Surgery for penile cancer

Penile tumors can often be surgically removed. The consequences for the penis will depend on the tumor size. If possible, we will use penile sparing surgery techniques.

Reconstruction

By using penile sparing surgery techniques we may be able to reconstruct the part of the penis that had to be removed by means of a skin transplant. This will minimize the effects of the surgery on your life. The penis will retain its urinary and sexual function. If the tumor is too big, we may no longer be able to use these penile sparing techniques and often have to remove the entire penis.

Sentinel node procedure

We can take a sentinel node biopsy before your surgery. This will help us track down possible (minimal) metastases in the lymph nodes. If we find that the cancer has spread to the sentinel node, we will have to remove the lymph nodes in the groin or pelvic area. We remove all lymph nodes, including those containing metastases.

Lymph node removal (lymph node dissection)

If the cancer has spread to the lymph nodes in the groin, we recommend additional surgery to remove the lymph nodes in the groin or pelvis because of the risk of metastases. We may be able to remove the lymph nodes through robot assisted surgery. Your urologist will insert a temporary tube for wound and lymph fluid drainage. The tube can be removed after a few days.

Admission and screenings

Most patients will only have to spend one night at the hospital after penile surgery or a sentinel node biopsy. If you have an additional lymph node dissection done, you may have so stay at the hospital days for approximately 3 days. We will schedule additional appointments for consultations during which we will discuss the results of the tissue analysis, and check the healing process of the surgical scar. We will continue to schedule screenings with you to ensure that the cancer does not return. After a lymph node dissection, one of our clinical nurse specialists will give you additional information.

Penile surgery – what to expect?

If your tumor is small enough, we will attempt to spare the penis as much as possible. Theissurgery can range from circumcision -the removal of the foreskin - to partial removal of the glans. These parts can often be reconstructed by means of a skin transplant. This will minimize the effects of the surgery on your life. The penis will retain its urinary and sexual function.

If penile sparing techniques are not an option for you, we will have to remove (a part of) the penis.

Efficacy

The prognosis for penile cancer is excellent, as long as the tumor has not spread. Once the cancer has spread to the lymph nodes (this is detected during a sentinel node biopsy, or immediately during diagnostics), the prognosis will be worse. If only a few lymph nodes are affected, the survival rate is still good (more than 70% survival after 5 years). If many lymph nodes in the groin and even in the pelvic region are affected, the prognosis is less good. If this is the case for you, you will be treated with chemotherapy and/or radiation therapy.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General or local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side-effects and complications

All regular functions of the penis will be restored in most patients after surgery with a penile sparing procedure (urination, regular sexual function). Recovery will take 2-3 weeks on average.

Urinary problems and sexual dysfunction

If we had to remove (a significant part of) the penis during surgery, you may experience urinary problems or sexual dysfunction. After a full penectomy, we will craft a new opening behind the scrotum for the passing of urine. This will require you to sit when using the toilet. The urinary sphincter will continue to function as usual, allowing you to control the flow. You will still be able to experience regular ejaculation.

After a lymph node removal surgery

If the lymph nodes in the groin were removed during surgery, you may experience lymph fluid buildup that can be removed with a needle. Many patients experience complications with surgical wounds that require additional care. About 10% to 15% of patients will experience lymphedema, lymph fluid buildup in the legs which can make it hard to walk. Compression stockings or lymphatic drainage massage may alleviate your symptoms.