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Penile calciphylaxis is a rare and severe complication primarily observed in patients with end-stage renal disease (ESRD) undergoing dialysis. A 50-year-old man presented with severe penile pain and phimosis. He had a history of hypertension and diabetes mellitus for 10 years, complicated by ESRD and was awaiting a cadaveric kidney transplant. He was on cinacalcet therapy for tertiary hyperparathyroidism. The patient underwent circumcision at which discolouration and necrotic patches involving the glans penis were noted. The histological findings were consistent with calciphylaxis and suppurative inflammation. However, due to persistent severe pain and progressive gangrene, a partial penectomy was performed. This report demonstrates the importance of consideration of calciphylaxis in patients with ESRD when presenting with penile pain, even phimosis.

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Local therapy for penile cancer provides robust survival and can preserve the penis functionally and cosmetically. Interventions must target the appropriate clinical stage. We reviewed studies regarding the primary therapy in penile cancer, from topical therapy to radical penectomy, and reconstructive techniques. Topical therapy (5-FU or Imiquimod) provides a robust oncologic response in patients with Ta or Tis disease. Multiple laser therapies are available for localized patients and those with low-grade T1 disease. There is a non-trivial risk of progression and nodal metastases in poorly selected patients. Wide local excision provides an oncologically sound option in patient with up to T1 disease; less evidence exists for Mohs microsurgery in the setting of penile cancer. Increasingly aggressive approaches include glansectomy and partial/radical penectomy, which provide 5- and 10-year cancer-specific survival rates of over 80%. Meticulous reconstruction is necessary for the durable function of the remaining penis. Preservation of voiding and sexual function occurs via penile skin grafting, glans resurfacing, creation of a functional penile stump, and phalloplasty with a penile implant. Perineal urethrostomy provides an alternative in pathology demanding extensive partial or radical penectomy, and a durable option for seated voiding. Clinical suspicion and timely diagnosis are paramount in terms of management as less-invasive options for earlier-stage disease develop.

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BACKGROUND: Radiotherapy (RT) represents an alternative treatment option for patients with T1 squamous cell carcinoma of the penis (SCCP), with proven feasibility and tolerability. However, it has never been directly compared with partial penectomy (PP) using cancer-specific mortality (CSM) as an end point. METHODS: In the Surveillance, Epidemiology, and End Results database (2000-2020), T1N0M0 SCCP patients treated with RT or PP were identified. This study relied on 1:4 propensity score-matching (PSM) for age at diagnosis, tumor stage, and tumor grade. Subsequently, cumulative incidence plots as well as multivariable competing risks regression (CRR) models addressed CSM. Additionally, the study accounted for the confounding effect of other-cause mortality (OCM). RESULTS: Of 895 patients with T1N0M0 SCCP, 55 (6.1%) underwent RT and 840 (93.9%) underwent PP. The RT and PP patients had a similar age distribution (median age, 70 vs 70 years) and more frequently harbored grade I or II tumors (67.3% vs 75.8%) as well as T1a-stage disease (67.3% vs 74.3%). After 1:4 PSM, 55 (100%) of the 55 RT patients versus 220 (26.2%) of the 840 PP patients were included in the study. The 10-year CSM derived from the cumulative incidence plots was 25.4% for RT and 14.4% for PP. In the multivariable CRR models, RT independently predicted a higher CSM than PP (hazard ratio, 1.99; 95% confidence interval, 1.05-3.80; p = 0.04). CONCLUSION: For the T1N0M0 SCCP patients treated in the community, RT was associated with nearly a twofold higher CSM than PP. Ideally, a validation study based on tertiary care institution data should be conducted to test whether this CSM disadvantage is operational only in the community or not.

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Primary penile extraosseous osteosarcoma (EOS) ranks the most uncommon amongst the differential penile masses, with only nine cases reported so far. In this report, we share the management of a 67-year-old Hispanic male who presented with a painful mass over his distal penile shaft and glans for the last two months. After initial imaging and complete blood investigations, he underwent partial penectomy. Histology revealed high-grade sarcoma, with osteoid production, favoring high-grade extra-skeletal osteosarcoma, with tumor necrosis involving approximately 5% of the tumor volume. The patient had bilateral palpable inguinal lymphadenopathy, which was seen even on a pre-op CT scan. The patient thus underwent bilateral robotic superficial and deep inguinal standard template lymph node dissection three weeks after his partial penectomy. His pathology was negative for malignancy in all examined lymph nodes. At his last follow-up, five months post his primary surgery, he had been doing well without concerns for recurrence.

