Total penectomy is a significant surgical procedure involving the complete removal of the penis. This operation is considered a last resort, performed when less invasive treatments are ineffective or unfeasible. The decision to undergo total penectomy is profound, bringing about substantial and irreversible changes to an individual’s physical anatomy and life.
Understanding Total Penectomy
Total penectomy involves the complete surgical removal of the penis, including its tissues and structures. This procedure also includes re-routing the urethra. A new opening, known as a perineal urethrostomy, is created in the perineum, the area between the scrotum and the anus, to allow for urination. This surgical intervention is irreversible. It is undertaken for serious medical conditions that pose a threat to life or severe, irreparable damage.
Medical Conditions Requiring Total Penectomy
The primary medical condition necessitating a total penectomy is penile cancer, particularly in advanced stages where the disease has spread extensively or deeply into the tissue. This cancer, though rare, can be severe, especially if it has invaded surrounding structures or is unlikely to respond to other treatments like radiation or chemotherapy. Total penectomy aims to remove all cancerous tissue, preventing further spread and potentially improving prognosis.
Severe trauma to the penis, such as extensive burns, can also lead to the need for a total penectomy. In such cases, the damage may be too extensive for reconstructive efforts, making complete removal the only viable option to preserve overall health. Similarly, severe infections like Fournier’s gangrene, if they have progressed extensively and caused widespread tissue destruction, may also necessitate this surgery. Additionally, some congenital anomalies that cannot be effectively managed through less invasive surgical means might also lead to this procedure.
The Surgical Process
Total penectomy is performed under general anesthesia, ensuring the patient is unconscious and feels no pain. The surgeon begins by making a circumferential skin incision at the base of the penis, followed by penile degloving, where the skin is peeled back. The penis is then dissected and separated from surrounding anatomical structures.
The main steps involve the complete removal of the penile shaft and often part or all of the urethra. The residual proximal stump of the corpora cavernosa, the erectile tissues, is then closed with sutures to control bleeding. A perineal urethrostomy is created by redirecting the urethra to an opening in the perineum. If cancer is involved, lymph node dissection in the groin area may also be performed to check for spread and remove affected nodes.
Life After Total Penectomy
Immediate post-operative recovery typically involves a hospital stay, during which pain management and wound care are provided. A temporary urinary catheter may be fitted to drain the bladder, and patients receive instructions on its care. Medications are prescribed to prevent complications such as blood clots, infections, and constipation.
Urinary function changes significantly, as urination now occurs through the perineal urethrostomy, requiring the individual to sit. This necessitates adjustments in hygiene practices and can impact daily routines. The procedure also impacts sexual function, resulting in the loss of penetrative sex and ejaculation. While penetrative intercourse is not possible, individuals can adapt to non-intercourse intimacy and explore other forms of sexual satisfaction through stimulation of remaining sensitive areas, such as the scrotum or areas around surgical scars.
The psychological and emotional impact can be significant, often involving body image issues, grief, and emotional distress. Feelings of shame or embarrassment can lead to decreased interest in sexual activity, and depression and anxiety are common. Counseling and support groups are resources for managing these emotions and adapting to the changes.
For some, reconstructive options like phalloplasty, which involves creating a new penis using tissue from other body parts, may be considered. This procedure is staged and may include the insertion of an erectile device to facilitate sexual intercourse. While phalloplasty can improve quality of life and satisfaction, it carries risks of complications such as urinary issues or implant dysfunction.