By Jill Stein
LYON, France -- November 17, 2009 -- Glans surfacing and reconstruction with the use of a split-thickness skin graft (STSG) is a safe and effective treatment for most patients with balanitis xerotica obliterans (BXO) or carcinoma in situ (CIS) of the penis, according to data reported at the 12th Congress of the European Society for Sexual Medicine (ESSM).
Evangelos Zacharakis, MD, University College London Hospitals National Health Service (NHS) Trust, London, United Kingdom, and colleagues reviewed results in 38 patients with BXO (n = 15) and CIS (n = 23) involving the penis who underwent reconstructive penile surgery at their institution over a recent 8-year period.
"The aim of this reconstructive technique is to maintain a functional penis without compromising control or function," Dr. Zacharakis said, speaking here on November 16. The procedure, he explained, involves complete excision of the affected tissue followed by reconstruction with the use of an STSG harvested from the thigh.
CIS on the shaft of the penis or on the mucosal surfaces of the glans or prepuce account for up to 10% of penile malignancies at the time of diagnosis, Dr. Zacharakis noted. The surgical management of premalignant and malignant penile lesions has changed significantly over the last decade, with increasing emphasis on penile preservation.
"Both CIS and BXO have historically represented challenges for the urologist," Dr. Zacharakis said.
In the present study, all patients with premalignant disease had a preoperative biopsy confirming CIS, and intraoperative frozen section confirmed that both deep and lateral surgical margins were clear. The mean duration of follow-up was 23.9 months.
Overall, 36 patients (94.8%) had complete graft take, and no significant immediate intraoperative or postoperative complications were observed.
All BXO patients had excellent cosmetic and functional results and have successfully resumed sexual activity.
Three of the CIS patients (13%) needed a glansectomy because of positive margins at the definitive histopathological examination. In addition, 2 patients required total resurfacing after a recurrence following partial resurfacing. The remaining 18 CIS patients were disease-free at the most recent follow-up, with about 75% of them reporting excellent cosmetic and functional results. Seven patients, or nearly a third, have resumed sexual activity.
While the results demonstrate that local excision and resurfacing is usually a safe and effective treatment, CIS patients should be warned about the possible need for a subsequent glansectomy to obtain complete clearance of the disease, Dr. Zacharakis said. Careful follow-up is required in these patients, particularly after partial resurfacing, he added.
[Presentation title: Glans Resurfacing for Benign and Malignant Conditions: A UK Experience. Abstract PO-08-006]
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