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Treatment of penile cancer (PC) focuses on organ preservation, employing various surgical and non-surgical approaches. These interventions may lead to disfigurement, impacting patients' functional outcomes and psychosocial well-being. We reviewed studies related to penile health and PC up to February 2024, limited to studies published in English. Studies employing health-related quality of life (HRQoL) assessments have identified a detrimental association between aggressive treatment and overall health status, physical functioning, and relationships. In contrast, organ-sparing demonstrates improved measures related to HRQoL and sexual function. Assessment through validated questionnaires reveals diverse voiding outcomes, and varying impacts on QoL and sexual activity, emphasizing the necessity for multidisciplinary personalized care. Studies highlight substantial variations in sexual function, with patients reporting adaptations, reduced satisfaction, and concerns about body image and sexual well-being. Furthermore, unmet needs include challenges in patient-clinician communication, obtaining information, and accessing psychosocial support. Patient experiences underscore the importance of timely diagnosis, treatment access, and addressing psychological consequences. Organ-sparing approaches have higher QoL preservation and sexual function. Individualized support, including sexual therapy, support groups, and family counseling, is essential for post-treatment rehabilitation. Timely diagnosis and comprehensive care are paramount in addressing the multifaceted impact of PC on patients and families.

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Introduction: Cholesterol crystal embolism is a rare microembolic disease caused by cholesterol crystals that can present with various symptoms after vascular surgery, catheterization, or anticoagulation therapy. We report a case of penile ulceration caused by cholesterol crystal embolism. Case presentation: A 72-year-old man undergoing maintenance dialysis for end-stage renal failure presented with penile pain and a black glans ulcer. Despite low-density lipoprotein apheresis, he was referred to our hospital because of lack of improvement. Based on his medical history and clinical presentation, including artificial vascular replacement and right toe amputation, cholesterol crystal embolism was suspected and partial penectomy was performed, thus confirming the diagnosis. Penile pain resolved after surgery, and he was discharged on Day 10. Unfortunately, he died after small bowel perforation developed 2 months after surgery. Conclusion: Penile ulcers caused by cholesterol crystal embolism may indicate the severity and progression of disease and typically require surgical intervention.

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We tested the feasibility and oncological outcomes after penile-sparing surgery (PSS) for local recurrent penile cancer after a previous glansectomy/partial penectomy. We retrospectively analysed 13 patients (1997-2022) with local recurrence of penile cancer after a previous glansectomy or partial penectomy. All patients underwent PSS: circumcision, excision, or laser ablation. First, technical feasibility, treatment setting, and complications (Clavien-Dindo) were recorded. Second, Kaplan-Meier plots depicted overall and local recurrences over time. Overall, 11 (84.5%) vs. 2 (15.5%) patients were previously treated with glansectomy vs. partial penectomy. The median (IQR) time to disease recurrence was 56 (13-88) months. Six (46%) vs. two (15.5%) vs. five (38.5%) patients were treated with, respectively, local excision vs. local excision + circumcision vs. laser ablation. All procedures, except one, were performed in an outpatient setting. Only one Clavien-Dindo 2 complication was recorded. The median follow-up time was 41 months. Overall, three (23%) vs. four (30.5%) patients experienced local vs. overall recurrence, respectively. All local recurrences were safely treated with salvage surgery. In conclusion, we reported the results of a preliminary analysis testing safety, feasibility, and early oncological outcomes of PSS procedures for patients with local recurrence after previous glansectomy or partial penectomy. Stronger oncological outcomes should be tested in other series to optimise patient selection.

