Pedrosa J A, Amstutz S P, Bihrle R, Mellon M J
Department of Urology, Indiana University School of Medicine, 535 Barn Hill Drive, RT 420, Indianapolis, IN, 46202, USA.
Int Urol Nephrol. 2014 Aug;46(8):1551-5. doi: 10.1007/s11255-014-0678-1. Epub 2014 Mar 15.
The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined.
Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes.
Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure.
Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.
阴茎远端原位鳞状细胞癌（CIS）累及尿道口通常被视为保留龟头手术的禁忌证。远端尿道切除术及后续重建可为尿道切除提供一种替代方法，同时在特定病例中保留阴茎。不幸的是，这种方法的长期肿瘤学结果尚不明确。
1988年至2012年期间，印第安纳大学医学中心的5例患者因阴茎鳞状CIS累及尿道口接受了远端尿道切除术及重建。对该队列进行回顾性分析，以评估功能和肿瘤学结果。
5例患者中，4例出现龟头病变，3例最初采用莫氏手术治疗，1例采用局部切除术。最后1例患者表现为广泛的尿道疾病，接受了一期尿道切除术。4例患者采用阴茎皮肤蒂移植进行重建，1例采用会阴尿道造口术。最终病理分期1例为T1期，其余4例为Tis期。随访时间为6至96个月。证实有1例局部复发，但发生在尿道外区域。患者接受部分阴茎切除术后的病理分析证实了这一点。2例患者在术后12个月和7个月需要进行尿道口扩张。
对于累及尿道口的阴茎鳞状CIS，远端尿道切除术是实现阴性手术切缘同时保留阴茎功能的有效替代方法。肿瘤学结果似乎可以接受，但仍需要更大规模的系列研究来证实我们的发现。
