World Journal of Urology

, Volume 36, Issue 2, pp 265–270 | Cite as

Thulium–yttrium–aluminium–garnet (Tm:YAG) laser treatment of penile cancer: oncological results, functional outcomes, and quality of life

  • Gennaro Musi
  • Andrea RussoEmail author
  • Andrea Conti
  • Francesco A. Mistretta
  • Ettore Di Trapani
  • Stefano Luzzago
  • Roberto Bianchi
  • Giuseppe Renne
  • Stefano Ramoni
  • Matteo Ferro
  • Deliu Victor Matei
  • Marco Cusini
  • Luca Carmignani
  • Ottavio de Cobelli
Original Article



To evaluate the oncological and functional outcomes of patients diagnosed with penile cancer undergoing conservative treatment through thulium–yttrium–aluminium–garnet (Tm:YAG) laser ablation.


Twenty-six patients with a penile lesion underwent ablation with a RevoLix 200 W continuous-wave laser. The procedure was carried out with a pen-like laser hand piece, using a 360 μm laser fiber and 15–20 W of power. Median (IQR) follow-up time was 24 (15–30) months. Recurrence rate and post-operative sexual function were assessed.


Median age at surgery was 61 years. Median (inter quartile range) size of the lesions was 15 [10–20] mm. Overall, 11 (47.8%) and 12 (52.2%) at the final pathology presented in situ and invasive squamous cell carcinoma (SCC), respectively. The final pathological stage was pTis, pT1a, pT2, and pT3 in 11 (47.8%), 7 (30.4%), 3 (13.0%), and 2 (8.7%) patients, respectively. Moreover, four (17.4%) patients had a recurrence of which three (13.0%) and one (4.3%) patients developed an invasive or in situ recurrence, respectively. After treatment 6 (26.1%) patients reported a conserved penile sensitivity, while 13 (56.5%) and 4 (17.4%) patients experienced a better or worse sensitivity after ablation, respectively. Post-treatment sexual activity was achieved within the first month after laser ablation in 82.6% of the patients.


Early stage penile carcinomas can be effectively treated with an organ preservation strategy. Tm:YAG conservative laser treatment is easy, safe and offers good functional outcome, with a minor impact on patient’s quality of life.


Penile cancer Conservative treatment Thulium–yttrium–aluminium–garnet laser Tm:YAG Quality of life Sexual function 


Author contributions

GM: project development and manuscript writing. AR: project development, manuscript writing, analysis, and interpretation of the data. AC: data collection, project development, and manuscript writing. FAM: data collection and project development. ET: project development and manuscript writing. SL: analysis and interpretation of the data. RB: data collection. GR: data collection. SR: data collection. MF: project development and manuscript editing. DVM: intellectual content. MC: data collection. LC: intellectual content and manuscript editing. OC: intellectual content and manuscript editing.

