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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.
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].
Please see section penile cancer for indications and section inguinal lymphadenectomy for surgical technique.
Care after Partial Penectomy
Early mobilization. Thrombosis prophylaxis. Wound inspections.
Analgesia:Analgesics according to the ladder of WHO pain management are given, e.g. metamizol and tramadol.
Drains and catheters:
- Wound drainage 1–2 days
- Bladder catheter 2–5 days
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Deutsche Version: Partielle Penektomie