A penectomy is the removal of the penis to treat penile cancer.

Penile cancer is uncommon in the United States and Europe. According to the American Cancer Society, about 2,100 men will be diagnosed with penile cancer in the U.S. in 2017.

The disease appears to occur more frequently in other regions of the world, including countries in South America, Africa, and in parts of Asia.

Most penile cancer is classified as squamous cell, but adenocarcinoma, sarcoma, and melanoma also occur.

What is a penectomy?

In rare cases, a penectomy may be done to treat a severe traumatic injury to the penis. However, it is performed mostly in cases where penile cancer has grown deep in the penis.

When surgery is needed, either a partial or full penectomy is done to remove cancer and improve a man's chances of survival.

Surgeons undertaking this operation typically want to leave as much of the penis intact as possible when they treat penile cancer.

Consequently, if it is possible, a surgeon will perform a partial penectomy to remove the end of the penis but leave some of the shaft.

When the cancer is located deeper in the tissue, a full penectomy may be recommended. This procedure involves removing the entire penis along with the roots, which extend into the pelvis.

A total penectomy does not affect a man's ability to urinate but does affect how the urine comes out of the body. A new opening is created between the anus and the scrotum for the urine to drain.

Depending on how advanced the cancer is, the testicles may also be removed. Men who require testicle removal may need to take supplements of the hormone testosterone, afterward.

Also, nearby lymph nodes may be removed, to determine if the cancer has spread beyond the penis.

Risks

A penectomy carries risks, as does any surgery. Some risks or complications can occur during or immediately after the procedure. Other risks may develop during recovery.

Complications of the procedure may be temporary or permanent.

Typical risks of surgery include an adverse reaction to anesthesia or excessive bleeding. Additional risks associated with a penectomy, in particular, may include:

wound infection

chronic pain

narrowing of the urethra

blood clots

possible inability to have sexual intercourse

inability to stand while urinating

lymphedema

Recovery

The recovery process after a penectomy depends on many factors, including a man's age, the extent of the cancer, and any other medical conditions that are present.

Notably, it will involve a man facing emotional challenges, as well as physical adjustments in his future life.

Physical adjustments

Immediately after surgery, a person may have a temporary catheter put into the bladder to drain the urine.

It is likely that doctors will prescribe medications for pain and to prevent a blood clot. Other medication may include antibiotics to cut the chances of an infection.

A man should not exercise or do any heavy lifting for several weeks after a penectomy.

Urination

Long-term effects of the surgical procedure can include changes to the way a man urinates, depending on whether a partial or full penectomy was done.

In the case of a partial penectomy, it may leave enough of the penis to allow urination while a man is standing. On the other hand, if a full penectomy was needed, a man will have to sit when urinating.

Sexual function

In the long-term, a penectomy may also affect sexual function.

Sexual intercourse may still be possible when a partial penectomy is performed. However, according to the American Cancer Society, sexual penetration is not possible after a full penectomy.

It can be helpful for men to talk with a doctor if they have concerns regarding sexual function.

Reconstruction surgery

Over time, recovery may include reconstruction surgery. Although it may not be an option in all cases, some men may be good candidates for surgery to rebuild the penis.

Penis reconstruction surgery, which is called phalloplasty, may help them regain some function of the penis.

Emotional recovery

Emotional recovery is also important after a man has had a partial or full penectomy.

Cancer and cancer treatments may cause a person to feel afraid, sad, or anxious. Also, losing a body part to cancer can be traumatizing.

In the case of a penectomy, the surgery can be lifesaving, but it can also affect a man's self-esteem and self-image.

While everyone recovers from a penectomy differently, feelings of depression or anxiety are not uncommon. Adequate support is essential for a man's successful recovery, emotionally.

Discussing alternatives to sexual intercourse and sexual satisfaction for themselves and their partner can be useful in coping with the long-term changes after a partial or full penectomy.

Importantly, whether support comes from family, friends, a cancer support group, or professional counseling, it can be invaluable for a man to talk to someone.


Other surgical options to treat penile cancer

Other options besides a penectomy are possible to treat penile cancer. In some cases, less aggressive surgery can be used.

What surgical procedure is used will depend on how large the tumor is and how deep into the tissue it has spread.

Surgical procedures may include:

Excision: A simple excision involves removing just the tumor and some of the surrounding tissue. An excision may be an option for a small tumor.

Mohs surgery: Mohs surgery involves removing layers of the tumor one at a time. As each layer of tissue is removed, it is immediately viewed under a microscope to identify the presence of cancer cells. Layers of tissue are removed until cancer cells are not found. Mohs surgery is used to save as much healthy tissue as possible while still removing all the cancer.

Circumcision: Circumcision may be used to treat penile cancer that only involves the foreskin. Also, a circumcision may be recommended before radiation therapy to the penis, as radiation may cause painful constriction of the foreskin.

Although surgery is most commonly used to treat penile cancer, additional treatment may also be used. In some instances, chemotherapy, immunotherapy (also known as biological therapy), and radiation may be used to treat penile cancer.

Additional treatment after surgery may decrease the chances of cancer returning.

Outlook

Typically, the outlook for penile cancer after a penectomy depends on the stage of cancer, the size of the tumor, and a man's age.

If the penile cancer has spread to other parts of the body, a man may require additional treatments and care.

However, the outlook for men, with penile cancer that is confined to the penis, who have had a partial or full penectomy is often good.

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