To Örebro University

Objective: This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma.

Material and methods: Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis.

Results: Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results.

Conclusions: A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge. 

Purpose:

We evaluate sexual function, sexual satisfaction and cosmetic results after laser treatment of penile carcinoma.

Materials and Methods:

A total of 67 patients were treated at our clinic for penile cancer using combined carbon dioxide and neodymium:YAG lasers from 1986 to 2000. At the time of this study 58 men, with a mean age of 64 years were alive, of whom 46 (79%) agreed to participate in a structured face-to-face interview addressing sexual function, sexual satisfaction and cosmetic results. The length of time that had elapsed since treatment ranged from 6 months to 15 years (median 3 years).

Results:

Of 40 patients (87%) who had been sexually active before treatment 30 (75%) had resumed activities at the time of the interview. Unaltered erectile function after treatment was reported by 33 patients (72%), 10 patients (22%) reported decreased function and 3 (6%) reported improved function. Of the 46 patients 23 (50%) were satisfied/very satisfied with their sexual life. After treatment only 3 of 30 (10%) of the evaluable men had dyspareunia. The cosmetic results were considered satisfying/very satisfying by 36 (78%) men.

Conclusions:

Laser treatment of localized penile carcinoma preserves the penis and generally provides satisfactory sexual function and cosmetic results.

ObjectivesThe aims were to assess the initial symptoms of penile carcinoma and patients’ time frame in treatment seeking, and to describe the effect of laser treatment on sexual activity and life satisfaction.Patients and methodsA retrospective face-to-face structured interview study of patients laser treated for localised penile carcinoma at the department of Urology in Örebro, Sweden, during 1986 to 2000. Sixty-seven was treated and 58 of them (mean age, 63 yr; range, 34–90) were alive at the time of this study. Forty-six (79%) agreed to participate.ResultsNinety-six percent of the patients recalled their first symptom of penile carcinoma. Superficial ulceration and fissures were the most common symptoms (39%). Thirty-seven percent delayed seeking treatment for more than 6 mo.The patients had a greater lifetime number of sexual partners and a greater lifetime prevalence of STIs than a Swedish representative comparator population.Some aspects of sexual life, such as manual stimulation/caressing and fellatio, decreased markedly after laser treatment.Patient satisfaction with life as a whole was approximately the same as that of the general population.ConclusionsPatients delayed seeking treatment for a considerable period, despite awareness of the first local symptoms. Men with laser-treated localised penile carcinoma resume their sexual activities to a large extent after the treatment. Except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators are satisfied with life as a whole and with other domains of life including satisfaction with sexual life.Take Home MessageIn this study of 46 men who received laser treatment for localised penile carcinoma, we found that they resumed their sexual activities to a great extent and coped well with nearly all aspects of life after the treatment.

Introduction. Coping with a diagnosis of cancer and, its treatment and recovery is a dyadic process within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. There are clinical reasons to view a couple’s sexuality, alone and together, as dependent factors for successful treatment.

Aim. The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and one year after organ-sparing laser treatment of penile carcinoma.

Methods. A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners; median age was 60 (37-73) years and 57 (30-72) years, respectively. Length of partner relationship ranged between 1 and 54 years; median 29 years. The participants completed structured interviews before treatment, and at 6 months’ and 12 months’ follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication skills, and life satisfaction.

Main outcome measures. The interviews contained almost the same questions for patients and partners at all three measuring points. Moreover, three well-validated instruments were included: HADS, IIEF-5, and LiSat-11. Most of the questions were extracted from a national representative study of Swedish men and women and from this sample an ad hoc comparator population of 935 men and 809 women was selected.

Results. There were no significant differences between interview data at 6 and 12 months’ follow-up. Eight out of 29 couples had not been sexually active for several years before diagnosis and did not resume activity; further 4 couples had ceased having penetrative intercourse at follow-up. Sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia and about a fourth of the women had decreased vaginal lubrication before treatment. At follow-up increased sexual function was found, with the exception of erectile function and partners’ orgasm. The couples showed within-couple agreement concerning sexual activities, erectile dysfunction, retarded ejaculation, and lubrication dysfunction. Relatively few (41%) had an ongoing verbal mutual communication about their sexuality. Overall life satisfaction was found to be at par with the general population as most of domains of closeness, health, leisure and provision. Exceptions were patients somatic health and, at follow-up, sexual satisfaction. Couples with an active partner-related sexual life at follow-up showed coherence in high satisfaction with life as a whole. Sexually inactive couples showed coherence in being dissatisfied with their sexual life at baseline as well as after 12 months.