Skeppner Elisabet, Andersson Swen-Olof, Johansson Jan-Erik, Windahl Torgny
Department of Urology, Örebro University Hospital, Örebro, Sweden.
Scand J Urol Nephrol. 2012 Oct;46(5):319-25. doi: 10.3109/00365599.2012.677473. Epub 2012 Jul 2.
This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma.
Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis.
Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results.
A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge.
本研究旨在评估阴茎癌患者及医生延误诊治的初始症状及相关因素。
2005年至2009年期间，于厄勒布鲁大学医院泌尿外科开展一项前瞻性研究，纳入50例采用保留器官技术治疗的阴茎癌患者及9例行部分截肢术的患者。通过面对面结构化访谈并结合自我评估表，让患者描述临床症状、就医情况及延误原因。同时从病历中提取数据，确定全科医生评估、专科治疗与诊断时间之间的时间间隔。
红斑、皮疹和湿疹是最常见的初始症状（35%）。总体而言，65%的患者延误超过6个月，其中pT1和pTis肿瘤患者占比小但无统计学差异。有稳定伴侣并不影响延误情况。患者延误的最常见原因是对性器官部位出现的症状感到尴尬。9例患者从首次专科就诊到诊断存在医生延误超过3个月的情况。其中8例患者咨询皮肤科医生并接受多次活检，结果为癌前病变。
相当一部分患者延误超过6个月，可能是由于红斑、皮疹或湿疹等良性初始症状。尴尬和否认等心理因素以及意识或知识不足也可能起作用。