Compliance with ethical standards

Conflict of interest

Prof. Luca Carmignani has a scientific contract with Quanta System. The other authors declare no conflicts of interest, including specific financial interests or relationships or affiliations relevant to the subject matter or materials discussed in the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Chaux A, Netto GJ, Rodriguez IM, Barreto JE, Oertell J, Ocampos S et al (2013) Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol 31(4):861–867CrossRefPubMedGoogle Scholar
  2. 2.
    Arya M, Li R, Pegler K, Sangar V, Kelly JD, Minhas S et al (2013) Long-term trends in incidence, survival and mortality of primary penile cancer in England. Cancer Causes Control CCC 24(12):2169–2176CrossRefPubMedGoogle Scholar
  3. 3.
    Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR (2007) Incidence trends in primary malignant penile cancer. Urol Oncol 25(5):361–367CrossRefPubMedGoogle Scholar
  4. 4.
    Backes DM, Kurman RJ, Pimenta JM, Smith JS (2009) Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control CCC. 20(4):449–457CrossRefPubMedGoogle Scholar
  5. 5.
    Munoz N, Castellsague X, de Gonzalez AB, Gissmann L (2006) Chapter 1: HPV in the etiology of human cancer. Vaccine 24(Suppl 3):S1–S10CrossRefGoogle Scholar
  6. 6.
    Hakeberg OW, Compérat E, Minhas S, Necchi A, Protzel C, Watkin N (2014) EAU guidelines on penile cancer. EAU Guidelines Office, Arnhem, The Netherlands. ISBN 978-90-79754-65-6Google Scholar
  7. 7.
    Leijte JA, Kirrander P, Antonini N, Windahl T, Horenblas S (2008) Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol 54(1):161–168CrossRefPubMedGoogle Scholar
  8. 8.
    Bandieramonte G, Colecchia M, Mariani L, Lo Vullo S, Pizzocaro G, Piva L et al (2008) Peniscopically controlled CO2 laser excision for conservative treatment of in situ and T1 penile carcinoma: report on 224 patients. Eur Urol 54(4):875–882CrossRefPubMedGoogle Scholar
  9. 9.
    Schlenker B, Tilki D, Seitz M, Bader MJ, Reich O, Schneede P et al (2010) Organ-preserving neodymium–yttrium–aluminium–garnet laser therapy for penile carcinoma: a long-term follow-up. BJU Int 106(6):786–790CrossRefPubMedGoogle Scholar
  10. 10.
    Meijer RP, Boon TA, van Venrooij GE, Wijburg CJ (2007) Long-term follow-up after laser therapy for penile carcinoma. Urology 69(4):759–762CrossRefPubMedGoogle Scholar
  11. 11.
    Ravi R (1993) Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol 72(5 Pt 2):817–819CrossRefPubMedGoogle Scholar
  12. 12.
    Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11(3):299–304CrossRefPubMedGoogle Scholar
  13. 13.
    Colecchia M, Nicolai N, Secchi P, Bandieramonte G, Paganoni AM, Sangalli LM et al (2009) pT1 penile squamous cell carcinoma: a clinicopathologic study of 56 cases treated by CO2 laser therapy. Anal Quant Cytol Histol 31(3):153–160PubMedGoogle Scholar
  14. 14.
    Piva L, Nicolai N, Di Palo A, Milani A, Merson M, Salvioni R et al (1996) Therapeutic alternatives in the treatment of class T1N0 squamous cell carcinoma of the penis: indications and limitations. Arch Ital Urol Androl 68(3):157–161PubMedGoogle Scholar
  15. 15.
    Frimberger D, Hungerhuber E, Zaak D, Waidelich R, Hofstetter A, Schneede P (2002) Penile carcinoma. Is Nd:YAG laser therapy radical enough? J Urol 168(6):2418–2421 (discussion 21) CrossRefPubMedGoogle Scholar
  16. 16.
    Rothenberger KH, Hofstetter A (1994) Laser therapy of penile carcinoma. Urologe A 33(4):291–294PubMedGoogle Scholar
  17. 17.
    Skeppner E, Windahl T, Andersson SO, Fugl-Meyer KS (2008) Treatment-seeking, aspects of sexual activity and life satisfaction in men with laser-treated penile carcinoma. Eur Urol 54(3):631–639CrossRefPubMedGoogle Scholar
  18. 18.
    Windahl T, Andersson SO (2003) Combined laser treatment for penile carcinoma: results after long-term followup. J Urol 169(6):2118–2121CrossRefPubMedGoogle Scholar
  19. 19.
    Tietjen DN, Malek RS (1998) Laser therapy of squamous cell dysplasia and carcinoma of the penis. Urology 52(4):559–565CrossRefPubMedGoogle Scholar
  20. 20.
    van Bezooijen BP, Horenblas S, Meinhardt W, Newling DW (2001) Laser therapy for carcinoma in situ of the penis. J Urol 166(5):1670–1671CrossRefPubMedGoogle Scholar
  21. 21.
    Teichmann HO, Herrmann TR, Bach T (2007) Technical aspects of lasers in urology. World J Urol 25(3):221–225CrossRefPubMedGoogle Scholar
  22. 22.
    Herrmann TR, Liatsikos EN, Nagele U, Traxer O, Merseburger AS (2011) EAU guidelines on lasers and technologies. EAU Guidelines Office, Arnhem, The Netherlands. ISBN 978-90-79754-96-0Google Scholar
  23. 23.
    Schover LR (2005) Sexuality and fertility after cancer. Hematol Am Soc Hematol Educ Progr 1:523–527Google Scholar
  24. 24.
    Kieffer JM, Djajadiningrat RS, van Muilekom EA, Graafland NM, Horenblas S, Aaronson NK (2014) Quality of life for patients treated for penile cancer. J Urol 192(4):1105–1110CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Gennaro Musi
    • 1
  • Andrea Russo
    • 1
    Email author
  • Andrea Conti
    • 1
  • Francesco A. Mistretta
    • 1
  • Ettore Di Trapani
    • 1
  • Stefano Luzzago
    • 1
  • Roberto Bianchi
    • 1
  • Giuseppe Renne
    • 2
  • Stefano Ramoni
    • 3
  • Matteo Ferro
    • 1
  • Deliu Victor Matei
    • 1
  • Marco Cusini
    • 3
  • Luca Carmignani
    • 4
  • Ottavio de Cobelli
    • 1
    • 5
  1. 1.Department of UrologyIstituto Europeo di OncologiaMilanItaly
  2. 2.Department of PathologyIstituto Europeo di OncologiaMilanItaly
  3. 3.Department of DermatologyFondazione Ca’ Granda IRCCS PoliclinicoMilanItaly
  4. 4.Department of UrologyIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  5. 5.Università degli Studi di MilanoMilanItaly

Personalised recommendations