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INTRODUCTION: We report a rare case of primary malignant melanoma with inguinal lymph node metastasis in the male urethra. CASE PRESENTATION: A 57-year-old male patient presented with a small tumor on the ventral surface of the penis, which was discovered 5 months ago and did not cause pain or discomfort. In the past month, the patient has developed symptoms of urinary incontinence. MRI and PET/CT scans revealed a primary tumor in the penile urethra, but no metastases were found. The patient underwent partial penectomy surgery and laparoscopic bilateral inguinal lymphadenectomy within one month. The pathological combined with immunohistochemical staining confirmed primary malignant melanoma in the urethra with right inguinal lymph node metastasis. Despite complying with surgical and immunotherapy treatment with Pembrolizumab for 18 cycles, the patient was diagnosed with recurrent cancer in the penile stump after 05 months and he passed away after 18 months. DISCUSSION: Urethral melanoma is a rare and highly invasive type of cancer. It was often diagnosed at a late stage because the initial symptoms were not obvious in the lower urinary tract. Additionally, cancer progressed very quickly, making it difficult to treat. CONCLUSION: Urethral melanoma, if detected at a late stage with lymph node metastasis, has a significantly poor prognosis irrespective of the treatment method employed. However, to our best knowledge, very few publications can be found on this disease, and the strategic treatment remained unknown.

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OBJECTIVES: To establish the level of access to healthcare, education, social and geographical factors predisposing a negative surgical outcome and higher mortality rate in patients with penile cancer. METHODS: This is a retrospective, longitudinal and analytical study. Ninety-three medical records of adult male patients diagnosed with penile cancer were reviewed. Fisher's exact test was performed to determine the association between the level of healthcare, social and geographical factors, and the outcomes for penile cancer. RESULTS: Patients without primary care access had a higher chance of having lymphovascular invasion at the time of diagnosis (OR=37.5, P<0.0001), a higher mortality rate at 24 months after diagnosis (OR=19.2, P=0.005), a lack of high school diploma or equivalent (OR=3.8, P=0.049) and a higher likelihood of referral from a provincial hospital (OR=10.1, P<0.0001). Patients without a favorable surgical outcome (radical penectomy) were more likely to have been referred from a provincial hospital (OR=6.8, P<0.0001) and not have access to a primary care center (OR=149.5, P<0.0001), a tertiary care center (OR=20.7, P=0.003), and a high school diploma (OR=7.9, P=0.004).  Conclusions: The lack of access to primary care is strongly associated with vascular invasion at diagnosis, lower educational level, a referral from provincial zones, and a higher mortality rate at 24 months. Patients who did not have access to primary and tertiary care, a high school diploma, and were referred from the province were more likely to have a radical penectomy.

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Penile cancer is a rare malignancy worldwide except in parts of Africa, Asia and Latin America where higher incidences have been reported. The disease leads to serious physical disfigurement of the male genitalia which can have debilitating consequences, thus it may alter micturition patterns and impair penetrative sexual intercourse. The lack of cancer registries and epidemiological surveillance programs in Ghana makes estimation of the prevalence in Ghana difficult hence to advance the course of knowledge, awareness and prevention of penile cancers, it is imperative that such cases are brought to the fore and discussed. We report two cases of penile cancer that had partial penectomy and inguinal lymphadenectomy at the Korle Bu Teaching Hospital. Clinical findings and intervention of these reported cases highlight the management process and it further assessed the psychological impact of intervention. The two patients presented to our outpatient department with penile lesions which were confirmed to be penile cancer. The first patient presented with a 30 year history with recurrent ulceration while the other presented with just 1 (one) year history of penile lesion. Both patients required partial penectomy and inguinal lymphadenopathy in the treatment of their condition. The major risk factors as reported in this case study, include uncircumcision, previous treatment for sexually transmitted infections, multiple sexual partners and smoking. Treatment is associated with reduction in sexual function although quality of life may remain satisfactory. Strong family and psychological support are key cornerstones for good treatment outcomes.

