V12-09 Inguinal Reconstruction After Lymphadenectomy in Metastatic Penile Cancer

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology II (V12)1 May 2024V12-09 INGUINAL RECONSTRUCTION AFTER LYMPHADENECTOMY IN METASTATIC PENILE CANCER Silvia Altomare, Nicola Pavan, Cristina Minasola, Riccardo Scalia, Davide Baiamonte, and Alchiede Simonato Silvia AltomareSilvia Altomare , Nicola PavanNicola Pavan , Cristina MinasolaCristina Minasola , Riccardo ScaliaRiccardo Scalia , Davide BaiamonteDavide Baiamonte , and Alchiede SimonatoAlchiede Simonato View All Author Informationhttps://doi.org/10.1097/01.JU.0001009480.90141.21.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile cancer is a rare in developed countries, is characterized by a progressive course, driving to death within 2 years if untreated. Radical inguinal lymphadenectomy is indicated in case of nodal metastases, followed by adjuvant chemotherapy. In advanced disease, cutaneous involvement with local ulceration can be present and surgery must be more invasive, leading to a severe loss of substance. METHODS: This is the case of a 73 Years old patient presenting with a 7 centimeters lesion of the glans involving the distal penile shaft and bilateral nodes metastases with evident ulceration on the right groin. The patient presented with anemia, cachexia and Paraneoplastic Hypercalcemia. Staging CT scans showed no evidence of distant metastasis; iliac lymphadenopathy bilaterally up to 1 cm. 7 cm lesion of distal penile shaft; bilateral inguinal nodes swelling (max 7 cm). Bone scan: negative. After oncologic consultation, suggesting debulking surgery, the patient underwent partial penectomy and bilateral inguinal lymphadenectomy. The lymphadenectomy of the right side required a dissection up to femoral vessels surface. After mass removal, the severe loss of substance upon femoral vessels was replaced with Sartorius muscle to protect vascular structures. The loss of skin was replaced using the scrotal skin after mobilization of right testis. At one month follow up the skin flap was vital. RESULTS: Different flaps can be used for reconstructing wounds resulting from penile or lymph node resections to reach local control of the disease and prevent local structures impairment: the tensor fascia lata myocutaneous flap (TFL), the anterolateral thigh flap and the vertical rectus abdominis myocutaneous flap (VRAM); flaps from the rectus femoris, gracilis, and sartorius muscles are options in cases less skin loss.In this case, considering the cachectic status of the patient ad his low performance status we chose to use Sartorius muscle and scrotal skin for reconstruction to be less invasive and to facilitate the patient rehab. CONCLUSIONS: The Sartorius flap in combination whit scrotal skin flap is a less invasive alternative for patient with severe inguinal loss of substance from inguinal nodes dissection. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e997 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Silvia Altomare More articles by this author Nicola Pavan More articles by this author Cristina Minasola More articles by this author Riccardo Scalia More articles by this author Davide Baiamonte More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement PDF downloadLoading ...