(178) GLANDULAR RESURFACING WITH BUCCAL MUCOSA GRAFT FOR SUPERFICIAL GLANS PENILE CANCER: SURGICAL TECHNIQUE
Authors: Raheem O , Venishetty N , Areti A , Kalidoss S , Kocjanic E 
Published: December 2024

Introduction

Penile cancer, although rare, significantly impacts the glans penis, presenting a considerable clinical challenge due to its location and potential implications for patient quality of life. The incidence rate of penile cancer ranges between 0.66 and 1.44 per 100,000 men, with variations depending on geographical and demographic factors.

Objective

Early-stage penile cancer, such as Carcinoma in situ (CIS), can be effectively managed with appropriate surgical interventions. However, the choice of surgical technique is crucial to ensure complete removal of cancerous tissues while preserving the functional and aesthetic aspects of the glans penis. This video presentation aims to address these challenges by demonstrating a meticulous surgical procedure for glans resurfacing using a buccal mucosa graft.

Methods

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.

Results

This video serves as an invaluable educational tool for medical students and surgical residents, providing a comprehensive visual guide to the glans resurfacing procedure. The detailed demonstration includes each step of the surgical process, from the initial excision of the affected epithelium to the final placement and stabilization of the buccal mucosa graft. By showcasing the meticulous technique required to achieve clear surgical margins, the video underscores the importance of precision in oncological surgery.

Conclusions

The video highlights the critical role of surgical technique and post-operative care in the treatment of superficial glans penile cancer. The use of a buccal mucosa graft offers significant advantages, including ease of harvest and excellent integration with the penile tissue, making it an ideal choice for glans resurfacing procedures. The step-by-step guide provided in the video emphasizes the importance of achieving negative surgical margins to prevent cancer recurrence while maintaining the structural and functional integrity of the glans penis. Proper post-operative management, including careful dressing and follow-up appointments, is essential to ensure optimal healing and patient recovery. This educational resource underscores the necessity of a meticulous and informed approach to surgical oncology, ultimately aiming to enhance treatment outcomes for patients with superficial glans penile cancer.

Disclosure

No.