Background Information:

What are the other Names for the Procedure?

• Complete Penectomy
• Partial Penectomy
• Removal of a part of Penis

What is the Penectomy surgical procedure?

Penectomy is a surgical procedure that involves the partial or complete removal of the penis and creation of a new channel for urination.

What part of the Body does the Procedure involve?

A Penectomy procedure involves the penis and occasionally the perineum.

Why is the Penectomy surgical procedure Performed?

A Penectomy procedure is performed for the following reasons:

• It is predominantly performed due to malignant tumors within the penis
• Sometimes, due to a traumatic injury to the penis

What are some Alternative Choices for the Procedure?

When surgery is indicated, there are usually no alternatives to a Penectomy procedure.

What are the Recent Advances in the Procedure?

No significant recent advances are noted for the Penectomy procedure.

What is the Cost of performing the Penectomy surgical procedure?

The cost of Penectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Penectomy procedure on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.deltamedix.com/urology/penectomy.php (accessed on 11/10/2014)

http://www.urology-textbook.com/partial-penectomy.html (accessed on 11/10/2014)

Prior to Penectomy surgical procedure:

How is the Penectomy surgical procedure Performed?

• The Penectomy procedure maybe performed under general or spinal anesthesia.
• The urinary tube (urethra) is identified by passing a urinary catheter (a tube)
• The surgeon uses a tourniquet (a bandage tied around the shaft of the penis) to reduce bleeding
• Depending on whether the procedure is partial or complete, either a portion of the penis (the head- glans and a part of the shaft) or the total penis is surgically removed
• The surgeon makes an incision along the skin of the penis going around it once. Superficial blood vessels are sutured to minimize bleeding during removal
• In Complete Penectomy, the remaining portion of the urethra is connected to an opening made in the skin behind the scrotum (the bag-like structure with the testicles)
• The catheter is left in place for some time, until the surgical wound heals. The incision is then sutured

Where is the Procedure Performed?

A Penectomy procedure is performed in a hospital.

Who Performs the Procedure?

An urologist performs the Penectomy surgical procedure.

How long will the Procedure take?

A Penectomy procedure may take up to 2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Penectomy procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Penectomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Penectomy surgical procedure?

Before a Penectomy procedure, the patient has to undergo certain tests, such as:

• Blood tests
• Chest X-ray
• Computerized tomography (CT scan)
• Cystoscopy
• Electrocardiography (ECG)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Penectomy procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Penectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia by injection or general anesthesia by injection and inhalation is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Penectomy procedure

What are the possible Risks and Complications during the Penectomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes
• The possible risks or complications that may arise during the Penectomy surgical procedure are:
• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Penectomy surgical procedure?

• After the Penectomy surgical procedure, the patients are sent to an area of the hospital called postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle, shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital, 3-5 days after the surgery is performed

After the Penectomy surgical procedure:

What are the possible Risks and Complications after the Penectomy surgical procedure?

Post Penectomy procedure, the following complications may arise:

• Excessive bleeding
• Infection in the surgical wound
• Narrowing of the urethra

What is the Prognosis after the Surgery?

When Penectomy is performed for cancer of the penis, the prognosis depends on many factors including the cancer stage. If cancer is completely removed during Penectomy, the prognosis is generally excellent.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, or prolonged constipation
• Inability to urinate out of the catheter
• Signs of an infection
• Muscle aches, headache
• Dizziness
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Penectomy surgical procedure?

At home, the following post-operative care is recommended, after a Penectomy procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery. However, the physician may advise individuals to take regular naps during the day when tired
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with a mild, unscented soap. Replace the dressings after showering
• Under the physician’s advice, individuals may take certain non-prescription medications, such as acetaminophen. However, ask your physician, if ibuprofen or aspirin are acceptable

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 2-4 weeks to recover from a Penectomy surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Penectomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• An urologist
• A pathologist

The patient is advised to inquire and confirm the type of billing, before the Penectomy surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA