Perspectivas do homem submetido à penectomia / Perspectives of man submitted to penectomy / Perspectivas del hombre sometido a la penectomía

Objetivo: o presente artigo objetiva descrever as perspectivas do paciente submetido à penectomia e conhecer as perspectivas deste paciente após a penectomia. Métodos: trata-se de um estudo de caso realizado em um hospital federal na cidade do Rio de Janeiro com dois pacientes que estiveram internados no ano de 2017 e foram submetidos a penectomia. A coleta de dados foi realizada no ano de 2018 através de uma entrevista semiestruturada. Os participantes foram amparados pelos princípios éticos estabelecidos pela resolução 466/ 2012 do Conselho Nacional de Saúde, sendo que este estudo foi aprovado sob o número 2.769.381. Resultados: constatou-se que a penectomia nestes estudos de caso era a única terapêutica. Com isso, o desejo de estar com a família e prolongar a vida foram determinantes na adesão ao tratamento. Conclusão: concluiu-se que mesmo com as mudanças no corpo, a penectomia foi realizada na perspectiva de prolongar a vida

Objective: this article aims to describe the perspectives of patient submitted submitted to penectomy and to know the perspectives of this patient after the penectomy. Methods: its a case study realized in a federal hospital of Rio de Janeiro city with two patients who were admitted to the hospital during 2017 and underwent to penectomy surgery. The data collection was realized during 2018 with a semi-structured interview. The participants were protected by the ethics principles established by the resolution 466/ 2012 of the National Health Council and this study was approved under the number 2.769.381. Results: it was found that penectomy in this case studies was the only therapy. Thereby, the desire of being among their family and to extend their life was determinants to adhere the therapy. Conclusion: it was concluded that even with the changes in their body, the penectomy was realized to extend the life

Objetivo: el presente artículo objetiva describir las perspectivas del paciente sometido a la penectomía y conocer las perspectivas de este paciente después de la penectomía. Métodos: se trata de un estudio de caso realizado en un hospital federal en la ciudad de Río de Janeiro con dos pacientes que estuvieron internados en el año 2017 y fueron sometidos a penectomía. La recolección de datos se realizó en el año 2018 através de una entrevista semiestructurada. Los participantes fueron amparados por los principios éticos establecidos por la resolución 466/2012 del Consejo Nacional de Salud, siendo que este estudio fue aprobado bajo el número 2.769.381. Resultados: se constató que la penectomía en estos estudios de caso era la única terapéutica. Con ello, el deseo de estar con la familia y prolongar la vida fueron determinantes en la adhesión al tratamiento. Conclusión: se concluyó que incluso con los cambios en el cuerpo, la penectomía se realizó en la perspectiva de prolongar la vida

Caracterización de pacientes tratados por cáncer de pene, con invasión de ganglios locorregionales en el Servicio de Urología del HCIPS de Asunción del Paraguay / Characterization of Patients treated for Penile Cancer with Locoregional Nodes Invasion in HCIPS Urology Unit, Asunción del Paraguay

Introducción: El cáncer de pene tiene una alta incidencia en Latinoamérica, siendo el carcinoma epidermoide el tipo histológico más frecuente. También es sabido que el cáncer de pene suele presentar diseminación a los ganglios linfáticos inguinales, antes de la progresión a la enfermedad metastásica. Objetivo: Caracterizar a los pacientes tratados por cáncer de pene con invasión locorregional en el Servicio de Urología del Hospital Central del Instituto de Previsión Social (HCIPS) de Asunción del Paraguay. Materiales y métodos: Se realizó un estudio retrospectivo, de pacientes tratados con cáncer de pene con invasión locorregional entre los años 2014 y 2017. Se analizaron las siguientes variables: estadificación, tratamientos empleados según la clasificación y complicaciones. Resultados: Los 18 pacientes tratados por cáncer de pene con invasión locorregional fueron adultos mayores, con una edad media de 78,5 años. El tipo de intervención más frecuente fue la linfadenectomía inguinal bilateral (44%). Solo cuatro pacientes fueron sometidos simultáneamente a penectomía y linfadenectomía. Las complicaciones posoperatorias se presentaron en 8 casos (44%), siendo el linfedema la más frecuente. Conclusiones: Los factores pronósticos adversos más importantes son la presencia de adenopatías, el estadío clínico al diagnóstico y el grado de diferenciación celular. El tratamiento más eficaz del cáncer de pene es quirúrgico, reservando la quimioterapia y la radioterapia para adyuvancia o terapia de rescate, siendo las complicaciones más graves, mientras más radical sea la cirugía.(AU)

