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947Dynamic sentinel node biopsy in penile cancer: A retrospective study
945
946
IS THE ASSOCIATION B E T W E E N BALANITIS X E R O T I C A OBLITERANS AND PENILE CARCINOMA UNDERESTIMATED?
MAGNETIC RESONANCE IMAGING IN THE STAGING OF PENILE CARCINOMA
Pietrzak E I, Hadway E I, Corbishley C. 2, Watkin N. 1 Kayes 0., Freeman A., Hare C., Ralph D., Minhas S. 1St. Georges Hospital, Urology, London, United Kingdom, 2St. Georges Hospital, Dept of Cellular Pathology, London, United Kingdom INTRODUCTION & OBJECTIVES: Balanitis Xerotica Obliterans (BXO) is a common penile disease that usually involves the prepuce and glans. There have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship. The reported incidence of penile carcinoma in patients with BXO varies from 2.6% to 5.8%, leading some authors to advocate circumcision in all cases, with close follow-up in those with persistent glans disease. This study was designed to determine the incidence of BXO in a consecutive series of penile carcinomas in one centre. MATERIAL & METHODS: A prospective analysis of all cases of penile cancer referred to the unit over a 24-month period, to determine the prevalence of BXO. RESULTS: 108 Cases of penile malignancy were reviewed, 29 of which had BXO (27%). This group included 24 cases of squamous cell carcinoma and 5 cases of carcinoma-in-situ. In 24 cases, BXO and malignancy presented synchronously. In 3 other cases, cancer occurred in the background of chronic persistent BXO. In 2 cases penile cancer was maly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and presented at a younger age but this did not reach statistical significance. CONCLUSIONS: A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. Patients presenting with longstanding BXO and those in whom BXO has not resolved following circumcision need to have biopsies, and careful follow up.
Institute of Urology and Nephrology, Andrology, London, United Kingdom
INTRODUCTION & OBJECTIVES: Assess the accuracy and potential use of magnetic resonance imaging in staging primary and recurrent penile carcinoma.
MATERIAL & METHODS: 38 Patients were pre-operatively staged for primary and recurrent penile carcinoma using magnetic resonance imaging. All patients were diagnosed with squamous cell carcinoma of the penis on preceding surgical biopsies. Prostaglandin E-I(PGE-1) analogues were injected to induce tumescence.
RESULTS: MRI scans reported staging TO (n=3), T1 (n=15), T2 (n=15), T3 (n=5) and T4 (n=0). These results were correlated with the histopathological diagnosis from the resected surgical specimens; as the gold-standard. From these data, the sensitivity for detecting T1 and T2 tumours is 93% and 80% for T3 tumours. The relative specificities were: T1 (95%), T2 (95%) and T3 (97%).
CONCLUSIONS: MRI offers an accurate, non-invasive means of staging penile cancer. Conservative surgical techniques can then be offered to patients with T1 or T2 tumours.
947 DYNAMIC SENTINEL NODE RETROSPECTIVE STUDY
BIOPSY
IN
PENILE
CANCER: A
MASTURBATION
AND
MASS
DELUSION
-
THE
STORY
OF
SPERMATORRHOEA Perdon/t S?, Autorino R. 2, De Sio M. 2, Damiano R. 3, Claudio L. 1, Di Lorenzo 0. 4, Schiavo M. 2, D' Armiento M. 2 ~National Cancer Institute Fondazione G. Pascale, Urology, Naples, Italy, aSecond University of Naples, Urology, Naples, Italy, 3Magna Graecia University, Urology, Catanzaro, Italy, 4Federico II University, Oncology, Naples, Italy
Hodgson D.
Guy's Hospital, Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: To evaluate the role of dynamic sentinel node biopsy (DSNB) in the management of selected squamous cell penile carcinoma patients. MATERIAL & METHODS: From 1994 to 2000, 48 patients with pT2-T3 tumour and clinically negative nodes (Group A, mean age 63 yrs) had undergone penectomy and, after four weeks, a prophylactic radical inguinal lymphadeneetomy (RIL). From 2001 to 2004, 20 patients with pT2-T3 and clinically negative nodes (Group B, mean age 67 yrs) had undergone penectomy and DSNB. Preoperative lymphoscintigraphy had been performed after intradermal injection of 99mTecnetium nanocolloid around the primary tumour. The sentinel node had been intraoperatively identified with the aid of patent blue dye and a gamma ray detection probe. After 4 weeks RIL had been performed.
