Functional Outcomes of Glansectomy to Treat Localised Penile Cancer: A Systematic Review

14 studies, 327 procedures: 91% retained erectile function after glansectomy, but outcome reporting was too inconsistent to draw firm conclusions

Journal: International Journal of Impotence Research | Published: 2025-04-15 | Type: Systematic Review | PMID: 40229589 Authors: Pang KH, Alnajjar HM, Muneer A — Male Genital Cancer Centre, Andrology, University College London Hospitals Funding/COI: No funding listed. Authors declare no competing interests.

Summary

Glansectomy — surgical removal of the glans penis — is a penile-preserving approach for penile cancer confined to the glans, used when less invasive options aren't sufficient. This systematic review pooled 14 studies covering 327 procedures to assess what patients actually experience afterward: sexual function, urinary function, sensation, and appearance satisfaction. The headline numbers look reasonable, but the review's own conclusion is that the evidence base is too heterogeneous to mean much without standardized outcome measures.

Claims

• Recurrence rate: 9.1% (range 0–25%) at mean follow-up of 40.7 months (range 13–52 months)
• Disease-specific survival: 87.5–100% across included studies
• Erectile function preserved: 91.1% (range 50–100%)
• Sexually active at follow-up: 62.5% (range 33.3–100%)
• Voiding while standing: 75.6% (range 66.7–100%)
• Maintained glans sensation: 83.7% (range 63.6–91.2%)
• Satisfaction with penile appearance: 86.3% (range 68.2–100%)
• Partial graft loss: 6.1% (range 0–17.6%)
• Meatal stenosis (urethral opening narrowing): 8.1% (range 0–14.3%)

Study Quality

This is a systematic review conducted with reference to the 2020 PRISMA statement, covering 14 studies and 327 glansectomy procedures — a small total given the rarity of penile cancer. The pooled numbers are mean values across studies with vastly different methodologies, follow-up durations, and patient selection criteria, which is the central problem. Ranges that span from 33% to 100% (sexual activity) or 50% to 100% (erectile function) signal that these aren't stable estimates — they reflect apples-to-oranges aggregation across institutions with different definitions of "preserved" function and different tools for measuring it.

Notably, the full-text methodology section provided appears to be from an ESMO clinical practice guideline rather than this review's own methods section, which limits assessment of search strategy and inclusion/exclusion criteria from the available data.

Red Flags

• Ranges are enormous: A 50-percentage-point spread in erectile function preservation (50–100%) means the pooled 91.1% figure is nearly meaningless as a predictive number for any individual patient or institution
• No standardized outcome measures: The authors explicitly flag this as the review's core limitation — there are no consensus tools for measuring functional outcomes after glansectomy, so every included study measured different things differently
• 327 patients across 14 studies averages to 23 patients per study — these are small, single-center series
• Retrospective design likely dominates the included literature; functional outcomes from retrospective chart review are notoriously unrereliable
• No funding source listed — unclear whether this was investigator-initiated or industry-adjacent
• Follow-up heterogeneity: Range of 13–52 months mean follow-up across studies makes time-dependent outcomes (recurrence, stenosis progression) difficult to compare

Strengths

• Penile cancer is rare and under-studied; any systematic synthesis of the literature is useful
• PRISMA-adherent methodology
• The authors are honest and direct about the evidence quality problem — the review's main value is documenting the gap, not filling it
• Covers oncological and functional outcomes together, which reflects how patients actually weigh the decision

Verdict

This review is most useful as a map of how little we know. The functional numbers — 91% erectile preservation, 86% appearance satisfaction — sound reassuring, but the ranges underneath them make them nearly unusable for counseling individual patients. If you want to know whether glansectomy is broadly tolerable, this paper says probably yes. If you want to know by how much, under what conditions, and how that compares across surgical techniques, this paper tells you we don't have the measurement infrastructure to answer that yet. The authors are right to call for standardized reporting frameworks; that's the actual contribution here.