Introduction: Penile cancer has a high incidence in Latin America, with squamous cell carcinoma being the most frequent histological type. It is also known that penile cancer has a spread to the inguinal lymph nodes, before the progression to metastatic disease. Objective: Characterize the patients treated for penile cancer with locoregional invasion in the Urology Service of the Hospital Central del Instituto de Previsión Social (HCIPS), Asunción of Paraguay. Materials and methods: A retrospective study was conducted of patients treated with penile cancer with locoregional invasion between 2014 and 2017. The following variables were analyzed: staging, treatments used according to the classification and complications. Results: The 18 patients treated for penile cancer with locoregional invasion were older adults, with an average age of 78.5 years. The most frequent type of intervention was the bilateral ilioinguinal (44%). Only four patients were subjected simultaneously to penectomy and lymphadenectomy. Postoperative complications occurred in 8 cases (44%), lymphedema being the most frequent. Conclusions: The most important adverse prognostic factors are the presence of adenopathies, the clinical stage at diagnosis and the degree of cell differentiation. The most effective treatment of penile cancer is surgical, reserving chemotherapy and radiotherapy for adjuvance or rescue therapy, being the complications more serious, the more radical the surgery is.(AU)

Auto-amputation of penis due to carcinoma: Still a threat in the era of modern medicine: Report of two cases.

Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic inguinal lymph nodes. Supra-pubic urinary diversion was the initial management in both the patients. The first patient was treated with combined chemo-radiation, but he succumbed to death following two cycles of chemotherapy. The second patient was successfully treated with total penectomy and perineal urethrostomy. He recovered well but was lost to follow-up.

Relación entre los factores clínico patológicos y enfermedad ganglionar inguinal en cáncer de pene / Relation between clinical pathological factors and inguinal node disease in pennies cancer

Determinar la relación entre factores clínicopatológicos y enfermedad ganglionar inguinal en cáncer de pene, en los pacientes del Instituto de Oncología “Dr. Miguel Pérez Carreño”. Estudio retrospectivo, descriptivo, transversal, de 76 pacientes con cáncer de pene1995-2011. Un total de 76 pacientes, 20 (26,31%) entre los 51-60 años, siendo el grupo etario con mayor incidencia; el estadio más frecuentemente el IIIB con 23 casos (30,26%), histología predominante carcinoma epidermoide 62 casos (81,57%); la invasión angiolinfática positiva 37 pacientes y 19 casos (51,35%), presentaron metástasis ganglionar inguinal, y 31 casos (45,58%) sin invasión angiolinfática 0% de metástasis. Grado histológico: Los tumores GI 41 de 76 casos (54%), el 29,2% (12 casos) se presentó con metástasis inguinal, los tumores GII y GIII el 77% (17 casos), y 100% (5 casos) respectivamente; en relación al (T), grado histológico y metástasis inguinales, los T1G1 fueron los más frecuentes, con 22 casos, solo 1 de ellos con metástasis, de los T2, los T2G2 fue el de mayor frecuencia con 8 casos, 6 de ellos, con metástasis ganglionar inguinal, los T3G1, estuvo conformado por 10 pacientes, siendo el de mayor número de pacientes, 5 de ellos presentaron metástasis ganglionar inguinal; el resto de T3 y T4 presentaron MT. El grado histológico asociado a la profundidad de invasión y la invasión linfovascular son factores predictivos importantes de enfermedad ganglionar en cáncer de pene.

To determine the relationship between the clinics pathological factors and the presence of inguinal nodal disease in penile cancer in patients view in the Oncology Institute Dr. Miguel Pérez Carreño. Retrospective, descriptive and transversal investigation, with 76 patients with diagnostic of penile cancer view between the years 1995-2011. A total of 76 patients, 20 (26.31%) between 51-60 years old, and the age group with the highest incidence, stage IIIB more frequently with 23 cases (30.26%), squamous cell carcinoma predominant histology 62 cases (81.57%), positive angio lymphatic invasion in 37 patients and 19 (51.35%) had inguinal lymph node metastases, and 31 cases (45.58%) without groin metastases, as to histological grade, tumors GI 41 of 76 cases (54%), 29.2% (12 cases) presented with inguinal metastases, GII and GIII tumors 77% (17 cases), and 100% (5 cases) respectively, in terms of the (T), histological grade and metastatic inguinal T1G1 were the most frequent, with 22 cases, only 1 patient with metastasis, the T2, the T2G2 had the highest frequency of 8 cases 6 of them, with inguinal lymph node metastasis, the T3G1, consisted of 10 patients, with the largest number of patients, 5 of them presented inguinal lymph node metastasis, the rest of T3 and T4 showed metastases. The histological grade associated with the depth of invasion and lymph vascular invasion are important predictors of nodal disease in penile cancer.

