Penectomía parcial y reconstrucción peneana. Manejo quirúrgico inicial del cáncer de pene localizado / Partial Penectomy and Penile Reconstruction. Initial Surgical Management of Localized Penile Cancer

Introducción: La cirugía para el cáncer de pene (CP) es mutilante y afecta significativamente la calidad de vida de los pacientes. Mostramos nuestra experiencia en reconstrucción peneana (RP) y proponemos el manejo reconstructivo simultáneamente con el oncológico. Materiales y métodos: Se registraron todos los pacientes llevados a RP en 4 hospitales universitarios de Colombia por el mismo cirujano (JPN), desde 2007 hasta abril de 2012. Las variables analizadas fueron: indicación de la reconstrucción, estado oncológico del paciente, técnica quirúrgica y seguimiento. Se documentó fotográficamente cada caso. Resultados: Se realizaron 15 RP, edad promedio 49 años y seguimiento promedio 15 meses. En 12 pacientes se hizo el procedimiento oncológico y la reconstrucción simultáneamente, 4 con desepitelización (resurfacing) del glande, 2 con glandectomía y 6 con penectomía parcial; los 3 restantes tenían penectomía previa. Todos los injertos fueron de piel de espesor parcial y el sitio donante la cara externa de la cadera. Hubo 2 complicaciones relacionadas con la reconstrucción, una estrechez del meato uretral y otro caso con isquemia en el 30% del injerto. En 3 pacientes se encontró enfermedad ganglionar desde el diagnóstico inicial y en 2 durante el seguimiento; ninguno ha tenido recaída local y uno murió por su enfermedad de base. Los demás han reportado calidad de vida adecuada con buenos resultados cosméticos y funcionales. Conclusiones: La reconstrucción del pene debe ser propuesta simultáneamente con la penectomía parcial y en un mismo tiempo quirúrgico

Introduction: Surgical management for penile carcinoma is mutilating and affects significantly quality of life. Hereby we present our experience on penile reconstruction (PR) immediately after oncologic resection. Materials and methods: We included all patients from January 2007 until April 2012 who underwent PR after partial penectomy (PP). Patients included in the study were seen at four different hospitals. All procedures were done by the same surgeon. Information included were: oncological status at the moment of surgery, surgical technique used for reconstruction. Each case was also registered photographically. On follow-up visits data about outcome and patient's satisfaction were registered. Results: During the study period 15 patients underwent PR. Average age at the moment of surgery was 49 years. Average follow-up was 15 months. In 12 patients PR was made at the same time as PP. Of those, four cases underwent glans resurfacing, 2 glandectomy, 6 partial penectomy, and the remaining 3 have had PP in a different time in the past. Every case underwent a split thickness graft procedure. Only 2 patients had postoperative complications. One of them presented urethral stricture and the other had graft ischemia. Three patients had positive nodes at the moment of PP and two during the follow-up. None of the cases have presented local recurrence and only one died. On follow-up the remaining patients refer a good quality of life and felt happy with esthetic results. Conclusions: Given the results presented hereby we propose that PR must be part of the same procedure as the PP

Partial penectomy and penile reconstruction. Initial surgical management of localized penile cancer.

INTRODUCTION: Surgical management for penile carcinoma is mutilating and affects significantly quality of life. Hereby we present our experience on penile reconstruction (PR) immediately after oncologic resection. MATERIALS AND METHODS: We included all patients from January 2007 until April 2012 who underwent PR after partial penectomy (PP). Patients included in the study were seen at four different hospitals. All procedures were done by the same surgeon. Information included were: oncological status at the moment of surgery, surgical technique used for reconstruction. Each case was also registered photographically. On follow-up visits data about outcome and patient's satisfaction were registered. RESULTS: During the study period 15 patients underwent PR. Average age at the moment of surgery was 49 years. Average follow-up was 15 months. In 12 patients PR was made at the same time as PP. Of those, four cases underwent glans resurfacing, 2 glandectomy, 6 partial penectomy, and the remaining 3 have had PP in a different time in the past. Every case underwent a split thickness graft procedure. Only 2 patients had postoperative complications. One of them presented urethral stricture and the other graft ischemia. Three patients had positive nodes at the moment of PP and two during the follow-up. None of the cases have presented local recurrence and only one died. On follow-up the remaining patients refer a good quality of life and felt happy with aesthetic results. CONCLUSIONS: Given the results presented hereby we propose that PR must be part of the same procedure as the PP.

[No-scalpel vasectomy]. / Vasectomia sin bisturi.

PIP: No-scalpel vasectomy was developed by Dr. Li Shunkiang in China in 1974. In 1989 Profamilia carried out 18 tubal ligations for every vasectomy procedure, and this year in Bogota the first group of Profamilia surgeons underwent training in no-scalpel vasectomy. By 1995 the ratio of tubal ligations to vasectomy dropped to 10 to 1 at the national level and to 4 to 1 in Bogota. The evaluation of no-scalpel vasectomy procedures was conducted at the Men's Clinic in Bogota covering the period of 1989-94. 7513 procedures were done by 5 trained surgeons during this period. The expected incidence of complications was 3%. A sample of 2257 was obtained for evaluation. Variations in the management of the vas deferens included: 1) 1898 cases of ligation with silk and the interposition of the fascia; 2) 227 cases of monopolar electrocoagulation and interposition of the fascia; 3) 21 cases of monopolar electrocoagulation without interposition of the fascia; 4) 9 cases of ligation with silk without interposition of the fascia; and 5) 15 other cases with some kind of technical difficulty. There were no significant differences with respect to the distinct variants. The major complications were: 1) 0.3% had hematoma, 2 cases required surgical drainage; 2) 0.26% had infection, 2 cases required surgical drainage and intravenous antibiotics for scrotal abscess; 3) 1.14% had epididymitis, a congestive type that responded well to anti-inflammatory drugs, while in some cases tetracycline was needed; 4) 0.22% had vasocutaneous fistula, which were resected without problems; and 5) 0.30% had other complications including granulomas of the cord or the scrotal wall. Only 1.27% patients had to see a doctor for postoperative pain.^ieng