Partial Penectomy Surgery in Delhi, India

Partial penectomy surgery is the procedure to remove the end of the penis. This operation is done to treat small penile cancer located toward the end of the penis. After the surgery, the patient can still urinate and ejaculate with the remaining penis. While it is mainly used to treat penile tumours, it may help severe penile trauma patients.

When is surgery needed?

Partial penectomy removes cancerous growth at the end of the penis. Penile cancer is rare. It occurs in less than one individual per million people. It is more common in Asia, Africa and South America. A full penectomy may be used for gender affirmation and trauma cases. Penile surgery can have huge changes in the patient's life, mentally and physically. Therefore, such radical surgery is only done if the patient has exhausted all non-invasive treatment options, such as radiation and targeted drug therapy. The following conditions can lead to penile cancer:

• HPV virus infection
• Aids
• Smoking 
• Old age
• Penis/ foreskin in unhygienic condition

Diagnosis

The doctor will ask the patient for a physical examination and discuss the symptoms. They will ask about any change in skin colour or if the area has become thicker than before. They will look for lumps and ulcers that can bleed. Swelling, red rash, and crusty bumps on the penis may also show penile cancer.

They may recommend other tests to confirm the diagnosis, such as biopsy, in which the doctor takes a small sample of tissue from a skin lesion on the patient's penis. These samples are then sent to pathology to investigate for any abnormality. The cells will be staged if they look like cancer cells. Staging might aid in creating an efficient treatment plan.

The TNM staging system is the most often used. T stands for the primary tumour: how far it has grown within the penis or nearby organs. N stands for spread to nearby lymph nodes. M is for metastasis to other organs.

If the doctor feels the cancer has spread to neighbouring lymph nodes, other tests will be performed. A lymph node biopsy will aid in determining the stage and grade of the malignancy.

X-rays, CT scans, ultrasound, and magnetic resonance imaging (MRI) are examples of imaging tests. These examine the inside of the body for tumours or other symptoms of cancer spread.

Treatment

If the cancer is limited to the upper region of the penis and has the potential to spread, a partial penectomy will be performed. If the malignancy is only at the tip, the surgeon can do a glossectomy to remove the tip (glans). On the glans, the surgeon can do a skin graft.

If the surgeon conducts a partial penectomy, they will strive to preserve as much of the organ as possible. They will aim to make it such that the patient may urinate (pee) while standing and have a nearly normal sexual life.

If the patient is having a penectomy for penile cancer, the surgeon may remove lymph nodes to determine whether the cancer has spread. Doctors will inject a radioactive dye near the malignancy to determine whether the sentinel lymph node is affected. Cancer is most likely to spread to the sentinel lymph node initially. If the dye reaches the lymph node, it is removed and analysed.

If cancer is discovered, other lymph nodes will be removed based on the results. If no malignancy is discovered, no further surgery is required.

Who Are the Best Candidates for Surgery?

The patient is a good candidate for surgery if they:

• Have exhausted non-surgical treatments
• Suffers from Penile cancer
• Cannot be qualified for Mohs surgery
• The penis is only present on the tip of the penis or Glans
• In good physical and mental health

Who Should Not Consider Surgery?

The patient should avoid laminoplasty if:

• Patients above the age of 60 are at higher risk for surgical complications.
• They can benefit from Mohs Surgery, which is far less invasive than a penectomy
• Poor mental health
• Have not tried all the non-surgical treatment options

How to Prepare for Surgery?

• Routine Test

The patient will be subjected to blood tests, echocardiogram, X-rays, and other imaging to clear them for surgery and create a surgical plan.

• General Formalities

Doctors and nurses will discuss the risks of the procedure and ask for the patient's consent to the surgery. The patient should share all their medical history with the doctor and let them know if they cannot accept a blood transfusion. The surgery might not require a blood transfusion, but they may ask just to be prepared.

• Avoid alcohol 

Avoid alcohol one week before and two weeks after surgery to avoid bleeding.

• Stop taking blood thinners and pain medication

The patient should inform the personnel about all their medications and supplements. They must stop using blood thinners and pain relievers like aspirin. Otherwise, they may not qualify for surgery or suffer from complications during the surgery.

• Plan for Ahead

Get at least one week off from work. The patient may need a family member or a friend to take care of daily tasks initially while they recover. The patient should let them know what things they need help with. If they need help finding someone available to help them out full-time, they should ask some people who can help them in shifts. 

Possible Complications

General Surgical Complication:

• Bleeding
• Wound infection
• Deep vein thrombosis
• Pulmonary embolism
• Lung problems
• Urinary retention
• Anaesthesia 

Complications Specific to Penectomy:

• infection
• chronic pain
• narrowing of the urethra
• blood clots
• being unable to have sexual intercourse
• having to sit while urinating
• Lymphedema

Taking Care After Surgery

Following penectomy surgery, the patient normally needs to stay in the hospital for a brief period, usually only one or two nights. Most probably, they will be fitted with a temporary catheter to drain their bladder. If necessary, the hospital will provide them with instructions on how to use and care for a self-catheter.

If a partial penectomy is performed, the patient should be able to urinate while standing up because of the residual penis. Satisfactory intercourse is achievable. What's left of their penis shaft can still become erect. It generally gains enough length to penetrate. They should be able to reach orgasm and ejaculate even without the sensitive head.

They will be given medication to help them avoid blood clots, infections, and constipation. Their doctor will also prescribe pain medicine to assist them in controlling their symptoms. The doctor will also advise the patient on which activities to avoid. Follow their advice to improve their rehabilitation. Feelings of stress or depression or questioning our identity are understandable. Talking with a counsellor may help the patient. 

Review

Reviewed By Dr Rohit Kaushal, Senior Consultant, Urology, Kidney Transplant on 6 June  2024.