Total Penectomy Surgery in Delhi, India

Total penectomy is a surgical procedure that is performed for locally advanced penile cancer. The procedure removes all parts of the penis, including the roots that lead to the pelvis. This is a significant operation and requires the creation of a new opening in the perineum (area between scrotum and anus) for passing urine in a sitting position.

Total penectomy surgery is a major surgery done either in general or spinal anaesthesia. The outlook of the surgery is generally favourable, and overall disease response and prognosis depend on whether the disease has spread outside the penis to lymph nodes or distant areas.

Inguinal-pelvic Lymph node dissection is usually required in candidates for total Penectomy. The surgeon might need to remove the scrotum and testicles along with total Penectomy in some cases.

The following makes a good candidate for total penectomy surgery:

• Patients with localised penile cancer
• Cancer that cannot be treated with other options like penile preserving surgeries/ topical therapies
• No prior surgery in that area
• Having a good life expectancy.

The following candidates are not suitable for a total penectomy:

1. Patients that have early diagnoses and low-grade penile cancer
2. Cancer can be treated with other treatments like topical therapy, laser ablation, and or partial penectomy
3. Total Penectomy may not be curable for patients with metastatic disease to other organs

Total Penectomy is an operation which has physical and psychological implications. However, for a particular subset of the patient with localised disease, total Penectomy is the best option and potentially curative.

Before the surgery, usually, a biopsy is planned to evaluate the primary penile lesion and confirm the diagnosis. The doctor will also order some tests like blood tests, CT Scan, MRI, ultrasound, and more to check for penile cancer growth and assess spread to lymph nodes or distant areas.

The patient will have an office consultation with the doctor to discuss the details of the total penectomy surgery. The doctor will explain the techniques involved during the surgery along with its risks and benefits.

Just like any other major surgery, total penectomy may lead to some complications.

• Infection
• Narrowed urethra
• Lymphedema
• Urinary problems
• Fluid collections
• Being unable to have sexual intercourse
• Need for lifelong testosterone supplementation
• Chronic pain
• Depression
• Blood clots
• Reaction to anaesthesia
• Necrosis of skin

After the surgery is complete, the patient needs to stay in the hospital for a few days. The surgeon may put a temporary urinary catheter to drain urine from the bladder. The medical team will provide specific instructions on how to take care of the catheter.

After the surgery, the patient will not be able to have sexual intercourse for the rest of their life. The patient may sometimes experience the feeling of stress, and talking to a counsellor may be helpful. Moreover, due to the diverted urethra, the patient needs to sit down to urinate. In some cases, surgical reconstruction of the penis may be possible.

The doctor will also provide information about the medications that need to be taken after the surgery. Special instructions may include:

• Take medications on time
• Maintain proper hygiene at the incision site
• Avoid any strenuous activity for at least four weeks
• Drink plenty of water and other fluids
• Catheter/perineal urethrostomy care
• Follow up with the doctor on a regular basis

One should immediately call the doctor if the following symptoms persist:

• High-grade fever
• Difficulty in passing urine
• Prolonged swelling or foul-smelling discharge from the wound site
• Severe pain
• Persistent bleeding from the wound

1. How to Spot Skin Cancer and Prevention of Skin Cancer