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Partial Penectomy: Surgery for Penile Cancer

Indications for Partial Penectomy

Partial penectomy is the method of choice for the local control of invasive penile cancer and a prerequisite for accurate pathologic staging. Limitations of partial penectomy for advanced penile cancer is tumor localization and length of the penile shaft, the urinary stream should still be possible to be directed by the patient after surgery.

Surgical Technique of Partial Penectomy

Preoperative Patient Preparation

• Exclusion or treatment of a urinary tract infection
• Perioperative antibiotic prophylaxis
• Supine position
• Spinal or general anesthesia
• Insertion of a transurethral catheter
• Tourniquet around the penile shaft to reduce bleeding

Safe Distance from the Tumor

The recommendations for the surgical distance from the penile tumor vary between authors: the former recommendation of 2 cm is reduced to 1 cm in recent publications. A circular skin incision is made around the penis shaft. Superficial veins and the dorsal nerve-vascular bundle are isolated and ligated [fig. partial penectomy]. The urethra is isolated and cut 1 cm further distally. The specimen is sent for frozen section to secure the complete excision.

Partial penectomy (from left to right): circular skin incision. Incision of the corpora cavernosa, the urethra is disected 1 cm distal of the cavernosal dissection. Closure of the corpora cavernosa with sutures and spatulation the urethra. Skin sutures.

Closure of the Corpora Cavernosa

Sutures through the tunica albuginea are done to close the corpora cavernosa vertically. Care is necessary to avoid narrowing of the urethra or neomeatus. The excess end of the urethra is spatulated at 12 o'clock.

Meatal Reconstruction and Skin Closure

Subcutaneous wound drainage (mini redon drains). Skin closure of the penile shaft. The meatus is reconstructed by additional sutures between skin and spatulated urethra [fig. partial penectomy].

Inguinal Lymphadenectomy

Please see section penile cancer for indications and section inguinal lymphadenectomy for surgical technique.

Care after Partial Penectomy

General measures:

Early mobilization. Thrombosis prophylaxis. Wound inspections.

Analgesia:

Drains and catheters:

• Wound drainage 1–2 days
• Bladder catheter 2–5 days

References

  Deutsche Version: Partielle Penektomie