Definition & Overview
Penectomy is the surgical procedure for partial or complete removal of the penis. It is mostly performed for the treatment of penile cancer and in cases wherein badly damaged or injured part of the organ has to be removed to avoid further complications. Penis resection is also highly considered when cancer of nearby parts, such as the bladder or rectum, spread to the penis. Penectomy can be partial or radical. The extent of the damage and spread of cancer cells are the factors that are taken into consideration when determining the type of penectomy to perform.
Penile cancer is still quite uncommon, though there are reports of increasing incidence in the last century or so. Though there has been no major advancement in this particular surgical field, there has been increasing awareness and support available for those who undergo this major surgical procedure.
Who Should Undergo & Expected Results
Partial penectomy is typically advised for patients whose cancer has not spread to other parts of the penis. On the other hand, total or radical penectomy is performed when cancer cells have spread to the shaft and nearby parts of the patient’s genitals. This procedure is considered as the last option in cases wherein the patient’s condition does not respond or improve with other cancer treatment methods like chemotherapy or radiation therapy.
Penis resection is also considered following a major injury or damage to the organ, though most surgeons strive to preserve as much part as possible.
The outcome of penectomy is dependent on the stage of the cancer being treated. Patients who undergo penis resection during the early stages of penile cancer have a good survival rate though recurrence is still a major possibility.
This type of surgery is known to have a significant physical, emotional, and psychological impact on the patient’s day-to-day life. Most undergo drastic lifestyle changes and are encouraged to join support groups. Those who undergo total penis resection are unable to perform penetrative sexual intercourse. However, advances in the field of reconstructive surgery, such as phalloplasty, provide some options for those who wish to regain the original form and some measure of functionality in their penises.
How Does the Procedure Work?
Penectomy is a major surgical procedure done in a hospital. Patients are administered with general anaesthesia before the surgeon inserts a catheter into the urethra. During a partial penectomy, the areas to be excised are identified and located. The surgeons will then remove as little part as possible and in some cases, will only remove the glans, much like what is done during circumcision. The urethra is then brought to the new opening of the skin and the incision is closed. The excised part is then sent to a lab where it will be examined by a pathologist for further assessment.
In total penectomy, the surgeon will remove the entire organ and bring the end of the urethra to the new opening in the perineum. Whenever indicated, the patient may undergo additional surgical procedures to remove the inguinal lymph nodes as part of penile cancer treatment.
Possible Complications and Risks
Though bleeding is a risk during penectomy, it is quite manageable and does not typically require transfusion. Some patients may also have an adverse reaction to the anaesthesia used.
Infection in the surgery site is also a possibility, which is characterized by swelling, redness, and drainage of pus. Antibiotic therapy is then recommended to address this complication immediately, as there is a possibility for the infection to travel to the blood and cause serious medical conditions. In some cases, the patient may also experience urinary tract infection and have difficulty urinating.
Urethral stricture is another possible complication of penectomy, in which there is scarring in the urethra as a result of the surgery.
Deep vein thrombosis or pulmonary embolism may also occur. The former is indicated by pain and swelling in the lower extremities while the latter is characterized by shortness of breath and chest pain.
Some patients also report chronic pain in the surgical site and pain similar to that experienced by amputees.
National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Penile cancer. 2012. Version 1.2012.
Pettaway CA, Lance RS, Davis JW.Tumors of the penis. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 34.