Câncer de pênis em jovem de 23 anos associado a infecção por HPV 62 - relato de caso / Penile cancer in a 23-year-old ossociated with HPV 62 infection - Case Report

Introdução: o câncer de pênis é uma doença maligna rara, de alta morbidade e mortalidade, que acomete principalmente homens com idade avançada. Tem pico de incidência na sétima década de vida, muito raro em jovens. Em alguns países da África, da Ásia e da América do Sul, representa cerca de 10% das doenças malignas que acometem homens. No Brasil, o câncer de pênis representa 2% do total de cânceres em homens e é mais frequente nas regiões Norte e Nordeste do país, onde a taxa de incidência varia entre 1,3 a 2,7 por 100.000. Má higiene peniana, retenção de esmegma, e fimose são consideradas fatores de risco para câncer de pênis.Em populações que praticam circuncisão, a incidência de câncer de pênis é baixa mesmo em países pouco desenvolvidos como Nigéria e Índia. Há muitos estudos na literatura apontando como provável causa a infecção pelo HPV, tendo como provável precursor inicial a lesão verrucosa inicial. Relato de caso: paciente E.G.S.,masculino, 23 anos, branco, católico, não estuda, trabalha com telefonia, natural de Osasco (SP) e procedente de Barueri (SP). É casado e não tem filhos. O paciente relata que possuía fimose desde a infância, que impossibilitava a exposição completa da glande. Em novembro de 2010 relata surgimento de nódulo de 1 cm de diâmetro no pênis. Foi realizada postectomia em 24 de fevereiro de 2011 para tratamento de fimose, durante a qual se realizou biópsia da lesão, diagnosticada como carcinoma epidermoide grau III. Estudo biomolecular apontou infecção por HPV 62. Foi realizada penectomia parcial para retirada da lesão em 21/03/2011. No momento da cirurgia, a lesão já se apresentava com 7 x 5 x 4 cm, com lesão úlcero-infiltrativa de 3 x 5 cm, distante 1 cm do óstio uretral. Discussão: nosso paciente apresentava fimose que impossibilitava a exposição completa da glande desde a infância, prejudicando a higiene peniana. A fimose predispõe à retenção de células descamativas e resíduos da urina (esmegma) que podem causar irritação crônica com ou sem infecção bacteriana da glande ou do prepúcio. A circuncisão diminui achance de contrair doenças venéreas, infecções do trato urinário e possibilita melhor higiene. Além disso, está associada a menor incidência de HPV, que se mostra como importante fator de risco para o desenvolvimento do câncer peniano. Observou-se profunda redução na persistência do vírus entre pacientes circuncidados, de até 90%, sendo importante na resolução da infecção e proteção contra a malignização. O HPV 62 foi encontrado em pacientes do sexo feminino, causando lesõeses camosas intraepiteliais de alto grau, compatíveis com lesões dos subtipos mais oncogênicos de HPV.

Introduction: cancer of the penis is a rare malignant disease, causing high morbidity and mortality, which mostly affects elderly men. It has a peak incidence in the seventh decade of life, very rare in young people. In some countries in Africa, Asia and South America represents about 10% of the malignancies that affect men. In Brazil, penile cancer represents 2% of all cancers in men and is most common in the north and northeast of the country,where the incidence rate varies from 1.3 to 2.7 per 100.000. Poor penile hygiene, smegma retention, and phimosis are considered risk factors for penile cancer. In populations that practice circumcision, the incidence of penile cancer is low, even in underdeveloped countries like Nigeria and India. There aremany studies in the literature pointing HPV infection as the probable cause, with the probable initial precursor the initial verrucosa. Case report: patient E.G.S., male, 23 years, white, catholic, without studying, working with telephony, native from Osasco (SP), born in Barueri (SP). He is married and has nochildren. The patient reports that he had had phimosis since childhood, which precluded complete exposure of the glans. In November 2010 reported the appearance of a nodule with 1 cm in diameter in the penis. Circumcision was performed on February 24, 2011 for the treatment of phimosis, and a biopsy was performed during the treatment, diagnosed as squamous cell carcinoma grade III. Biomolecular study showed HPV 62 infection. Partial penectomy was performed to remove the injury on 21/03/2011. At surgery, the injury already had with 7 x 5 x 4 cm, ulcerative-infiltrative lesion of 3 x 5 cm, 1 cm away fromthe urethral orifice. Discussion: our patient had phimosis which precluded complete exposure of the glans in childhood, affecting penile hygiene. Phimos is predisposes to squamous cell and urine and waste (smegma) retention, that can cause chronic irritation with or without bacterial infection of the glans orforeskin. Circumcision decreases the chance of contracting sexually transmitted diseases, urinary tract infections and provides better hygiene. It is also associated with lower incidence of HPV, which shows it self as an important risk factor for the development of penile cancer. There was dramatic reductionin the persistence of the virus among circumcised patients, up to 90%, being important in the resolution of infection and protection against malignancy. The HPV 62 was found in female patients, causing squamous intraepithelial lesions of high degree, compatible with lesions of more oncogenic subtypes of HPV.