Bird E, Coburn M
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Urol. 1997 Dec;158(6):2146-8. doi: 10.1016/s0022-5347(01)68182-5.
We present a new alternative to amputating penectomy, subcutaneous penectomy, in the male patient with urethral cancer.
The surgical management and followup of 3 men with squamous cell cancers of the urethra are reviewed.
At 22, 9 and 6 months postoperatively all patients were without evidence of local recurrence and were satisfied with phallic appearance. In 1 of 2 patients in whom the dorsal neurovascular bundle was not preserved there was distal glans necrosis and wound separation which resolved after conservative management. One of the 3 patients is contemplating phallus reconstruction. The patient who had pelvic lymph node metastases before penectomy died of metastatic complications without local failure 9 months postoperatively.
Phallus preservation in men with urethral cancer can be accomplished successfully with this type of procedure. The dorsal neurovascular bundle should be preserved when feasible. We contend that the cosmetic and potential reconstructive outcomes are superior to amputation without sacrificing cancer therapy in the appropriately selected patient.
我们为患有尿道癌的男性患者提供一种阴茎切除术的新替代方法，即皮下阴茎切除术。
回顾了3例尿道鳞状细胞癌男性患者的手术治疗及随访情况。
术后22个月、9个月和6个月时，所有患者均无局部复发迹象，对阴茎外观满意。在2例未保留背侧神经血管束的患者中，有1例出现龟头远端坏死和伤口裂开，经保守治疗后痊愈。3例患者中有1例正在考虑阴茎重建。阴茎切除术前有盆腔淋巴结转移的患者术后9个月死于转移并发症，无局部复发。
采用这种手术方式可成功保留患有尿道癌男性患者的阴茎。可行时应保留背侧神经血管束。我们认为，在适当选择的患者中，这种手术在不牺牲癌症治疗效果的情况下，美容效果和潜在的重建效果优于阴茎切除术。
