The original article ‘Diagnosis of penile cancer with ex vivo fluorescence confocal microscopy using the Histolog® Scanner’ was published in BJU International and can be found in full here. 

Objectives

To evaluate the feasibility and diagnostic performance of ex vivo fluorescence confocal microscopy (FCM) using the Histolog® Scanner (SamanTree Medical SA, Lausanne, Switzerland) for the assessment of penile cancer (PeCa) specimens, and to compare FCM-based diagnoses with standard formalin-fixed, paraffin-embedded (FFPE) histopathology.

Patients and Methods

We conducted a single-centre study including 12 patients with clinical or radiological suspicion of PeCa who underwent diagnostic or excisional biopsy between June 2022 and November 2023. Fresh biopsy specimens were stained with a nuclear fluorescent dye and scanned ex vivo with the Histolog Scanner. Digital images were retrospectively reviewed by two uropathologists and compared with conventional haematoxylin and eosin-stained FFPE sections.

The primary endpoint was diagnostic concordance between FCM and histopathology in detecting invasive squamous cell carcinoma (SCC); secondary endpoints included sensitivity, specificity, and overall feasibility of image acquisition.

Results

A total of 29 FCM scans were obtained. Diagnostic image quality was achieved in 28/29 scans (96.6%).

FFPE analysis confirmed invasive SCC in eight patients, differentiated penile intraepithelial neoplasia in three, and an atypical squamous proliferative lesion (ASPL) in one. FCM correctly identified tumour category in 11/12 patients, yielding an overall accuracy of 91.7% (95% confidence interval [CI] 61.5–99.8%).

Sensitivity for invasive SCC detection was 87.5% (7/8; 95% CI 47.3–99.7%), and specificity was 100% (4/4; 95% CI 39.8–100%).

One SCC was misclassified as ASPL on FCM. Median workflow time was ~5 min/specimen.

Conclusions

Ex vivo FCM is a feasible, rapid imaging technique that enables high concordance with histopathology for the diagnosis of PeCa. This pilot study represents the first assessment of ex vivo FCM in penile malignancies and provides preliminary evidence supporting its potential role in intraoperative margin assessment. Larger prospective studies are required to confirm its diagnostic accuracy and clinical utility.

Citation:

Zhang, X., Almeida-Magana, R., Mendes, L.S.T., Lavergne, D.F., Alnajjar, H., Shaw, G., Freeman, A., Muneer, A. and Haider, A. (2026), Diagnosis of penile cancer with ex vivo fluorescence confocal microscopy using the Histolog® Scanner. BJU Int. https://doi.org/10.1111/bju.70239

Learn More about Penile Cancer

Methods

An extensive review was conducted to analyse and compare diagnostic and treatment recommendations from publicly available guidelines published by the American Urological Association, European Association of Urology, Canadian Urological Association, and the International Society of Sexual Medicine. Key similarities and differences regarding PD definition, evaluation, non-surgical treatments, and surgical management were systematically compared.

Results

Areas of general consensus across guidelines include the importance of comprehensive history-taking for PD diagnosis and the role of intracavernosal injection as the ‘gold standard’ for assessing penile deformity prior to invasive intervention. Shared decision-making and thorough patient counselling are universally emphasised. Plication or incision and grafting surgery is generally reserved for patients with preserved erectile function, whereas penile prosthesis implantation is the preferred surgical option for those with erectile dysfunction unresponsive to medical therapy. Non-surgical treatments remain an area of controversy due to limited evidence of efficacy; however, intralesional injections are recognised by all panels as a potential treatment option, especially in the acute phase. Further research intoPD pathophysiology and rigorous outcomes studies are needed to inform novel treatments and refine surgical management strategies.

Conclusion

While major urological societies demonstrate substantial consensus on several aspects of PD evaluation and management,key areas of divergence remain, underscoring the need for further research to guide evidence-based care.

