背景:阴茎癌治疗中的器官保留手术(OSS)旨在维持器官的形态和功能,并保持与健康相关的生活质量(HRQoL)。然而,缺乏探讨这些结局的综合证据.
目的:目的试图审查HRQoL,功能,美学,OSS或根治性阴茎切除术治疗阴茎癌后的心理结果。
方法:对MEDLINE和Cochrane数据库的系统评价包括报告功能的研究(性,泌尿或感觉),原发性阴茎癌手术治疗后的生殖器外观或HRQoL/心理健康。英文报告(2000-2022年),纳入患者报告或客观的临床结果指标,有资格。非手术治疗策略和转移性疾病的研究被排除在外。对数据进行汇编和分析。
结果:纳入26项研究。性功能是研究最多的结果(754名受访者;19项研究),最常见的是原始的15项和删节的5项国际勃起功能指数。OSS后勃起功能的保存一般描述,引用的总体性满意度有所下降。对排尿功能的评估不均匀,术前评估很少,这使得研究间比较困难。大多数患者似乎能够在OSS之后从站立姿势中消失,喷药是最常见的症状。根治性腺体切除术后的裂层皮肤移植和尿道腺体成形术都描述了某些感觉功能的维持。有限的研究表明,患者对OSS后生殖器美容有合理的满意度。阴茎癌手术后的大多数研究都描述了对HRQoL的负面影响,与阴茎手术和淋巴结清扫术的侵袭性相关。焦虑,抑郁症,据报道,阴茎癌幸存者的自尊心降低。关系幸福感各不相同,一些幸存者报告说这一点没有改变。
结论:OSS可以保留性元素,泌尿,和感觉功能,对符合条件的患者来说,支持优于根治性阴茎切除术的优势。然而,由于规模小,全面的理解仍然有限,异质患者队列,获取病前数据的挑战,和结果测量的可变性。OSS后患者报告结果的标准化是可取的。
Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.
The aim sought to
review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.
A systematic
review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.
Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.
OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.