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Introduction: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients., Patients and Methods: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors., Results: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10 mL (range 10-25). Mean operative time was 185 min (range 120-170). Median number of nodes removed was 10.25 nodes (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48 hours but ranged from 24-96 hours within the series., Conclusions: The modified VEIL technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique., Material and Methods: 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions., Variables: 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics., Results: Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills., Conclusions: PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Endoscopic Inguinal Lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection., Material and Methods: We present the modified endoscopic inguinal lymphadenectomy in a 70 years-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up is described, Results: Operative time was 120 min. Nine lymph nodes were retrieved and none of then showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted., Conclusion: The endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of these new approach., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: We evaluated the reproducibility of video endoscopic inguinal lymphadenectomy (VEIL) and we report our initial experience in the treatment of penile cancer with palpable inguinal lymph nodes., Material and Methods: From July 2006 to November 2010 were conducted 33 VEIL in 20 patients as complementary treatment for penile cancer in two referral hospitals in Latin America. We analyzed the epidemiological and clinical characteristics of patients and surgical and oncologic outcomes., Results: Fifty-five percent of the patients included were clinical stage N0 and 45% were N +. Thirteen patients underwent bilateral VEIL and the remaining seven underwent VEIL unilateral and conventional open surgery in the contralateral limb. The average operative time for VEIL was 119 minutes and mean resected lymph nodes was 8 per lymphadenectomy. The overall complication rate was 33.2%. No patient had skin necrosis. The lymphatic complication rate was 27.2%. Of the 6 cases in which the saphenous vein was preserved (18.2%) there were no lymphatic complications (P=,2). The overall survival rate was 80% and cancer-specific survival was 90%. Mean follow-up was 20 months., Conclusions: VEIL in the adjunctive treatment of penile cancer is safe, reproducible and may be an alternative to conventional lymphadenectomy. Patients with palpable lymphadenopathy also may benefit from this technique. Oncological results seem to be adequate however require longer follow-up to be confirmed., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Aggressive angiomyxoma denotes an extremely infrequent mesenchymal tumour. In virtually every case it involves genital, pelvic or perineal female structures. Cases involving male patients are extremely rare. It is a distinctive tumour with a characteristic clinical course and specific and well characterized microscopic features. The authors report an additional clinical case in a young male patient with massive scrotal and penile involvement, necessitating exeresis followed by complex reconstructive procedure implying flap and graft use. A review of the available literature concerning etiopathogenic, clinical, imagiologic, histological and differential diagnosis, therapeutic and prognostic aspects is also presented.

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient's prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct bladder carcinoma's invasion of the corpora cavernousum. A total penectomy due to a penile infected necrosis was required.

Objectives: To study the characteristics and evolution of the epidermoid penis tumours., Material and Methods: It was carried out a retrospective study on the epidermoid penis tumours treated in our center between 1981 and 2005., Results: 16 tumours penis epidermoides were diagnosed. The average age of the patients was of 71.7 years (interval between 54 and 90 years). In 80% of the cases they are diagnosed in advanced stadiums (T3 and T4). The most habitual presentation forms are the ulcerous lesions (53%) and papilar (33%). The average diameter of the lesion was 2.3 cm, and the most frequent localization the glands (53%) and balano prepucial (33%). They were carried out 7 local scissions, 8 partial penectomies, one total penectomy, and an local scission pluslocal treatment with 5-fluoracile. With a follow-up of 24 months 5 relapses took place, mainly in patients subjected to local excision of the lesion (p = 0.06 log-rank test)., Conclusions: The epidermoid carcinoma of the penis is a tumoral lesion characteristic of advanced ages that is diagnosed later and treated in not very aggressive way. Therefore it is frequent the advanced stadiums and the tumour relapses.

Prostate cancer is a disease that appears with a very high frequency. However, the presence of metastasis to the penis is rare. Only 98 cases reported in the literature up to 2003. We present one case of a patient with painless metastatic nodules on the penis secondary to a prostate cancer.

