PHALLUS PRESERVATION FOR URETHRAL CANCER - SUBCUTANEOUS PENECTOMY

Purpose: We present a new alternative to amputating penectomy, subcuta neous penectomy, in the male patient with urethral cancer. Materials a nd Methods: The surgical management and followup of 3 men with squamou s cell cancers of the urethra are reviewed. Results: At 22, 9 and 6 mo nths postoperatively all patients were without evidence of local recur rence and were satisfied with phallic appearance. In 1 of 2 patients i n whom the dorsal neurovascular bundle was not preserved there was dis tal glans necrosis and wound separation which resolved after conservat ive management. One of the 3 patients is contemplating phallus reconst ruction. The patient who had pelvic lymph node metastases before penec tomy died of metastatic complications without local failure 9 months p ostoperatively. Conclusions: Phallus preservation in men with urethral cancer can be accomplished successfully with this type of procedure. The dorsal neurovascular bundle should be preserved when feasible. We contend that the cosmetic and potential reconstructive outcomes are su perior to amputation without sacrificing cancer therapy in the appropr iately selected patient.