Citation:

Chierigo, F., Fallara, G., Tozzi, M., Salonia, A., Ferro, M., Alnajjar, H.M., Muneer, A. and Pang, K.H. (2026), Guideline of guidelines: Peyronie’s disease. BJU Int. https://doi.org/10.1111/bju.70201

What is Peyronie’s Disease? 

Peyronie’s Disease is caused by fibrous scar tissue (or plaque) that develops under the skin of the penis. Symptoms of Peyronie’s disease include:

• Significant curvature
• Pain
• Erectile dysfunction in some cases 

 There are usually two phases to this condition. The first is the acute phase, presenting with pain and changing curvature. The second is the chronic phase where the plaque hardens, the curve stabilises, and pain often subsides.

 Peyronie’s is treatable. It is important to seek early evaluation by a urologist or andrologist, as treatment is more effective when begun in the early stages.

 You can read more about Peyronie’s Disease on our blog here.

If you’re concerned that you have symptoms that may be Peyronie’s Disease, then please get in touch with us.

Not being able to perform in the bedroom can be embarrassing, but erectile dysfunction (ED) is a common global problem – affecting up to one in five men!

It can be a result of medical issues (organic ED), such as vascular disease, nerve damage, hormonal deficiency, pelvic surgery or pelvic trauma. Alternatively, it can be related to psychological factors such as stress, anxiety, relationship issues, or sexual abuse.

ED can also be caused by lifestyle factors, including smoking and drinking alcohol, drug abuse, obesity, fatigue, and sleep disorders – not to mention medications such as antidepressants, diuretics, corticosteroids and medications for heart disease.

At Harley Street Andrology, we specialise in men’s health London-wide and can provide a prompt diagnosis and treatment, including shockwave therapy, to help you regain confidence.

Read on to find out more about this pain-free, minimally invasive, and effective treatment option for erectile dysfunction.

What is shockwave therapy for erectile dysfunction?

Shockwave therapy is a clinically-proven, safe, regenerative therapy used to restore vascular and smooth muscle function which in turn helps to restore penile function.

The procedure is non-invasive and involves the use of an ultrasound probe.

This is moved slowly and gently over the penis while low-intensity energy sound waves are passed through the skin and into the penile shaft.

These shock waves help smooth muscle cells enter a repair mode which helps them to function better and also stimulate the growth of new blood vessels, which helps increase blood flow and allows for a stronger erection.

Shockwave therapy for ED targets the underlying cause of the problem without medication in a way that’s quick, painless, and discreet.

How long does shockwave therapy for erectile dysfunction take to work?

Each session lasts half an hour or less, and you can return to work and your daily activities immediately afterwards.

However, the time it takes for the results of shockwave therapy to become apparent can vary depending on your age and the severity of your condition.

For example, some men may notice considerable improvements in as little as a few weeks, while it may take longer for others.

The benefits of shockwave therapy often take longer to come into effect than pills for ED, but most people know that good things take time.

Combining shockwave therapy with other approaches (i.e. improving fitness, strengthening the pelvic floor, and eating healthier) can also provide longer-lasting results.

How many shockwave treatments are needed for erectile dysfunction?

For the cumulative effects to be felt and for the body to respond to the treatment effectively, the recommended course of shockwave therapy for ED is one session per week for six weeks.

Older patients and men with more severe cases of erectile dysfunction may require additional sessions.

After you’ve had six sessions of shockwave therapy, our urologists will review your progress and determine whether you have achieved your end goal or if a further course of treatment is necessary.

Is shockwave therapy expensive?

With shockwave therapy, you’re investing in a holistic treatment approach.

When compared to more invasive treatment options for erectile dysfunction, such as surgery or stem cell therapy, shockwave therapy is a more cost-effective option for erectile dysfunction.

The total cost of treatment will vary depending on how many sessions of shockwave therapy you need, which will be determined on a case-by-case basis during your initial consultation.

As with most therapies, the more sessions you need, the more you’ll pay.

For a better idea of how much shockwave therapy will cost you, why not book your appointment.