Penectomy for the Treatment of Penile Cancer
Penectomy is the surgical procedure to remove all or part of the penis. This procedure is mainly used as treatment against penile cancer.
Penile cancer is a collection of malignant, or cancerous, cells either inside or on the surface tissue of the penis.
Removing the penis is a procedure that isn’t undertaken lightly because it has both physical and psychological consequences. Doctors may recommend the procedure, either full or partial if your situation warrants it. Although it’s mainly used if you have penile cancer, in rare cases it might be recommended following severe penile trauma.
Besides surgery, other treatment options include radiation therapy, chemotherapy, and various drugs. No treatment is 100 percent effective, and you need to discuss the pros and cons of each option with your doctors.
If a penectomy is recommended, the surgery can involve different techniques. It can be total or partial and may include additional procedures.
Total penectomy involves the removal of your whole penis. In this case, surgeons will create a new urinary opening in the perineum. The perineum is the area between the scrotum and the anus. This is known as a perineal urethrostomy.
Partial penectomy removes the end of your penis but leaves the shaft intact.
Both procedures may be done under either general or spinal anesthesia, meaning that you either sleep through the operation or remain awake but are totally numb in the area of the surgery.
Further steps that may be necessary include the removal of the testicles and scrotum, and the lymph nodes. Surgery to remove the penis and testicles is known as emasculation, but this is typically done only in the case of very advanced cancers.
In certain situations, such as cancer invading deep tissue, it may be necessary to remove some of your lymph nodes.
To assess whether or not the sentinel lymph node is affected, doctors will inject a radioactive dye close to cancer. The sentinel lymph node is the first node to which cancer is likely to spread. When that dye is seen at a lymph node, the lymph node is removed and evaluated.
Depending on the results, if cancer is found, other lymph nodes will also be taken out. If no cancer is found, further surgery isn’t required.
Testing of the lymph nodes in the groin requires an incision to be made into the groin so the lymph nodes can be extracted for evaluation.
Stage 1 cancer offers various options for treatment. This may include circumcision, if tumors are just in the foreskin, or a more thorough surgery, such as:
- Mohs surgery
- wide excision
- partial penectomy
Further options may be radiation therapy or laser ablation.
Recovery from surgery
Immediately following penectomy surgery, whether total or partial, you’ll usually need a short stay in the hospital, typically only one or two nights. It’s possible that a temporary catheter will be fitted to drain your bladder. The hospital will give you instructions on how to use and care for your catheter if needed.
If you have a partial penectomy, you should still be able to urinate through the remaining penis while standing up. A total penectomy creates a new urinary opening in the perineum. This will mean that you have to sit down to urinate.
You’ll be given medications to prevent blood clots, infections, and constipation. Your doctor will also prescribe medication to help manage your pain. Your doctor will also give you advice on activities to avoid. Follow their recommendations to improve your recovery.
You may need a friend or family member to take care of daily tasks initially while you recover. Let your helper know what things you aren’t able to do and what help you need.
If you can’t find someone who’s available to help you out fulltime, consider asking a few people to help who can assist you in shifts.
It’s important to take all your medications as directed by your doctor. This will help prevent pain, infections, and constipation.
You’ll also want to help your lungs recover from the anesthesia. Your doctor may recommend lung exercises. Deep breathing and relaxation can also help maintain lung health and facilitate drainage of lymphatic fluid. You should do breathing and lung exercises several times every day for the first week, or whenever you’re more tense than usual.
Complications of penectomy
Like all surgery, penectomy carries risks. Some of these risks, or complications, can arise either during surgery or afterward. They may appear immediately or overtime during your recovery period. Some complications may only be temporary, but others may be permanent.
Besides risks typically associated with all surgery, such as a reaction to anesthesia or bleeding too much, there are others associated only with a penectomy. These complications include:
- chronic pain
- narrowing of the urethra
- blood clots
- being unable to have sexual intercourse
- having to sit while urinating
Additionally, there is the possibility of lymphedema. This refers to local swelling resulting from a blockage in the lymphatic system.
Even though cancer may be completely removed, life after surgery may lead to psychological problems. After partial penectomy, satisfying intercourse may be possible for you. What is left of the shaft of your penis can still become erect? It usually gains enough length to achieve penetration. Even without the sensitive head, you should continue to be able to reach orgasm and ejaculate.
After total penectomy, full intercourse is impossible but, with effort, you can still achieve pleasure. You reach orgasm through the stimulation of sensitive areas, such as the scrotum and the skin behind it.
Feelings of stress or depression, or questioning your identity are understandable. Talking with a counselor may be helpful for you.
Surgical penis reconstruction may be possible. If this is of interest to you, ask your doctor about it.
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