8
ESSM
Today
Penile cancer is an uncommon malignancy. For
the more advance disease phase, aggressive
therapy with partial or total penectomy is still the
conventional and necessary treatment. Surgical
treatment is inevitably mutilating and may cause
a devastating effect on a man’s self-image.
Considering the strong impact on patients’
sexual life we evaluated sexual function and
satisfaction after partial penectomy.
The patients in the present study (n=25) repre-
sented all those who attended our institutions
and were diagnosed and treated for penile
cancer during the period from October 2011
to November 2013. All patients underwent par-
tial penectomy and were invited to a follow-up
investigation at the out-patient clinic. Sexual
pre-surgical baseline was calculated. The pre-
operative IIEF (International Index of Erectile
Function) scores were registered systematically.
For the first domain, erectile function average
score was 28.68 (range 24,5 – 30). Orgasmic
function score was 9.86 (range 8.8 – 10).
Sexual desire score was 8.75 (range 7.9 – 10).
Intercourse satisfaction rate was 12.5 (range
11.8 – 14.5). Overall satisfaction rate was 9.01
(range 7.9 – 9.8).
Sexual outcomes of each patient were esti-
mated by taking into consideration four stand-
ardized and validated questionnaires.
The
EDITS
questionnaire (Erectile Dysfunction
Inventory of Treatment Satisfaction) was used
to assess patients and partners ‘treatment sat-
isfaction. The EDITS Patient average rate was
74.97 (range 43.18 – 93.18); EDITS Partner
average rate that was 73.25 (range 50 – 95.7).
The
IIEF 15
addresses the relevant domains of
male sexual function that are erectile function,
orgasmic function, sexual desire, intercourse
satisfaction, and overall satisfaction. With re-
gard to erectile function (IIEF 1-5,15), average
score was 21.28 (range 12 – 29). Orgasmic
function analyzed by questions 9 and 10
reached a score of 7.92 (range 2 – 10). Items
11 and 12 investigate about sexual desire; the
average score was 7.16 (range 3 – 10). Inter-
course satisfaction is described by items 6,7
and 8 and registered a score of 7.32 (range
0 – 14). The overall satisfaction average score
(items 13,14) was 6.52 (range 4 – 10).
The
QEQ
questionnaire (Quality of Erection
Questionnaire) evaluating patient himself in
objective and truthful manner regarding his
erection registered a score of 77.46 (range
33 – 91.6).
The
SEAR questionnaire
(Self-Esteem and
Relationship) is divided in two domains. The
first eight items of the SEAR questionnaire
analyze the patient‘s sexual relationship. The
overall score of SEAR 1 – 8 was 68.06 (range
28.12 – 96.8). The second domain of the
SEAR is about confidence and has two sub-
domains self-esteem and overall relationship.
SEAR 9 – 12 self-esteem score was 73.25
(range 43.75 – 100); SEAR 13 – 14 overall
relationship score was 74.5 (range 25 – 100).
Although penile cancer is an uncommon ma-
lignancy, the majority of patients will have
5 years disease specific survival of over 90%
despite local recurrence 25. Hence, these long
term survivors will live with the sexual and
psychosexual effects of their treatment. Inevi-
tably, partial penectomy resulted in changes to
both feelings of masculinity and perception of
self and body image. These feelings may also
have an emotional basis and be associated
with unconscious fears from a “cracked” image
of lover to reticence in showing the surgical
site to the partner. Furthermore, for our young
patient without partner, changed appearance
was a major concern and a potential barrier
to seeking new relationship.
Although uncommon, penile cancer is a di-
agnosis with profound implications for men‘s
sexual life. This study indicates a high percent-
age of patients and partners satisfaction about
the surgical treatment with a promising results
regarding recovery of sexual function, self-
esteem and overall relationship satisfaction.
Pretreatment correct education and a proper
multidisciplinary follow up may improve sexual
outcome after partial penectomy.
Key from KOLS:
Sexual outcomes after partial penectomy for
penile cancer: Results from a multiinstitutional study
by Salvatore Sansalone and Valerio Iacovelli
valerio iacovelli
Prof.Salvatore Sansalone
Senior Lecturer in Urology
Dept. of Experimental Medicine
and Surgery
University Tor Vergata
Rome, Italy
