Types of surgery for penile cancer

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.

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.

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.