Raheem, O.A. Venishetty, N, Areti, A, Kocjancic, E

Glandular Resurfacing, Superficial Glans Penile Cancer

Penile cancer, although rare, significantly impacts the glans penis, with an incidence rate between 0.66 and 1.44 per 100,000 men. This video presents a step-by-step surgical procedure for glans resurfacing using a buccal mucosa graft to treat Carcinoma in situ (CIS) located at the distal glans penis. The primary goals of this technique are complete tumor removal with negative surgical margins and organ preservation to maintain functionality and appearance. The buccal mucosa graft is chosen for its favorable characteristics, including ease of harvest, compatibility with wet environments, and excellent neovascularization properties. These features make it an ideal graft for penile procedures. The approach taken in the video details the harvesting process, emphasizing the importance of avoiding the Stensen's duct to prevent complications. Glans resurfacing is indicated for superficial penile cancers confined to the glans, such as Tis, Ta, T1aG1, and T1aG2 stages. The surgical steps include excising the affected glans epithelium and subepithelium with clear margins, placing the buccal mucosa graft over the excised area, and stabilizing it with stay sutures and quilting techniques using 5/0 Vicryl Rapide. Post-operative care involves the insertion of a 16-F silicone catheter, careful dressing of the surgical site, and providing patients with detailed wound-care instructions. Follow-up appointments are scheduled at one- and two weeks post-surgery. This video serves as an educational tool for students and residents, demonstrating the effective combination of oncological control and organ preservation. It highlights the importance of surgical technique and post-operative care to achieve optimal outcomes in treating superficial glans penile cancer.

While the video recording of the glans lesion excision is not included, we followed the surgical oncologic principle of excising the glans lesion until no visible disease and all lesions were sent to pathology including the margins. Afterward, we proceeded with glans resurfacing and grafting with buccal as shown.

Kamel, Mohamed H; Khalil, Mahmoud I; Eltahawy, Ehab; Davis, Rodney; Bissada, Nabil K 2019. Organ-sparing procedures in GU cancer: part 2-organ-sparing procedures in testicular and penile tumors. International urology and nephrology, 51 10, 1699-1708

Pappas A, Katafigiotis I, Waterloos M, Spinoit AF, Ploumidis A. Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature. Biomed Res Int. 2019;2019:5219048. doi:10.1155/2019/5219048

Shabbir M, Muneer A, Kalsi J, et al. Glans Resurfacing for the Treatment of Carcinoma In Situ of the Penis: Surgical Technique and Outcomes. European Urology. 2011;59(1):142-147. doi:10.1016/j.eururo.2010.09.039

Sharma G, Sharma S, Parmar K. Buccal mucosa or penile skin for substitution urethroplasty: A systematic review and meta-analysis. Indian J Urol. 2020;36(2):81-88. doi:10.4103/iju.IJU_298_19

Yao HHI, Sengupta S, Chee J. Penile sparing therapy for penile cancer. Transl Androl Urol. 2020;9(6):3195-3209. doi:10.21037/tau.2019.08.07

Zimmerman WB, Santucci RA. Buccal mucosa urethroplasty for adult urethral strictures. Indian J Urol. 2011;27(3):364-370. doi:10.4103/0970-1591.85441