalités et les résultats escomptés des traitements conservateurs, une prise en charge des dysfonctions sexuelles associées, l'information sur les possibilités de reconstruction. Penile cancer is a rare condition but has one of the highest potentials among genitourinary cancers for jeopardizing sexuality. It affects older, often sexually active men. Its management varies according to the severity of the disease: cytotoxic creams, resurfacing, brachytherapy, excisional biopsy, glansectomy, partial or total amputation. The negative impact on well-being and sexuality is more important as the surgery is mutilating. The treatment must therefore be as conservative as possible, without oncological compromise. The management of sexuality must include enlightened information on the modalities and expected results of conservative treatments, management of associated sexual dysfunctions, and information on the possibilities of reconstruction. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide real-world data on the multidisciplinary management of metastatic penile squamous-cell carcinoma (mpSCC) patients and their survival outcomes, particularly those who receive best supportive care (BSC). Methods: A retrospective analysis of 1720 patients, managed via a supra-regional penile-specialist multidisciplinary team was conducted between January 2006 and May 2020. Results: A total of 101 patients (median age 63 years; interquartile range 56–72 years; 73% ECOG 0/1) were included. Of these, 32% (32/101) had previously received adjuvant chemotherapy prior to metastatic recurrence, 58% (59/101) received chemotherapy and 42% (42/101) received BSC. Further, 17% (17/101) received second-line systemic therapy, and 3% (3/101) received third-line systemic therapy. For first-line systemic-therapy, there was a 46% (27/59) clinical benefit rate (CBR), with 9% (5/59) complete response, 15% (9/59) partial response and 22% (13/59) stable disease. Patients receiving second-line therapy (n =17) had a 29% (5/17) CBR. Median progression-free survival for first- and second-line treatment was 3.2 and 2.2 months, respectively. Median overall survival (mOS) for all patients was 6.2 months. mOS for first-line chemotherapy, second-line chemotherapy and BSC patients was 7.2, 4.5 and 2.0 months, respectively. Conclusions: First-line platinum-based chemotherapy is associated with notable response rates in mpSCC patients. Agents with better response rates are needed urgently potentially in combination with platinum-based chemotherapy. Level of evidence: Level 2b. [ABSTRACT FROM AUTHOR]

To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown. Materials and Methods: An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing. Results: Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies. Conclusions: Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection. [ABSTRACT FROM AUTHOR]

To compare the safety and effectiveness of minimally invasive surgery (MIS) with open inguinal lymph node dissection (O-ILND) in penile cancer. We performed a systematic reviews and cumulative meta-analyses of primary results of interest according to PRISMA criteria, and quality assessment followed AMSTAR. The system searched five databases, including Zhiwang, Embase, PubMed, Cochrane Library and Web of Science. The search period ranged was from database creation until September 2023. The statistical analysis software used Stata16. A total of 16 studies, including 898 patients. Compared to O-ILND, MIS is superior in length of stay (WMD = −2.96, 95%CI [-4.38, −1.54], P < 0.05), drainage time (WMD = −3.24, 95%CI [-4.70, −1.78], P < 0.05) and estimated blood loss (WMD = −35.70, 95%CI [-46.27, −25.14], P < 0.05), while operation time, recurrence rate and 5-year overall survival rate are the same. The number of lymph nodes dissection between the two groups are not statistically significant. Subgroup analyses found that there are more lymph nodes dissection in robotic-assisted inguinal lymph nodes dissection (WMD = 0.50, 95%CI [0.20, 0.80], P < 0.05). The overall complication rate of MIS was lower (OR = 0.26, 95%CI [0.09, 0.70], P < 0.05). Minimally invasive inguinal lymph nodes dissection appears to be a better option for penile cancer cases. But more large samples and multicenter studies are needed to further confirm. [ABSTRACT FROM AUTHOR]

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The main purpose of this study was to compare the surgical strategy and clinical outcomes of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer. 21 patients were diagnosis with squamous cell carcinoma and identified from March 2010 to December 2020 in our department. Ten patients were received single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy (robot-assisted group), and eleven patients underwent laparoscopic inguinal lymphadenectomy (laparoscopic group). Preoperative physical examination and related auxiliary examinations all indicated bilateral inguinal lymph node enlargement, and there was no distant metastasis patient presented during the follow-up period. There was no intraoperative conversion to open surgery. The operation time under robot-assisted group was 104 ± 13 min which was significantly shorter than laparoscopic group (136 ± 11 min, P < 0.01). The average number of lymph nodes was 22.2 ± 4.5 of both sides in robot-assisted group, which was statistically different compared with laparoscopic group (15.4 ± 3.1, p < 0.01). Moreover, there was significant difference of hospitalization cost between two groups (CNY 67429 ± 5586 vs 28582 ± 3774, P < 0.01). No differences in operation time, blood loss, and length of stay were recorded. The single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy reveals with shorter operating time, and better surgical effect, Moreover, we prefer to no change the trocars layout and mechanical arm system during the operation. [ABSTRACT FROM AUTHOR]