Introduction: Up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus., Clinical Case: A 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma., Comment: The development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.

We present an alternative treatment of the intraepithelial neoplasms of penis (Bowen's disease), the topical application of imiquimod 5% cream. It was applied 3 times weekly for 5 weeks. Imiquimod is an imidazoquinolone immune response modifier that has been shown to have indirect antiviral and antitumor effects with few adverse effects. Imiquimod 5% cream may represent an alternative treatment option for Bowen's disease.

A 64 years-old man is treated in our hospital presenting a big tumor in glans penis. During the surgical act, another neoplasm is detected in the urethra. The microscopic study showed a concomintant epidermoid carcinoma of glans penis and urethra with non-affected tissue between both tumors.

Objective: We report a recidive of penis carcinoma after 21 years of surgery., Methods: This is the case of a male of 85 years old, with partial penectomy; by epidermoid carcinoma. In physics exploration, that it displays excrecente lesion at level of gland of 1 month of evolution. Biopsy being the result of epidermoid carcinoma reason why is made. Total penectomy, a with cutaneus uretrostomy., Results: The histopathological study of the piece, confirm a epidermoid carcinoma well differentiated.

We present a case of penile malignant melanoma. Its rarity of less than 1% of masculine genital malignant neoplasms, the absence of standardised protocols as for other neoplasms, impel us to its publication.

Penile melanoma is a very uncommon neoplasm, being reported less than 60 cases. Event yet it outlines not few doubts about its diagnosis and treatment, and in advanced stages represents a challenge for the future since it prognosis is awful at short time. In the present article, its presented a glans melanoma diagnosed and treated at our Service. We make a brief revision of the literature and some basic issues on the management of this entity when it's localized in penis, since in the cases in which it extends far from this organ is yet oncological field.

Objective: To explain and analyse when and how to use the new staging technique used in patients with squamous carcinoma of the penis, through the procedure of dynamic biopsy of the sentinel lymph node., Patients and Methods: We demonstrate the technical application of the dynamic biopsy of the sentinel lymph node, in a 40-year-old patient, diagnosed as suffering from squamous carcinoma of the penis. We use preoperative lymphatic visualization through lymphogammagraphy, together with intraoperative detection through gamma scanning, in order to detect and identify the sentinel lymph node., Conclusions: We consider the dynamic biopsy of the sentinel node by the individual pattern of the lymphatic drainage as a new applicable Nuclear Medicina technique. It is an extremely useful technique in order to achieve early dissemination, by allowing us to identify patients with sub-clinic lymphatic spread, who will be candidates to regional lymphatic dissection.

Objective: To analyze the series of patients who underwent inguinal lymphadenectomy in our Center due to squamous penile carcinoma, between years 1984 to 1999., Material and Methods: Lymphadenectomy was carried out in 19 patients, with a mean age of 61 years. Bilateral ilioinguinal (42.1%) was the most frequent type of intervention. Only four patients underwent penectomy and lymphadenectomy simultaneously. We present the clinical and pathological results, according to the 1997 TNM classification., Results: Palpable inguinal nodes after antibiotherapy remained in seven out of 12 patients. The overall correlation between N and pN stages in our series was 68.42%. Pathological results according to pT and pN stages are also presented. Postoperative complications were present in 13 cases (68.42%), (lymphedema being the most frequent one). In those patients with two or less pN(+) nodes, an overall one-year and five-year survival of 90 and 80% were obtained; compared to 11.11 and 0% when there were more than two., Conclusions: The importance about control of metastatic lymph nodes in squamous carcinoma of the penis, places inguinal lymphadenectomy as an essential tool, in those suitable cases. However, its incidence of complications makes a progressive agreement about its indications be necessary.

