Wide local excision surgery combined with 5-aminolaevulinic acid photodynamic therapy for Paget's disease of the scrotum in elderly people
Jie Gu, Dongjie Li, Xiong Chen, Yuanqing Dai, Zhongwei Zhao, Yao Bai, Xinji Tan, Mingquan Chen, Sheng Hu, Xiaobo Zhang
Abstract
ObjectiveTo investigate the safety and efficacy of wide local excision surgery combined with 5-aminolaevulinic acid(ALA)-photodynamic therapy(PDT)in treating Paget's disease of the scrotum in elderly people.
MethodsPatients with an average age of 68.4±4.7 years undergoing wide local excision surgery combined with ALA-PDT for Paget's disease of the scrotum from June 2014 to February 2018 were followed up.All patients underwent wide local excision surgical treatment first and were then enrolled in ALA-PDT study after the diagnosis of Paget's disease of the scrotum was confirmed.Four cases were eliminated as a result of two patients refusing photodynamic therapy for various reasons and two patients lost during follow-up after ALA-PDT.A total of 16 patients were included in the study, of whom 6 cases were in Ray stage A1, 7 cases in stage A2 and 3 cases in stage B. Patients underwent 3 courses of ALA-PDT after operation.Then the efficacy, short- and medium-term complications were followed up.
ResultsThe duration of disease among the 16 patients ranged from 4 to 76 months before diagnosis, with an average of 35.7 months.Surgery was performed immediately after diagnosis.Ten patients underwent resection and suture and 6 patients were treated with skin flap transfers.Of the patients treated with surgery, 3 patients received suspicious lymph node dissection and 1 patient underwent reoperation due to skin flap necrosis.Patients were followed up for 3 months to 3 years and 6 months after ALA-PDT.Recurrence and distant metastasis occurred in 2 cases, with 1 case of brain metastasis and 1 case of systemic metastasis, and the overall recurrence rate was 12.5%.During the follow-up, there were no other serious complications except for 1 case(6.3%)with lower limb movement disorders.
ConclusionsWide local excision surgery combined ALA-PDT has good clinical outcomes, low recurrence rates and few complications for the treatment of Paget's disease of the scrotum in elderly people.
Key words:
Paget's disease of the scrotum; Local excision surgery; Photodynamic therapy
Contributor Information
Jie Gu
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Dongjie Li
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Xiong Chen
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Yuanqing Dai
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Zhongwei Zhao
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Yao Bai
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Xinji Tan
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Mingquan Chen
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Sheng Hu
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Xiaobo Zhang
Department of Geriatric Urology, Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
Institute of Urolithiasis, Central South University, Changsha 410008, China