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INTRODUCTION: Partial penectomy is one of the common organ preserving procedures for penile malignancies and certain benign conditions. Partial penectomy causes psychosexual morbidity to the patient. Dorsal spatulation of urethra is classically done while performing the procedure, it carries risk of meatal stenosis along with compromised cosmesis. Several complex neoglans reconstructive techniques exist to prevent stenosis and improve cosmetic outcomes. We hereby describe outcomes of a simple and reproducible modification of the procedure by ventral spatulation of the urethra. MATERIALS AND METHOD: An analysis of 31 partial penectomies from May 2016 to June 2019 using a ventral spatulation technique was done. Patients were followed up for an average of 1 year to look for meatal stenosis, the morphological appearance of residual stump and psychosexual well-being. RESULTS: None of the patient had meatal stenosis on follow up. All patients had a satisfactory cosmetic outcome, scoring 6 or more on ANA scale. Seventeen patients reported "satisfied", six scored "highly satisfied "and eight were "harmonic" with the outcome. Out of 31, significant patients (20) were sexually active with most of them "equally satisfied or dissatisfied" or "very much satisfied." CONCLUSION: Used uncommonly, ventral spatulation of urethra is a simple, reproducible and less time consuming alternative, which avoids the chances of meatal stenosis and gives goodcosmetic results with psychological benefits to patients.

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With the passage of time, there has been a major paradigm shift in the surgical management of penile cancer from radical to organ preserving penile surgical techniques, with closer surgical margins which offer good oncological, cosmetic and functional outcomes with improved physical and psychosexual well-being. This article aims to provide an update of the current organ preserving surgical strategies for penile cancer.

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Carcinoma penis is a rare malignancy which mostly occurs after the sixth decade of life. It is managed surgically and partial penectomy is the most common procedure done in carcinoma involving the distal penis. Partial penectomy provides the opportunity of preservation of sexual function and enables the patient to micturate in standing position. The conventional technique of neourethra creation in partial penectomy is slitting the urethra dorsally. We propose an alternative approach to neourethra formation. Technique involves ventral slitting of the urethra followed by suturing which begins at the ventral aspect and continued in a parachute fashion toward the dorsal end. This new technique will help primary physicians and surgeons in providing better surgical results in caring for patients with carcinoma penis.

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Introduction: Classical teaching of a 2 cm macroscopic surgical margin for surgical treatment of primary penile cancer is overly aggressive. Contemporary evidence suggests narrow but clear margins have similar survival outcomes for localized disease. This study aims to determine the oncological outcome of using a risk-adapted algorithm to selection of macroscopic surgical margin based on biopsy grade of disease: 5 mm margin for grade 1, 10 mm margin for grade 2, and 20 mm margin for grade 3. Methods: This is a retrospective case series of patients who underwent penile-sparing surgery for biopsy-proven penile SCC by a single surgeon from May 2010 through to January 2019. Clinicopathological data were extracted from medical records. Primary outcome was the positive margin rate. Secondary outcomes were overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and local recurrence-free survival (RFS). Kaplan-Meier survival analysis was used to determine survival outcomes. Results: A total of 21 patients were included in this study. The median age was 65. Pre-operative biopsy grade was grade 1 in 19.1% of patients, grade 2 in 47.6%, and grade 3 in 33.3%. The median size of tumor on examination was 20 mm. Using a grade-stratified algorithm for macroscopic surgical margin, only one patient (4.8%) had a positive margin. This patient had G1T3 disease and proceeded to have a total penectomy for oncological clearance. The median margin clearance was 7 mm. The 12-month OS, CSS, MFS, and local RFS were 94.6%, 94.6%, 81.0%, and 92.3%, respectively. Conclusion: This study suggests that using a grade-stratified approach to aim for a narrower macroscopic surgical margin does not appear to significantly alter the oncological outcome, with a negative margin rate of 95.2% in our this series. This enables more men to be eligible for organ preserving surgery and thereby improve their quality of life in the urinary function and sexual function domain. Larger prospective studies are warranted to confirm these findings.

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INTRODUCTION: Painful tip penile ischemic lesion that varies from ulceration to dry gangrene which is calcified in a patient with ESRD on chronic dialysis is a seriously complicated disease due to microvascular disease of subcutaneous and adipose tissue. CASE PRESENTATION: 72 gentleman who is on chronic dialysis for the last 8 years because of ESRD, In which he developed many vascular disease and amputation done for him presented with spreading black painful areas at the tip of the glans for which conservative treatment took place for about month. DISCUSSION: The diagnosis and management of this rare disease still unclear. Diagnosis mostly clinical, treatment conservative versus surgical. CONCLUSION: Controversies of for penile Calciphylaxis diagnosis and treatment for its rarity, high mortality rate, and as its part of systematic disease treatment till know individualized according to patient status and extent of the necrotic area.

