Total Penectomy

Preoperative Preparation and Planning

Penile cancer is a relatively uncommon diagnosis among men in the United States and Europe and primarily occurs in older uncircumcised men and in locations with poor hygiene. Risk factors include human papilloma virus, poor hygiene, smoking, and number of sexual partners. Often there is a delay in diagnosis; thus, most invasive penile cancers are fairly obvious ( Fig. 132.1 ). Before total penectomy is to be undertaken, the diagnosis should be confirmed histologically with a biopsy to assess for depth of invasion and tumor grade. Excisional biopsy may also be obtained at the time of surgery on frozen section, particularly for cases when the diagnosis is not in doubt. Total penectomy is indicated when penile tumors have significant size or are in a location that prevents adequate surgical margins. In addition, it may be indicated when preservation of adequate phallus for voiding from a standing position is not achievable.

FIGURE 132.1

Penile cancer, gross appearance.

A thorough staging workup, including careful palpation of the inguinal nodes and a computed tomography scan of the chest, abdomen, and pelvis, should be performed before surgery. These studies can identify the presence and extent of lymph node metastasis or distant metastases, the most important elements for determining survival and treatment after total penectomy. In addition, laboratory evaluation should be performed with careful attention to calcium values, which may need correction before surgery in patients with advanced penile cancer. Because many advanced penile tumors are also associated with secondary infection, it is important to treat these patients with antibiotics before surgical intervention.

Patient Positioning and Surgical Incision

Place the patient in an exaggerated dorsolithotomy position (similar to that for a perineal prostatectomy). Make sure to adequately pad the leg to prevent injury to the peroneal nerve, which can result in foot drop. Isolate and drape the lesion by sewing a surgical glove in place over the penis or tumor with a silk tie or by placing a condom over the penis ( Fig. 132.2 ). Make an elliptical incision around the penis ( Fig. 132.3 ).

FIGURE 132.2

Preparation for total penectomy.

FIGURE 132.3

Incision for total penectomy.

Operative Technique

Jan 2, 2020 | Posted by in UROLOGY | Comments Off on Total Penectomy

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