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Penis Resection


Medical editor Bjørn Brennhovd MD
Urologist
Oslo University Hospital

General

If the penile cancer is localized, conservative treatment is recommended, especially in younger, sexually active men, however, treatment should be chosen for the best prognosis. 

Penile cancer is a multifocal disease in the epithelium of the glans and inner fold of the prepuce . With conservative surgery where parts of the glans with epithelium are conserved, the patient must have thorough follow-up for many years. If this is not possible, a partial amputation is recommended with removal of the entire glans.  

Indications

  • Squamous epithelial penile cancer, PeIN - T1
  • T2 fit for resection and the patient is fit and motivated for frequent follow-up after treatment.

Goal

  • Conservative treatment to cure penile cancer.

Equipment

  • Chlorhexidine 5mg/ml
  • Drape
  • Local anesthesia
  • Sterile rubber elastic 
  • Scalpel blade 
  • Absorbable sutures
  • Sterile vaseline compress
  • Cup with formalin
  •  


    Preparation

  • The patient must be informed about the nature of the surgery and follow-up routines.
  • A punch biopsy of the tumor should be completed with result from pathologist available.
  • If an epithelial skin transplantation will be performed, the donor site must be prepared. 
  • Antibiotic prophylaxis (anaerobic and aerobic bacteria)

  • Implementation

    Small tumors are removed under local anesthesia, block anesthesia, or general anesthesia/spinal anesthesia.

    • A penile block is performed. The anesthesia is injected at the root of the penis.
      • Find the edge of the pubic bone.
      • Perform the injection deep into the pudendal nerve and the dorsal nerve of the penis. Inject slowly.
      • Allow the anesthesia to work for 10 minutes.
      • Inject local anesthesia around and under the tumor. Allow it to work for 2 minutes.
      • Check with forceps whether the anesthesia is adequate.
    • Squeeze the glans/distal penis and apply a tourniquet to stop blood flow. 
    • Mark the borders of the resection (free margins) to the sides and in depth).  
    • Resect with good margins around the tumor.
    • Inspect the specimen for macroscopically involved margins.
    • Orient the specimen and mark with sutures toward the meatus and dorsally.
    • Place the specimen in a cup with formalin.
    • Assess whether it is necessary to repair the defect on the glans with a transplant.
    • Release the tourniquet and stop blood flow with diathermy, or possibly with small suture ligatures.
    • Suture the incision or transplanted epithelia from the prepuce/mouth/skin.
    • Apply a vaseline bandage.
    • Pull the prepuce forward.
    • Insert a thin catheter. (Ch 10 -14)
    • Bandage with mild compression.   

     


    Follow-up

  • Observe for hematoma. If present, it must be opened.
  • The catheter is removed the day after the operation.
  • Inform the patient on the pathology result.
  • The sutures should dissolve within 3–5 weeks.

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