INTRODUCTION & OBJECTIVES: Spermatorrhoea, or the involuntary loss of semen, was once considered "a subject of more importance, as regards human health and happiness, than perhaps any other that can be mentioned." The disease was championed by Claude Lallemand, a French Professor, who wrote in 1835 of "a disease that degrades man, poisons the happiness of his best days, and ravages society." It was in Britain and America, however, that his most fervent disciples held forth
RESULTS: In the group A nodal disease was found in 19 of 48 (39.6%) patients. Minor short-term complications (i. e. lymphocele, seroma, hematoma) occurred in 58 of 96 (60.4%) groins. Major long-term complications (i. e. skin necrosis, lymphocele, deep venous thrombosis, leg edema) occurred in 29 of 96 (30.2%) groins. In the group B metastases were noted in 7 of 19 (36.8%) patients, bilaterally in 3 of them. Preoperative lymphoseintigraphy revealed no sentinel node in 1 patient, while at subsequent RIL pathological examination revealed 2 metastatic nodes. In all cases with negative DSNB no metastatic nodes were found at the following RIL. Therefore the technique showed a 100% negative predictive value and 90% sensitivity. A greater morbidity was confirmed at RIL with 4 cases of major complications. CONCLUSIONS: DSNB has shown to be feasible and safe, with similar results to those of RIL, but lower morbidity. Thus, this procedure can be applied in selected low risk patients. Further studies are warranted to define the role of this mini-invasive technique in the management of penile cancer.
about the condition. Many young men had "terminated a short-lived, miserable existence by suicide, or dragged out his life in a state of idiotic imbecility through this unsuspected disease." The cause: "10ng continued and frequent self-abuse", the cure: cauterization of the prostatic urethra and spiked penile rings. It was only at the end of the century that surgeons, such as Sir James Paget, questioned the very existence of Spermatorrhoea, which had become "to the public a term of terror", and it faded from prominence. Similar conditions, however, are still "treated" in Eastern societies which have views of sex and sexuality equivalent to our pious 19th century forefathers.
European Urology Supplements 4 (2005) No. 3, pp. 239
946
IS THE ASSOCIATION B E T W E E N BALANITIS X E R O T I C A OBLITERANS AND PENILE CARCINOMA UNDERESTIMATED?
MAGNETIC RESONANCE IMAGING IN THE STAGING OF PENILE CARCINOMA
Pietrzak E I, Hadway E I, Corbishley C. 2, Watkin N. 1 Kayes 0., Freeman A., Hare C., Ralph D., Minhas S. 1St. Georges Hospital, Urology, London, United Kingdom, 2St. Georges Hospital, Dept of Cellular Pathology, London, United Kingdom INTRODUCTION & OBJECTIVES: Balanitis Xerotica Obliterans (BXO) is a common penile disease that usually involves the prepuce and glans. There have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship. The reported incidence of penile carcinoma in patients with BXO varies from 2.6% to 5.8%, leading some authors to advocate circumcision in all cases, with close follow-up in those with persistent glans disease. This study was designed to determine the incidence of BXO in a consecutive series of penile carcinomas in one centre. MATERIAL & METHODS: A prospective analysis of all cases of penile cancer referred to the unit over a 24-month period, to determine the prevalence of BXO. RESULTS: 108 Cases of penile malignancy were reviewed, 29 of which had BXO (27%). This group included 24 cases of squamous cell carcinoma and 5 cases of carcinoma-in-situ. In 24 cases, BXO and malignancy presented synchronously. In 3 other cases, cancer occurred in the background of chronic persistent BXO. In 2 cases penile cancer was maly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and presented at a younger age but this did not reach statistical significance. CONCLUSIONS: A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. Patients presenting with longstanding BXO and those in whom BXO has not resolved following circumcision need to have biopsies, and careful follow up.
Institute of Urology and Nephrology, Andrology, London, United Kingdom
INTRODUCTION & OBJECTIVES: Assess the accuracy and potential use of magnetic resonance imaging in staging primary and recurrent penile carcinoma.
MATERIAL & METHODS: 38 Patients were pre-operatively staged for primary and recurrent penile carcinoma using magnetic resonance imaging. All patients were diagnosed with squamous cell carcinoma of the penis on preceding surgical biopsies. Prostaglandin E-I(PGE-1) analogues were injected to induce tumescence.