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This study describes a case of a dog with a lacerated penile tear treated with partial penectomy followed by successful semen collections for artificial insemination. A 1.5-year-old Jack Russel Terrier with normal libido, genital organs and semen, had a penile laceration after copulation. The dog underwent a partial penectomy without orchiectomy, thus preserving the possibility of semen collection. Semen was successfully collected at 45 and 53 days after surgery, and it was used for artificial insemination of two bitches, one of which became pregnant. Therefore, this report demonstrated that semen may be collected from dogs with partial penectomy for artificial insemination, this technique has the potential to preserve fertility of dogs with penile lesions that require penectomy.(AU)

Este estudo descreve o caso de um cão que teve laceração peniana tratada por penectomia parcial seguida de coleta de sêmen para inseminação artificial bem sucedida. Um cão Jack Russel Terrier de 1,5 anos, com libido, órgãos genitais e sêmen normais, teve laceração peniana após cópula. O cão foi parcialmente penectomizado sem orquiectomia, preservando a possibilidade de coleta de sêmen. A coleta de sêmen foi bem sucedida 45 e 53 dias após a cirurgia, sendo utilizado para inseminação artificial de duas cadelas, uma delas se tornando gestante. Portanto, sêmen para inseminação artificial pode ser coletado em cães parcialmente penectomizados, esta técnica revelando ser uma potencial forma de preservação da fertilidade de cães com lesões penianas que necessitem penectomia.(AU)

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@#Penile calciphylaxis is a rare penile condition associated with end-stage renal disease and is found in 1-4% of hemodialysis patients. The condition has an overall mortality of 64%. Literature has yet to provide a gold standard for the management of this condition. The first case is a 58-year-old diabetic and hypertensive on hemodialysis who presented with ulcerating lesions on the penis. The patient underwent partial penectomy. The patient contracted pneumonia during recovery and expired 3 months after the procedure. The second case is a 56-year-old diabetic with end stage renal disease on dialysis who presented with dry gangrene of the penis. He underwent partial penectomy and was sent home after recovery.

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Penile cancer is a rare cancer, with the majority treated with penile preserving methods. There remains a role for partial and totally penectomy for advanced and more proximal penile cancers. Significant functional and psychological morbidity can ensue for patients undergoing surgical management. Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3-5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients' oncologic outcomes-however a role still exists for radical surgery in advanced penile malignancy.

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BACKGROUND: To assess prognostic factors and survival outcomes for partial penectomy (PP) and total penectomy (TP) patients with T1 and T2 squamous cell carcinoma of the penis. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 708 penile cancer patients. Among these, 607 underwent PP and 101 underwent TP. Kaplan-Meier analysis was used to compare survival outcomes between PP and TP patients. Univariate and multivariate Cox proportional hazards regression models were used to determine prognostic factors. RESULTS: There were significant differences in marital status and regional lymph node removal between patients of the PP and TP groups. Multivariate regression analysis demonstrated that age [odds ratio (OR) =1.045; 95% confidence interval (CI): 1.034-1.057; P<0.0001], T2 carcinoma (OR =1.388; 95% CI: 1.077-1.788; P=0.0114), node stage N1-3 (OR =3.351; 95% CI: 2.317-4.847; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.498; 95% CI: 0.255-0.972; P=0.0411) were independent predictors of overall survival (OS). Age (OR =1.019; 95% CI: 1.005-1.033; P=0.0065), stage N1-3 (OR =5.127; 95% CI: 3.213-8.181; P<0.0001), and ≥4 regional lymph nodes removed (OR =0.452; 95% CI: 0.219-0.932; P=0.0315) were independent predictors of cancer specific survival (CSS). However, there was no significant difference between PP and TP in terms of OS and CSS. CONCLUSIONS: There was no significant difference in terms of OS and CSS between patients treated by PP or TP. T2 was associated with shorter OS, while age and N1-3 were associated with shorter OS and CSS. Removal of ≥4 regional lymph nodes was associated with longer OS and CSS.

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INTRODUCTION: We aimed to evaluate adherence to the EAU guidelines (GL) on penile cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. MATERIALS AND METHODS: This is a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. RESULTS: Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20-0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24-0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. CONCLUSIONS: Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.

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