Abstract: Genitourinary (GU) cancers have greatly benefited from immunotherapy treatments, such as immune checkpoint inhibitors. However, the durable clinical response rate for these agents remains relatively low, calling for more innovative immunotherapy approaches. Adoptive cell therapy has shown a significant advancement in the treatment of cancer in recent years and represents a great potential for the treatment of GU cancers. This review summarizes the current advancements in cellular therapy strategies for the treatment of renal cell carcinoma, bladder cancer, and prostate and penile cancers. Further, current and past clinical trials of adoptive cell therapy in GU tumors are reviewed. Finally, a perspective on the future of cell therapy in GU tumors is discussed. [ABSTRACT FROM AUTHOR]

Le pronostic vital des cancers du pénis est lié à l'envahissement ganglionnaire. Aucun examen d'imagerie n'est suffisamment précis pour dépister les 25 % de patients cN0, micrométastatiques. Ainsi, pour les tumeurs > pT1G2, donc à risque d'invasion lymphovasculaire, la biopsie des ganglions sentinelles (GS) du pénis est recommandée. C'est l'alternative mini-invasive au curage inguinal modifié. Cette procédure est réalisée à l'aide du radio-colloïde Technitium 99 m (Tc99 m) injecté en préopératoire. Nous présentons ici la technique chirurgicale de prélèvement du ganglion sentinelle inguinal, dans les tumeurs du pénis, ainsi que ses résultats et complications rapportés dans la littérature. La biopsie du ganglion sentinelle a une morbidité faible avec des résultats carcinologiques satisfaisants. Cette technique est standardisée et fiable avec une courbe d'apprentissage rapide. Le curage modifié peut être remplacé avantageusement par le prélèvement du ganglion sentinelle pour les patients cN0 à risque de diffusion lymphatique locorégionale (> pT1a et/ou de grade > G1). À l'instar du curage diagnostique, le prélèvement doit toujours être bilatéral. Si possible réalisée tumeur en place, cette technique peut être différée quand l'indication d'une exploration lymphonodale est secondaire à la chirurgie d'exérèse (> pT1G1). Elle peut être reconduite uni- ou bilatéralement en cas de procédure non contributive (sinon un curage modifié du côté non exploré est nécessaire). La biopsie du GS des patients atteints d'un cancer du pénis est devenue une procédure fiable permettant la détection de l'invasion des ganglions lymphatiques le plus tôt possible avec une morbidité minime. Quand cette technologie est disponible, il n'y a pratiquement plus de place pour la lymphadénectomie diagnostique chez les patients atteints d'un cancer du pénis à risque métastatique, ce qui minimise la morbidité de ce bilan d'extension invasif, pourtant indispensable. The presence of lymph node involvement is the single most important prognostic factor for cancer-specific mortality. No imaging is sufficiently precise to detect the 25 % of cN0 patients with occult lymph node metastasis. For at least pT1G2 tumors, which are proned to lymphovascular invasion, an invasive staging technique is required as called risk-adapted approach. Dynamic Sentinel Node Biopsy (DSNB) of the penis is now recommended in first intention. It is the mini-invasive alternative to modified inguinal lymphadenectomy (MILDN). This procedure is performed using Technitium 99 m radio-colloid (Tc99 m) analyzed preoperatively. We present here the surgical technique of inguinal sentinel lymph node harvesting in penile tumors, as well as its results and complications reported in the literature. The sentinel node biopsy is a suitable procedure to stage clinically node-negative penile cancer, and it has a low complication rate. No learning curve as been demonstrated. MILDN can be advantageously replaced by dynamic sentinel node biopsy for cN0 patients at high risk for occult metastasis (> pT1a and/or grade > G1). This patients should ideally have bilateral visualization of the sentinel lymph nodes, reflecting the drainage pattern from the primary tumour. If possible, this minimal invasive procedure must be proposed during resection surgery. DSNB is feasible as a delayed procedure when the indication of a lymphonodal exploration is secondary to (> pT1G1). A repeat DSNB procedure can be offered on the proviso that uni- or bilateral MILDN may be carried out if there is repeated non-visualization on one or both sides. When this technology is available, the modified inguinal lymphadenectomy should no longer be used for patients with penile cancer at risk of metastasis. It minimizes the morbidity when an invasive staging approaches remain indispensable. [ABSTRACT FROM AUTHOR]

