What does this procedure involve?
Surgery for penile cancer involves removing the entire tumour, together with part of the penis.
If the cancer is on your foreskin, a circumcision may be all that is required. Cancers on the head of the penis (glans) can be removed with the glans and we then re-surface the tip of the penis with a skin graft. We can use grafts so that they look like the glans and improve the appearance of your penis.
More extensive cancers may require partial amputation of the penis, removing the head of the penis and part of the penile shaft. These procedures still allow the urethra (waterpipe) to exit at the tip of the remaining penis.
If your cancer is very extensive, we may need to remove the entire penis and bring out your urethra on the perineum (the skin between your scrotum and anus). You will still have normal control over passing urine but you will need to sit down to go.
Most specialist centres will offer procedures which ensure that as much of your penis as possible is preserved.
What are the alternatives?
- Local excision – leaving the majority of your penis intact (when the cancer is very small)
- Topical creams – to treat pre-cancerous disease or any abnormal cells after surgery
- Radiotherapy – occasionally used in exceptional cases of extensive cancer
What happens on the day of the procedure?
Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.
An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.
We usually provide you with a pair of TED stockings to wear, and give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.
Details of the procedure
- we usually carry out the procedure under a general anaesthetic
- we may give you an injection of antibiotics before the procedure, after you have been checked carefully for any allergies
- depending on the position and size of the cancer, we may just remove your foreskin (circumcision) or remove it together with the head of your penis (glansectomy)
- for more extensive tumours, we will remove the end of your penis with the cancer-bearing area (partial penectomy)
- for either of these procedures, we may take a skin graft from your upper thigh to apply to the remaining penis
- the urethra (waterpipe) is brought out through the graft at the tip of your penis
- we use dissolvable stitches throughout, which normally disappear within two to three weeks
- for very large tumours, we may need to remove all your penis (total penectomy) and bring your urethra out behind your scrotum (perineal urethrostomy)
- we put a catheter in your bladder through your urethra
- we put a firm dressing around the penis to limit any bruising and swelling
- if a skin graft has been used, we will arrange for the dressing to be removed after five to 10 days
- the catheter will be removed when your wounds have healed or when the skin graft has “taken” on your penis
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
|---|---|
| A degree of erectile dysfunction (impotence) |
 Almost all patients |
| Shortening of your penis |
Almost all patients |
| Spraying of urine when you urinate |
Almost all patients |
| Failure of the skin graft to take requiring further treatment (including a repeat graft) |
 Between 1 in 10 & 1 in 50 patients |
| Local recurrence of the cancer (on the penis) requiring further treatment |
Between 1 in 10 & 1 in 50 patients |
| Narrowing of the opening of the urethra requiring further treatment by stretching or re-fashioning |
Between 1 in 10 & 1 in 50 patients |
| Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) |
 Between 1 in 50 & 1 in 250 patients (your anaesthetist can estimate your individual risk) |
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:
- long-term drainage tubes (e.g. catheters);
- bladder removal;
- long hospital stays; or
- multiple hospital admissions.
What can I expect when I get home?
- you will get some swelling and bruising of the penis which may last several days
- you may be discharged with a catheter in your bladder
- if you do have a catheter, we will show you how to manage it at home
- you will be given advice about your recovery at home
- you will be given a copy of your discharge summary and a copy will also be sent to your GP
- any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
- a follow-up appointment will be made for you to have your dressings and your catheter (if present) to be removed
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
- an implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft);
- a regular prescription for a blood thinning agent (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran);
- a present or previous MRSA infection; or
- a high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment).
Questions you may wish to ask
If you wish to learn more about what will happen, you can find a list of suggested questions called “Having An Operation” on the website of the Royal College of Surgeons of England. You may also wish to ask your surgeon for his/her personal results and experience with this procedure.
Before you go home
We will tell you how the procedure went and you should:
- make sure you understand what has been done;
- ask the surgeon if everything went as planned;
- let the staff know if you have any discomfort;
- ask what you can (and cannot) do at home;
- make sure you know what happens next; and
- ask when you can return to normal activities.
We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:
- contact your GP;
- access your local NHS Smoking Help Online; or
- ring the free NHS Smoking Helpline on 0300 123 1044.
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.