Contribution of a case report of cutaneous horn of penis surgically treated with extensive resection of the implantation base. A well differentiated, microinvasive epidermoid carcinoma was histopathologically demonstrated on a hyperkeratosis squamous papilloma. Although underlying lesions to cutaneous horn are usually benign, malignant changes have been reported in up to one third of cases; surgical treatment should therefore include extensive resection of the implantation base.

A fibrosarcoma of the penis is an infrequent finding. This paper contributes one case found in the perineo-scrotal region emphasising some aspects of local staging procedures, as well as the differential diagnosis with other mesenchymal tumours; there is no validated treatment protocol, although there is widespread agreement that extensive surgical excision should be performed, such as was performed in this patient.

Verrucous carcinoma of the penis accounts for 5-17.8% of total carcinomas in the referred location that are diagnosed in our environment. Six cases of this rare neoplasia have been treated in our service and revised retrospectively. The epidemiological, clinical, diagnostic and therapeutic aspects of our series are analyzed and the issues around them discussed. Eventually, the benign biological behaviour of this tumour warranting conservative surgical treatment is ratified. In selected cases where the therapeutic modalities used do not yield material for histopathological analysis (laser, cryotherapy, etc.) prior obtention of a deep biopsy of the lesion to identify the likely presence of a well differentiated epidermoid carcinoma is imperative. Also, every effort should be made to monitor the cases of associated premalignant conditions.

Verrucous carcinoma includes approximately 5% of all neoplasias of the penis and is a tumoral variety of benign behaviour and differentiated histology. Our 10-case experience of penial verrucous carcinoma is reported here. In nearly all cases, partial penectomy was the definitive approach. No dissemination, locorregional or distant, was found in any of the report cases. Since prognosis of these tumours is good, we see no justification in performing lymphadenectomy, although it is advisable to adopt and expectant attitude when faced to inguinal adenopathies.

Exposition of one case of skin metastasis in a 35 year-old patient, diagnosed 10 years previously with epithelioid sarcoma of the penis, which was treated with total penectomy. The singularity of this case lies in the rarity of a pineal site for this tumour, as well as the infrequency of the skin metastasis. It should be noted the significance of long-term follow-up in this patients, since quite frequently they develop metastasis following a long asymptomatic period.

The penis carcinoma is a neoplasia representing 0.7% of all male neoplasias, with an annual incidence between 1 and 2 cases per 100,000 inhabitants/year. The present study compiles the authors' experience in treating 22 patients presenting this neoplasia in the period between 1977-90. The procedures carried out included local resection, partial amputation, radical penectomy with lymphadenectomy plus radiotherapy, and palliative surgery plus radiotherapy all based on staging made following TNM grading. Therapy complications, follow-up, and survival results are explained. There were 5 occasions of spinocellular carcinoma co-existing with other neoplasias: 1 colon adenocarcinoma, 1 prostate carcinoma, 1 cleaved small cell centrocytic diffuse lymphoma, and 2 skin epithelioma in other sites, and relevant literature was reviewed. A background of psoriasis treated with psoralens plus UV was present in 4 cases, and caution was advised towards genital protection in patients undergoing UV radiations whether for therapeutic, recreational or cosmetic reasons.

The squamous cancer of the penis has a very low incidence in our environment which means that very few centres have any cases and therefore lack any major experience. This handicap together with their treatment being divided between Urologists and Dermatologists decreases even more the number of cases seen and precludes the obtention of valid considerations. This report presents 15 cases of squamous cancer of the penis seen and followed-up for at least 5 years, and which were treated according to an established protocol in which the differential element, based in our results, is that ilial lymphadenectomy does not offer better results than chemotherapy in high-stage disease, with 33% survival, whereas in low-stage disease the use of surface and deep bilateral inguinal lymphadenectomy, in conjunction with micrographic surgery achieves survival rates of 100%. Morbidity in this case is standard (transient lymphedema, 100% patients; inguinal skin necrosis, 4% patients), while ilial lymphadenectomy has a high morbidity and some mortality.

