Penectomy
A penectomy is a surgical procedure involving the partial or complete removal of the penis.
Indications:
The primary indication for penectomy is penile cancer, typically squamous cell carcinoma. Less common indications may include:
- Severe penile trauma where reconstruction is not feasible.
- Refractory infection or necrosis of the penis.
- Severe cases of gender dysphoria, although this is less common with the advent of other gender-affirming surgeries.
Types of Penectomy:
- Partial Penectomy: Removal of a portion of the penile shaft, preserving the base and allowing for urination while standing. Enough penile length must be preserved for this.
- Total Penectomy: Complete removal of the entire penis, including the corpora cavernosa and spongiosum. In this case, a perineal urethrostomy is created, redirecting the urethra to open between the scrotum and anus, allowing for urination while sitting.
Procedure:
The specific surgical technique varies depending on the extent of the disease or condition necessitating the procedure. Generally, the procedure involves:
- Anesthesia: General or regional anesthesia is administered.
- Incision: An incision is made around the penile shaft to remove the affected tissue.
- Dissection: The corpus cavernosa and spongiosum are dissected and transected.
- Urethrostomy (Total Penectomy): If a total penectomy is performed, a perineal urethrostomy is created.
- Closure: The remaining tissues are reapproximated and the skin is closed with sutures.
Post-operative Care:
Post-operative care includes pain management, wound care, and monitoring for complications such as infection, bleeding, or urethral stricture. Psychological support and counseling are often recommended to address the emotional and psychological impact of the surgery.
Prognosis:
The prognosis following penectomy depends largely on the stage and grade of the underlying condition, particularly in cases of penile cancer. Early diagnosis and treatment generally lead to better outcomes.