Purpose

Perineal urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally-advanced or anatomically unfavorable penile cancer (PC) requiring total penectomy. Here, we report post-operative PU-related complications and PU stenosis rates after total penectomy with PU in a large multicenter cohort of PC patients.

Methods

We retrospectively reviewed the medical records of 299 patients who underwent PU as a means of urinary diversion for primary PC across seven international centers from 2000 to 2020. The Clavien-Dindo grading system was used to record 30-day post-operative complications. Cumulative incidence of stenosis was evaluated using the Kaplan-Meier method.

Results

Median patient age was 67 years (interquartile range (IQR) 58–74), and median follow-up was 19 months (IQR 7.2–57). A total of 58 patients (19%) developed a 30-day post-operative complication, of which 45 (79%) were deemed minor (CD Grade I and II). Wound infection (11%; CD grade I–III) and dehiscence (4.0%; CD grade I–III) were the more common complications. The overall incidence of stenosis was 12% (35/299 patients), of which 26 (74%) needed surgical revision (probability of stenosis revision at one year of 9.3%, median time until the revision: 6.1 months (IQR 3.0–13)). Only two stenoses were seen after two years of follow-up.

Conclusion

We present the most extensive series of PU in the management of PC to date. Wound infections of the primary surgical site were the most common complication. Stenosis occurred mostly within one and a half years after treatment.

中文翻译：

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阴茎癌会阴尿道造口术的结果：20年国际多中心经验

目的

会阴尿道造口术 (PU) 通常是需要完全切除阴茎的局部晚期或解剖学上不利的阴茎癌 (PC) 患者的最终尿流改道形式。在这里，我们报告了一个大型多中心 PC 患者队列中 PU 全阴茎切除术后 PU 相关并发症和 PU 狭窄率。

方法

我们回顾性审查了 299 名在 2000 年至 2020 年间在七个国际中心接受 PU 作为原发 PC 尿流改道的患者的医疗记录。使用 Clavien-Dindo 分级系统记录术后 30 天的并发症。使用 Kaplan-Meier 方法评估狭窄的累积发生率。

结果

中位患者年龄为 67 岁（四分位距 (IQR) 58-74），中位随访时间为 19 个月（IQR 7.2-57）。共有 58 名患者 (19%) 出现了术后 30 天的并发症，其中 45 名 (79%) 被认为是轻微的（CD I 级和 II 级）。伤口感染（11%；CD I-III 级）和裂开（4.0%；CD I-III 级）是更常见的并发症。狭窄的总体发生率为 12%（35/299 名患者），其中 26 名（74%）需要手术翻修（一年时狭窄翻修的概率为 9.3%，翻修前的中位时间：6.1 个月（IQR 3.0-13 ))。经过两年的随访，仅观察到两个狭窄。

结论

我们展示了迄今为止 PC 管理中最广泛的 PU 系列。原发手术部位的伤口感染是最常见的并发症。狭窄多发生在治疗后一年半内。