Case of an 83 year-old male with metastatic penis cancer located at the glans, secondary to moderately differentiated prostatic adenocarcinoma. There was early metastasis clinically expressed as several painful and ulcerous nodes at the glans corona and paraphimosis. The clinical rareness of metastasis in a porous body (glans) as opposed to the more frequent cavernous ones is outlined. Diagnosis was made through biopsy. Treatment is complex since neither radiotherapy, chemotherapy or hormonal-therapy appear to be effective. Occasionally, in the event of solitary nodes partial penectomy should be indicated. Usually, the only feasible treatment is palliative. Presence of such type of metastasis should always be considered as a sign of poor prognosis.

Penis epidermoid carcinoma is responsible for about 1% of deaths by neoplastic diseases in developed countries. During a 5-10 years follow-up review, we found 14 patients, 9 of which started as localized stages in glans and/or prepuce. Lymph node affection was found in 9 cases, either at beginning of diagnosis or during follow-up. Lymphadenectomy, which demonstrated metastatic affection in 4 cases, was considered indicated in 6 patients. Two cases received inguinal chain radiotherapy and the remaining one underwent chemotherapy as first therapy. Percentage of actual survival rate, found after 5 years, among the 14 patients studied was 42.8% (6 cases), still unchanged after a 10-year follow-up. Five patients died due to their basic illness progression and 3 died of other tumour-unrelated processes. The paper analyzes the results obtained based on the literature reviewed, and discusses current therapy approaches for inguinal metastatic conditions.

The present work reports one case of penis verruciform carcinoma. Such neoplastic process is considered to be a variation of the scaly carcinoma with specific histopathological features. Clinical and histopathological as well as therapeutic aspects (conservative or radical surgical therapy, depending on the evolutive stage and laser electrocoagulation) were analyzed.

Penis carcinoma shows an incidence between 0.3-1% of all male neoplasias. The verruciform variety represents 5-10% of total penis carcinoma. Verruciform carcinoma is a variety of squamous carcinoma presenting a usually benign behaviour and related to some virus species (H.P.V.). Three cases are presented with ages ranging between 47-87 years-old, all of which undergoing partial penectomy, their progression being monitored for two years.

A new case of penis verruciform xanthoma in a 28 years old patient with clinical suspicion of a pre-neoplasic condition is presented. Histology and ethiopathogenesis is commented upon, with special emphasis on differential diagnosis. Healing treatment is made through simple exeresis. The extreme rarity of this bening condition's presentation and location justifies publication since it represents one sixth of the reviewed literature.

This paper present the case of a man 72 year old with secondary penis cancer, as a late manifestation of a earlier well differentiated prostate focus, identified by P.A.A.F., which determined the rarity of the presentation and the choice of diagnostic method by puncture-aspiration with a thin needle. Treatment is very complex and neither radiotherapy nor estrogens therapy produced satisfactory results, leaving de choice of total penectomy only for those cases with intractable pain and if there is no pelvic extension.

Penile carcinoma is a rather infrequent neoplasia with an approximate annual rate of 1 to 2 cases per 100,000 inhabitants. In Spain, its presentation is rare, corresponding to 10.42% of all tumors and 0.7% of all malignant tumors of the male. In this report, the casuistic of our Department between the years 1978 and 1987 is presented. Ten patients diagnosed of penile carcinoma were treated, representing 0.1% of all the urological tumors seen during that period. Special emphasis has been placed on the need to perform national multicenter studies, due to the rare finding of such pathology. From an etiopathogenic perspective, chronic inflammation due to smegma accumulation and the presence of a prepuce seem necessary for the development of this pathology. The role of oncogenic viruses still remains to be cleared. After treatment, which was mainly surgical, a global survival rate of 60% was obtained with a follow-up period ranging from 1 month to 7 years. After pointing out several anatomical considerations relating to the lymph drainage of the penis, the different therapeutic alternatives (surgery, radiotherapy, chemotherapy) in the treatment of penile carcinoma were discussed.