Find out about the different types of surgery for penile cancer.
What type of surgery do I need?
The type of surgery you need for penile cancer (cancer of the penis) depends on:
- where the cancer is
- the type and size of the cancer
- whether the cancer has spread
Your doctor will talk to you about the best type of surgery for your cancer before your operation. You may need to travel to a specialist to have your surgery.
Laser surgery is the most common treatment for carcinoma in situ.
Your surgeon uses a powerful beam of light that acts like a knife. It cuts away the cancer cells but doesn't go too deep into the tissue. You have a general anaesthetic and will be asleep for the whole operation.
Circumcision means removing the foreskin. It is done if your cancer is only in the foreskin, or if you need to have radiotherapy.
You can have a circumcision under a local or a general anaesthetic. After your operation your penis is slightly swollen and bruised for about a week. You will have stitches that usually dissolve after a week to 10 days. Keep the wound clean. Wash or clean it as your nurse advises.
Some men worry about their sex lives after a circumcision. There is no proof that men are less sensitive or have more difficulty getting an erection after a circumcision.
In glans resurfacing surgery, your surgeon removes the top layers of tissue from the tip (glans) of the penis and covers the area with a skin graft.
This surgery treats carcinoma in situ (CIS), or small low grade cancers in the top layers of the skin on the penis.
Your surgeon removes the cancer along with a border of healthy tissue around it, usually a few millimetres wide. This lowers the risk of the cancer coming back. Your surgeon might call this a clear margin of tissue.
The tissue sample is sent to the lab to find out more about the cancer and to check that the border of tissue around the tumour is free of cancer cells.
You have a general anaesthetic for a wide local excision and will stay in hospital overnight. You will have some pain after the surgery and your penis may be swollen for a week to 10 days.
You may need to have the glans (head) of your penis removed. This operation is called a glansectomy.
Your surgeon will remove the head of your penis before doing a skin graft to make a new head. You usually have the skin taken from your thigh. After this operation your penis will look like a circumcised penis. You will be able to pass urine normally, and will be able to have sex after this operation.
If cancer has started to grow into the shaft of your penis, your surgeon will need to remove a bit more tissue. You still have a skin graft but your penis will be shorter. Surgeons can sometimes combine this type of surgery with a penis lengthening operation.
After a glansectomy operation you have a tube to drain the urine from your bladder (catheter) for about 5 days. And you need to stay in bed for 1 to 2 days. This gives the skin graft the best chance of healing well. You need to try not to rub or brush against the skin graft on your penis for the first couple of weeks.
Your nurse takes out your stitches around 5 days after your operation. You will also have a wound on your thigh where the surgeon removed the skin. It takes at least a couple of weeks for the area on your thigh to heal.
If your cancer is large you might need to have part or all of your penis removed. This is called a partial or total penectomy.
Removing part of the penis
Doctors now tend to do a glansectomy rather than a partial penectomy. If you need a partial penectomy, your surgeon will remove the end of the penis. They try to leave enough of the shaft of your penis behind to allow you to pass urine standing up. The flow of urine will be away from your body.
Removing the whole penis
A total penectomy is only done if the cancer cells go deeply into the penis or if the cancer is at the base of the penis. Your surgeon will remove the shaft and root of your penis. The root is the part inside your body. The surgeon will form a hole between your anus and your scrotum for you to pass urine through. You will still have control over passing urine because the muscle that closes the bladder is further inside your body.
A penectomy is a big operation and you will stay in hospital for at least a week.
Penis reconstruction after a penectomy
Your surgeon may make a new penis (reconstruction) after a penectomy, using tissue from elsewhere in the body. This operation is not common.
There are different ways to do the reconstruction:
- Your surgeon can take skin and muscle from your arm to rebuild the penis.
- Your surgeon forms a flap of skin from your scrotal sac and attaches this to the stump of your penis, and it stays in place for 4 to 6 weeks. In a second operation the surgeon cuts the end attached to the scrotum sac. They then reconnect the nerves if possible so you can have some feeling in your penis.
A reconstruction operation means there is a chance of having a penis that looks satisfactory. You can also pass urine normally. Having sex with a partner has been possible for some men after this surgery.
Your surgeon might also remove lymph nodes from your groin. As part of your tests to diagnose penile cancer your doctor will check your lymph nodes. If the nodes are swollen (enlarged) you have a fine needle aspiration. If this shows cancer cells your surgeon will remove your lymph nodes. This is called a lymph node dissection.
The fine needle aspiration might show no cancer cells even if your lymph nodes are larger than normal. In this case you might have the swollen node taken out and tested. If the surgeon finds cancer cells, you have the rest of your nodes removed.
Having lymph node surgery
You usually have surgery to remove the lymph nodes at the same time as surgery to your penis. The surgeon makes a cut (incision) into your groin to take the affected lymph nodes out.
You’ll be in hospital for a few days and have a wound about 10cm long. You also have a drain near to your wound to drain fluid that can build up around your operation site.
Your surgeon might remove the lymph nodes in your pelvis if the groin lymph nodes contain cancer cells. You usually have this as a second operation. The surgeon might make a cut in the lower part of your tummy (abdomen) to remove the lymph nodes.
Or you might have keyhole (laparoscopic) surgery. For keyhole surgery, the surgeon makes several small cuts in the abdomen. They put a bendy narrow tube called a laparoscope through the openings. The laparoscope has a small light and a camera fixed on its end. So the surgeon can see what they are doing on a television screen. The surgeon controls small instruments that fit down the tube.
Generally, men have less pain after keyhole surgery and you might also recover more quickly than after open surgery.