European Reference Network (ERN) eUROGEN is a cross-border collaboration set up by the European Commission in 2017 aimed at tackling rare urogenital conditions, including cancers. This report aims to assess ERN eUROGEN's operational activity with a focus on rare urogenital cancers. Data for descriptive analyses were collected retrospectively between 2013 and 2017, and prospectively between 2018 and 2020. Operational indicators were set by the European Commission from 2018. Additionally, in 2019/20 centres self-assessed clinical service provision and provided clinical metrics for rare cancer specialist centres as established by experts. Results revealed that the cumulative rare urogenital cancer population increased 519.8% from 1,631 in 2013 to 10,109 in 2020. This may provide opportunities for research and creation of a large cancer registry. In total, ten centres met the clinical requirements for rare cancer specialist centres providing evidence of high-volume. Differences in data collection methods between centres limit further analyses. Other rare cancer data identified 39 panel discussions, three webinars, and eight publications. Whilst limitations to data analysis remain, ERN eUROGEN has demonstrated excellent operational performance with promising opportunities for rare cancer research. • Analysis on ERN eUROGEN activity with a focus on rare urogenital cancers. •The number of patients and procedures at rare cancer specialist centres increased. •A large specific data registry for 25 years is currently being constructed. •ERN eUROGEN has contributed to rare urogenital cancer education and research. •Future possibilities for rare cancer research are discussed. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Although discovered in the late 19th century by the American physician Robert F Weir, lichen sclerosus is still a condition not fully understood. Initially considered a simple skin disorder, it mainly affects the genital regions of both men and women, producing white hypomelanotic lesions, that if left untreated tend to evolve into more serious health related problems. In this paper we conducted a thorough review of the literature in order to assess the current level of knowledge of lichen sclerosus of the male genitalia, to identify its etiology, clinical presentation and diagnostic methods, and establish the main treatment options. Materials and Methods. So far a total of five etiologic factors have been considered for lichen sclerosus: autoimmunity, genetics, hormonal infiuence, repeated microtrauma and infections. As only empirical observations sustain each of them, and none alone can explain or predict lichen sclerosus, it is assumed that this condition has a multifactorial origin, and the precise appearance mechanism has yet to be determined. Regarding the lichen sclerosus of the male genitalia, four distinct clinical stages of presentation have been described, based on the extent of the disease and the complications it produces. During the first stage the white hypomelanotic lesions can be observed at the level of the prepuce, that gets scarred and brittle, and can lead to phimosis. For the second stage the lichen lesions also affect the glans of the penis, that can fuse with the phimotic prepuce. The third stage marks the involvement of the urethra, patients exhibiting stenoses and strictures, of various degrees of severity. And the fourth and most dangerous stage represents the malignant transformation of the involved tissues, resulting in squamous cell carcinoma of the penis or urethra, verrucous carcinoma of the penis, and erythroplasia of Queyrat. While definitive diagnosis is obtained after a histopathological examination of a removed specimen, the clinical presentation can often be enough to identify lichen sclerosus. Imaging like ultrasound, computed tomography or magnetic resonance is also required to correctly assess the extent of the complications. Results. Various treatment options have been employed for lichen sclerosus thus far, ranging from local ointments and creams to surgical excision and correction in the complicated cases. Some, like the revulsives and X-rays, retain only historic value, having been already abandoned. Out of the topical treatments used nowadays, meant to alleviate the symptoms and reduce the lichen affected areas, the most common are corticosteroids, calcineurin inhibitors, hormonal creams and retinoids. The same effects have been obtained with some forms of phototherapy. But when lichen sclerosus evolves beyond simple skin lesions, surgery is required in order to correct the acquired complications. If phimosis is associated, a complete circumcision of the involved tissue is needed. For the second stage, if the prepuce is fused to the glans, a restoration of lost obscured coronal sulcus procedure achieves the best results. In the third stage, when urethral strictures develop, various forms of urethroplasties are necessary to restore normal micturition, and even perineal urethrostomies are considered in cases of panurethral strictures. The fourth and most severe stage of lichen sclerosus, marked by the malignant transformation, imposes an oncologic treatment catered to the extent of the disease, from a simple excision of a prepuce or penile tumor, to complete emasculation and ilio-inguinal lymph node dissection, or even palliative chemotherapy in metastatic cases. Conclusions. Although known for almost 150 years, lichen sclerosus is still not a fully understood disease. Being considered a simple skin disorder for a long time, it's been overlooked by both patients and physicians, and its true incidence is underestimated. Only recently, after all the evolutive complications of lichen sclerosus have been identified, more effort has been invested in the diagnosis and treatment of this condition. While uncomplicated lichen sclerosus can be managed by topic therapies, advanced forms require complex surgical interventions and experienced physicians in order to achieve the best results. But further research is still needed to clarify the etiology and evolution risks. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the presence of circulating tumor cells (CTCs) in patients with penile squamous cell carcinoma (PSCC). Methods: CTCs were isolated from 14 patients with PSCC, 6 patients with balanoposthitis, and 6 healthy individuals. CTCs were enriched based on cell surface markers and filtered through the IsoFlux device, followed by identification according to cell morphology and immunofluorescence studies. Results: CTCs were found in all PSCC blood samples but not in balanoposthitis samples and samples from healthy individuals. Immunofluorescence studies confirmed the tumor origin. When the patients with PSCC were stratified according to metastatic inguinal lymph node status, a statistically significant difference was observed in the number of detected CTCs. Conclusion: Our study showed that CTCs in PSCC may represent a valuable marker for differentiating PSCC from other tumors. Based on the correlation with some clinical parameters, CTC analysis is possibly relevant for noninvasive monitoring of disease progression and prognosis. The results also suggested a potential role of CTCs in preventing overtreatment, such as inguinal lymph node dissection. [ABSTRACT FROM AUTHOR]