A penectomy is a surgical procedure involving the removal of all or part of the penis. This permanent alteration is reserved for situations where less invasive treatments are insufficient to manage a serious underlying medical condition. The procedure is generally performed by a urological surgeon under general anesthesia. The extent of tissue removal is determined by the severity and location of the disease or injury, and it is considered necessary when the risks of disease progression outweigh the consequences of removal.
Medical Indications for the Procedure
The most frequent justification for a penectomy is penile cancer, typically squamous cell carcinoma. When the malignancy has invaded deeper tissues or is too advanced for organ-sparing techniques, surgical removal is the standard of care to achieve complete oncological clearance. The goal is to ensure no cancerous cells remain, increasing survival and preventing recurrence.
A penectomy may also be required for severe infection or catastrophic injury. This includes Fournier’s gangrene, a rapidly progressing necrotizing fasciitis affecting the genital region. If the infection causes irreversible necrosis, removal is necessary to halt its spread and save the patient’s life. Catastrophic trauma, such as a severe crush injury or avulsion that prevents reconstructive repair, can also mandate this procedure.
Types and Surgical Approach
The extent of the penectomy is based on the location and spread of the pathology, with surgeons aiming to preserve as much functional anatomy as possible. The two primary classifications are partial penectomy and total penectomy. A partial penectomy involves removing the glans and a portion of the shaft, leaving a remaining stump. This approach is used for smaller, distal cancers or localized injuries, allowing the patient to urinate while standing.
Margin clearance is fundamental, requiring the surgeon to excise the visible disease along with a surrounding border of healthy tissue, often aiming for a 5-millimeter margin to minimize recurrence. If the disease is more extensive, involving the proximal shaft or the base, a total penectomy is required. This procedure involves removing the entire external penile structure up to the root.
In a total penectomy, the urethra must be permanently rerouted. The surgeon performs a perineal urethrostomy, creating a new urinary opening in the perineum (the area between the anus and the scrotum). This new opening allows for controlled urination, but necessitates that the patient always sit to void.
Immediate Post-Surgical Recovery and Care
The initial recovery phase focuses on pain control, wound management, and monitoring for complications, typically involving a hospital stay of one to three days. Patients receive prescribed analgesics, sometimes including patient-controlled analgesia (PCA) pumps, to manage post-operative pain effectively. The level of pain experienced depends on the extent of the surgery performed.
The surgical site requires diligent care to promote healing and prevent infection. Patients receive detailed instructions on wound cleaning and dressing, and must adhere to activity restrictions, such as avoiding heavy lifting for several weeks. A temporary urinary catheter is usually placed to drain the bladder and keep the area dry, remaining in place for up to two weeks, especially after a total penectomy. The healthcare team closely monitors the site for signs of infection (redness, swelling, or drainage) and for delayed wound healing.
Long-Term Functional and Quality of Life Considerations
The long-term impact of a penectomy affects both physical function and psychological well-being. The most significant change is in voiding mechanics, especially after a total penectomy, which requires the patient to sit down to urinate due to the perineal urethrostomy. While a partial penectomy often preserves the ability to stand, some patients may still experience urinary spray.
Patients who undergo a partial penectomy may retain some erectile and sexual function, although sensitivity and satisfaction can be reduced. Conversely, a total penectomy makes penetrative sexual intercourse impossible, impacting sexual identity and intimacy. However, many men retain the ability to achieve orgasm through stimulation of other sensitive areas, and quality of life often shows patient adaptation over time. Psychological support, including counseling or sex therapy, is frequently recommended to help men and their partners navigate issues of self-image and relationship dynamics. Reconstructive options like phalloplasty may be discussed for those seeking an altered appearance, but the primary focus remains long-term disease control.