Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: oncological, surgical and functional outcomes.

This study aims to report the oncological, surgical and functional outcomes in 15 patients with locally advanced penile cancer who underwent total penile amputation with perineal urethrostomy (PU). A single-center retrospective analysis was conducted from January 2018 to September 2023. Outcomes included postoperative complications, cancer-specific survival (CSS), and overall survival (OS). Functional outcomes and pre and postoperative quality of life (QoL) were assessed by the International Prostate Symptom Score (IPSS) validated questionnaire. The median follow-up period was 10 months (SD±7). The median age of patients was 73 years (IQR 63-77), with a median Body Mass Index (BMI) of 28.1 kg/m (IQR 25.0-29.9). Risk factors included lack of circumcision (60.0%), history of lichen sclerosus (33.3%), and obesity (26.7%). The primary symptom reported was pain (67.0%). Total penectomy with PU was the initial surgery in 40.0% of cases; the rest underwent surgery after recurrence after penile organ-sparing surgery or partial penile amputation. Median operative time was 170 minutes (IQR 142.5-211.5), and the median hospital stay was 6 days (IQR 5-10). No local recurrence occurred during follow-up. The overall complication rate was 33.4%, with one patient (6.7%) requiring surgical revision (Clavien ≥ III). CSS was 80.0% with a median time to death of 6 months (IQR 3-13), and OS was 60.0%. Urinary symptoms and QoL significantly improved postoperatively (P = 0.0005 and P = 0.0012, respectively). Total penile amputation with PU is a safe procedure with acceptable complications and favorable functional outcomes.