RESULTS: MRI scans reported staging TO (n=3), T1 (n=15), T2 (n=15), T3 (n=5) and T4 (n=0). These results were correlated with the histopathological diagnosis from the resected surgical specimens; as the gold-standard. From these data, the sensitivity for detecting T1 and T2 tumours is 93% and 80% for T3 tumours. The relative specificities were: T1 (95%), T2 (95%) and T3 (97%).
CONCLUSIONS: MRI offers an accurate, non-invasive means of staging penile cancer. Conservative surgical techniques can then be offered to patients with T1 or T2 tumours.
947 DYNAMIC SENTINEL NODE RETROSPECTIVE STUDY
BIOPSY
IN
PENILE
CANCER: A
MASTURBATION
AND
MASS
DELUSION
-
THE
STORY
OF
SPERMATORRHOEA Perdon/t S?, Autorino R. 2, De Sio M. 2, Damiano R. 3, Claudio L. 1, Di Lorenzo 0. 4, Schiavo M. 2, D' Armiento M. 2 ~National Cancer Institute Fondazione G. Pascale, Urology, Naples, Italy, aSecond University of Naples, Urology, Naples, Italy, 3Magna Graecia University, Urology, Catanzaro, Italy, 4Federico II University, Oncology, Naples, Italy
Hodgson D.
Guy's Hospital, Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: To evaluate the role of dynamic sentinel node biopsy (DSNB) in the management of selected squamous cell penile carcinoma patients. MATERIAL & METHODS: From 1994 to 2000, 48 patients with pT2-T3 tumour and clinically negative nodes (Group A, mean age 63 yrs) had undergone penectomy and, after four weeks, a prophylactic radical inguinal lymphadeneetomy (RIL). From 2001 to 2004, 20 patients with pT2-T3 and clinically negative nodes (Group B, mean age 67 yrs) had undergone penectomy and DSNB. Preoperative lymphoscintigraphy had been performed after intradermal injection of 99mTecnetium nanocolloid around the primary tumour. The sentinel node had been intraoperatively identified with the aid of patent blue dye and a gamma ray detection probe. After 4 weeks RIL had been performed.
INTRODUCTION & OBJECTIVES: Spermatorrhoea, or the involuntary loss of semen, was once considered "a subject of more importance, as regards human health and happiness, than perhaps any other that can be mentioned." The disease was championed by Claude Lallemand, a French Professor, who wrote in 1835 of "a disease that degrades man, poisons the happiness of his best days, and ravages society." It was in Britain and America, however, that his most fervent disciples held forth
RESULTS: In the group A nodal disease was found in 19 of 48 (39.6%) patients. Minor short-term complications (i. e. lymphocele, seroma, hematoma) occurred in 58 of 96 (60.4%) groins. Major long-term complications (i. e. skin necrosis, lymphocele, deep venous thrombosis, leg edema) occurred in 29 of 96 (30.2%) groins. In the group B metastases were noted in 7 of 19 (36.8%) patients, bilaterally in 3 of them. Preoperative lymphoseintigraphy revealed no sentinel node in 1 patient, while at subsequent RIL pathological examination revealed 2 metastatic nodes. In all cases with negative DSNB no metastatic nodes were found at the following RIL. Therefore the technique showed a 100% negative predictive value and 90% sensitivity. A greater morbidity was confirmed at RIL with 4 cases of major complications. CONCLUSIONS: DSNB has shown to be feasible and safe, with similar results to those of RIL, but lower morbidity. Thus, this procedure can be applied in selected low risk patients. Further studies are warranted to define the role of this mini-invasive technique in the management of penile cancer.
about the condition. Many young men had "terminated a short-lived, miserable existence by suicide, or dragged out his life in a state of idiotic imbecility through this unsuspected disease." The cause: "10ng continued and frequent self-abuse", the cure: cauterization of the prostatic urethra and spiked penile rings. It was only at the end of the century that surgeons, such as Sir James Paget, questioned the very existence of Spermatorrhoea, which had become "to the public a term of terror", and it faded from prominence. Similar conditions, however, are still "treated" in Eastern societies which have views of sex and sexuality equivalent to our pious 19th century forefathers.
European Urology Supplements 4 (2005) No. 3, pp. 239