Penile amputation or penectomy

What is it?

Penile amputation (partial or total penectomy) is still the standard of care for definitive treatment of penile cancer. Although penectomy is necessary and curative for advanced and infiltrating tumors, it significantly reduces the patient's quality of life as it significantly impacts the urological and sexual sphere.

Patients with non-invasive disease and favorable features may be candidates for conservative surgery, with the aim of achieving the best possible aesthetic and functional results. However, these conservative techniques increase the risk of local recurrence compared to radical surgeries.

Technical difficulty:
medium
Average duration of the intervention:
2 hours
Average duration of hospitalization:
3 days

When is this procedure indicated?

Penile amputation surgery (partial penectomy) or penectomy surgery is indicated in the case of the presence of a penile lesion suspected for carcinomatous disease. Patients with non-invasive disease and favorable features may be candidates for conservative surgery, with the goal of preserving glans sensitivity and maximizing penile length. In cases of more advanced disease, complete removal of the penis is necessary.

How is it performed?

The main conservative techniques available today are:

  • topical treatment with 5-fluorouracil or imiquimod;
  • Laser ablation (CO2, argon, Nd:YAG or KTP);
  • circumcision and limited excision of the gland.

Partial penectomy is the most common treatment for infiltrating penile carcinomas. The main purpose of this surgery is the local control of the disease and its correct staging achieved with a penile amputation with a safety margin of at least 0.5 cm. This intervention also aims to maintain orthostatic urination and sexual activity whenever possible. Total penectomy, on the other hand, is more rarely practiced and only if strictly necessary. The urinary route in this case is diverted to the perineal level with a perineal urethrostomy. Penile amputation is also associated with the performance of an inguinal lymphadenectomy in cases where there is a suspicion of tumor invasion at the level of lymph nodes in this region.

Recovery

The recovery process after surgery is variable depending on whether the patient underwent conservative or radical surgery. In cases of conservative procedures the recovery is faster while in more radical cases between 4 and 6 weeks are necessary for a complete recovery. It is important to emphasize that psychological support by specialized personnel is strictly indicated during the treatment of patients affected by this pathology.

Short-term complications

Short-term complications of partial or total penectomy consist primarily of local pain, infection, bleeding, necrosis, and wound dehiscence.

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