The type of surgery you need for penile cancer depends on:
where the cancer is
the type and size of the cancer
whether the cancer has spread
your general health
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 centre to have your surgery.
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 within a few weeks. 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 penile intraepithelial neoplasia (PeIN), 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 one or two weeks.
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. You might have a skin graft to make a new head. This is not suitable for everyone. To do this you usually have the skin taken from your thigh. After this operation your penis will look like a circumcised penis. You should be able to have sex after this operation. You might notice a change in sensation. You are more likely to spray urine when passing urine after a glansectomy. Talk to your specialist nurse if this is a problem for you. They might suggest a male funnel to help to direct the urine stream. You might find it easier to sit down to pass urine.
If cancer has started to grow into the shaft of your penis, your surgeon will need to remove a bit more tissue. You can still have a skin graft but your penis will be shorter.
After a glansectomy operation you have a tube to drain the urine from your bladder (catheter) for 7 to 10 days. You may need to be on bed rest for a day or so if you had a skin graft. 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.
The stitches on your penis are dissolvable. You might have a dressing stitched in place on the penis graft. Your nurse removes these in the outpatient clinic 1 to 2 weeks or so after your operation. They usually take out your catheter at the same time.
You will also have a wound on your thigh where the surgeon removed the skin. These stitches are dissolvable. 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
It’s likely your team will recommend a partial penectomy if your cancer has grown into the erectile tissue. 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.
You might be offered a skin graft to give the appearance of a glans.
You are more likely to spray urine when passing urine after a partial penectomy. Talk to your specialist nurse if this is a problem for you. They might suggest a male funnel to help to direct the urine stream. You might find it easier to sit down to pass urine.
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
A penectomy is a big operation. You might stay in hospital for 1 to 5 days.
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 and can only be done when doctors are happy that there is no evidence of penile cancer. It is a separate surgery to the penectomy. It’s a big operation and is usually done in 2 or 3 stages at a specialist centre. The surgery can take up to 10 hours.
There are different ways of doing the reconstruction. The most common way is by taking skin and muscle from the arm to rebuild the penis. Another way is by using tissue from the tummy area (abdomen).
A reconstruction operation means there is a chance of having a penis that looks satisfactory. You can also pass urine normally. Having sex is possible if you have a penile implant after your reconstruction. You need to have another surgery for this.
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 may have a fine needle aspiration.
The fine needle aspiration might show no cancer cells even if your lymph nodes are larger than normal. In this case, you might have a sentinel lymph node biopsy to test your lymph nodes. If these further tests find cancer cells, you have your lymph nodes removed.
Having lymph node surgery
If you have cancer in the lymph nodes it is likely you have surgery to remove them. This is sometimes at the same time as your penile cancer surgery. The surgeon makes a cut (incision) into your groin to take the affected lymph nodes out.
You 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 drain stays in until it is safe to remove. You sometimes go home with a drain. You stay in hospital until you are well enough to go home. This can be for 2 to 10 days.
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.
Keyhole surgery and robotic surgery
You might have keyhole (laparoscopic) surgery or robotic surgery. For keyhole surgery, the surgeon makes several small cuts in the abdomen. They put a 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 directly. In robotic surgery, the surgeon uses a robot to hold the instruments which then mirror their movements.
Generally, people have less pain after keyhole surgery and you might also recover more quickly than after open surgery.
Information and support
This cancer affects a deeply personal and private part of your body. A few people prefer not to know about their operation in advance. But for most men, it may help you to cope better if you understand exactly what is going to happen. It is important to feel supported.
There should be information available for you to take home with you if you want it. Ask your surgeon or specialist nurse for a booklet or printed web pages that you can read through. This will help you to work out what questions you need to ask next time you go to the hospital.
We have information about living with penile cancer, which includes resources and information about organisations that offer support.
For support you can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.