V12-03 Perineoscopic Urethrostomy in Penile Cancer Patients

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology II (V12)1 May 2024V12-03 PERINEOSCOPIC URETHROSTOMY IN PENILE CANCER PATIENTS Alejandra Bravo-Balado, Raúl Sánchez, Pedro Hernández, Jorge Robalino, Josep Maria Gaya, Alberto Breda, Antonio Rosales, and Andrea Gallioli Alejandra Bravo-BaladoAlejandra Bravo-Balado , Raúl SánchezRaúl Sánchez , Pedro HernándezPedro Hernández , Jorge RobalinoJorge Robalino , Josep Maria GayaJosep Maria Gaya , Alberto BredaAlberto Breda , Antonio RosalesAntonio Rosales , and Andrea GallioliAndrea Gallioli View All Author Informationhttps://doi.org/10.1097/01.JU.0001009480.90141.21.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perineal urethrostomy is the definitive form of urinary diversion in patients with locally advanced or anatomically unfavorable penile cancer requiring total penectomy. However, its most common complications are wound infection (11%) and dehiscence (4%). In an attempt to improve postoperative results, we propose a minimally invasive technique with a perineoscopic approach. METHODS: A 2-cm mid-perineal incision is made followed by digital dissection of the subcutaneous space to create space for the insertion of an 11-mm balloon trocar and two 5-mm lateral balloon trocars for monopolar scissors and bipolar forceps. CO2 is insufflated at 15 mmHg, dissecting the perineal and scrotal spaces, and exposing the pendulous urethra. Next, incision and dissection of the bulbocavernosus muscle is made. After dissection and transection of the urethra, the distal end is removed through the mid-perineal incision and spatulated to create a perineal urethrostomy. An interrupted suture with 4-0 vicryl is performed, approximating the urethral edges and the skin. An 18Fr silicone bladder catheter is placed. Finally, in this case, a subtotal penectomy and bilateral videoendoscopic inguinal lymphadenectomy were performed according to the usual technique. RESULTS: We present a series of five patients with penile cancer who underwent total/subtotal penectomy with perineoscopic urethrostomy. Table 1 summarizes the postoperative outcomes. The median hospital stay was 5.6 days and the median total surgical time including subtotal penectomy and bilateral videoendoscopic inguinal lymphadenectomy was 5.4 hours. All patients were continent after removal of the bladder catheter. Only 1 patient presented a Clavien-Dindo 1 complication related to the perineoscopic urethrostomy (scrotal infection). At 1-year follow-up, one patient developed meatal stenosis, currently undergoing a dilation regime. Table 1. Postoperative outcomes. CONCLUSIONS: This is the first case series of perineoscopic urethrostomy in penile cancer patients. This minimally invasive technique represents an alternative for the open approach and for other urethral pathologies and could potentially improve morbidity and reduce surgical wound complications in these patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e995 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alejandra Bravo-Balado More articles by this author Raúl Sánchez More articles by this author Pedro Hernández More articles by this author Jorge Robalino More articles by this author Josep Maria Gaya More articles by this author Alberto Breda More articles by this author Antonio Rosales More articles by this author Andrea Gallioli More articles by this author Expand All Advertisement PDF downloadLoading ...