Types of surgery for penile cancer

Surgery is the main method of treatment for penile cancer; radiotherapy and chemotherapy are rarely used (see ‘Additional treatments‘). There are several types of operation for penile cancer, and which operation a man will have depends on the size and location of the cancer.
As the doctors can’t be sure of the extent of the cancer until they cut into the penis, there are times when the surgeon has to cut out a larger amount than initially expected. It is usual for the doctor to discuss this possibility with the man beforehand.
The main types of surgery to the penis are as follows:
  • Circumcision: If the cancer is small and affects only the foreskin, it may be possible to treat it by performing a circumcision (which is an operation to remove the foreskin and thereby leave the head of the penis uncovered). This is a small operation usually taking less than an hour, that may be undertaken using either local, regional or general anaesthesia.
  • Local excision: If the cancer is small and affects the head of the penis (the glans) it may be possible to perform a wide local cut or ‘excision’. This involves removal of the tumour together with a margin of healthy tissue around the cancer. This is a small operation, usually taking less than an hour, and is performed under regional or general anaesthesia.
  • Glansectomy: For some cancers located on the head of the penis (the glans), just that part can be removed (a glansectomy) while retaining as much as possible of the shaft of the penis; the head of the penis can be reconstructed with a skin graft. This is an operation that usually takes less than two hours, and is performed under regional or general anaesthesia.
  • Partial Penectomy: If the cancer is larger, then part or all of the shaft of the penis will need to be removed along with the head (a partial penectomy). This is an operation that usually takes less than an hour, and is performed under regional or general anaesthesia.
  • Total Penectomy: Removal of the whole penis, or ‘total penectomy’, is necessary if the cancer is located deep inside the penis or at its base. It is not usually necessary to remove the scrotum or the testicles. The urethra (tube through which the urine passes) will be redirected to a new opening, usually behind the scrotum and in front of the anus. This is an operation that usually takes around two hours, and is performed under regional or general anaesthesia. It may be possible to reconstruct the penis at a later date using tissue from elsewhere in the body.
The length of time taken to undertake penile cancer surgery, and to recover from it, can vary considerably depending on which operation is done (see also ‘Recovery from surgery‘). For instance, Big D had a circumcision and removal of a lump from his penis and was sent home the next day, whereas Mark was under anaesthetic for nearly eight hours for a total penectomy and stayed in hospital for several days. Some surgical procedures will be quicker and easier than others, but each operation is unique.

Tom had a circumcision and some lumps removed from the side and end of his penis under a general…

Age at interview 71

Gender Male

Age at diagnosis 69

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I had an operation whereby they removed the whole of my foreskin, they took some (for want of a better term) some lumps off the side and the end of my penis and I didn’t feel a thing because obviously I was unconscious at the time. I was rather surprised to be out of the hospital within 24 hours, back home and not really inconvenienced too much. I’d obviously a lot of swelling a lot of disfiguration but all my bodily functions I could go to the toilet, I could pass water without any problems, and I was sort of, well quite, quite relieved that that particular part of it was over.

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Frank was discharged eight days after his partial penectomy; he was very sore afterwards but…

Age at interview 77

Gender Male

Age at diagnosis 72

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I went into hospital, I had the operation and I was discharged after eight days. The operation was not as severe as I had been warned. I had a partial penectomy. The consultant said to me afterwards we had to dig deep but I think we’ve saved it So I had a partial penectomy and I was looked after wonderfully well and I came out of hospital – I was discharged as I say after eight days, I was very sore for several weeks afterwards and gradually things settled down.

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Men who have had a glansectomy or partial penectomy may have the end of their penis reconstructed either at the same time or in a later operation. If there is insufficient skin available around the penis, the surgeon can take skin, in what is called a ‘skin graft’, from other parts of the body, commonly from the thigh, to cover the end of the penis. The main purpose of this reconstruction is to improve the cosmetic appearance of the penis. When this is done, there will be a dressing on the penis for around 1 week and another dressing on the thigh for around 2 weeks. The patient will usually need to wear a catheter for a week or so (see ‘Using the toilet after penile cancer surgery‘).

When having his penis reconstructed, Mick did not have a skin graft, instead the surgeons were…

Age at interview 69

Gender Male

Age at diagnosis 67

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They took all the stuff off they skinned you, so like put like how you skin a plaice, a fish, you take the skin off and just took all the badness away. All what and what was left they just wrapped it round something. How they do it I don’t know [chuckles]. No point asking me about that, I don’t know how they did but they did it. But they never took… no skin graft. Which I was prettyyou know relieved about that really. Because I thought I was going to, could be in a little bit of pain. But I wasn’t. So it depends what kind of patients you have. That’s the… you know like I say if they had..if they’d been circumcised, they might have to have a skin graft. If they haven’t they might have the same as me. it’s nowt to worry about.

Because he didn’t take any skin off my thigh. He did something hopefully which was far better, which it mighto to some other people, what might have it down there. He might say I’m going to take a skin graft’ but if they’ve been circumcisedhich I hadn’t. That’s where it might have been, I hadn’t been circumcised. And that’s why he did something else, instead of taking skin off my thigh. I mean if they’d been circumcised it might have… they might take skin off the thigh. But he said it’d be a bit sore but not to worry about, that this pain will go away. So it might have worked two ways, I don’t know, you know with people. But when I say the operation went great, you don’t feel it.

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Peter went back to the hospital for a second operation to have a skin graft from his thigh put…

Age at interview 75

Gender Male

Age at diagnosis 72

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I had the operation and I was in a lot of pain after the operation because they actually did quite a severe – you know – procedure like and it took – looking back it didn’t seem to take as long but the pain kept with me for quite a bit like. And then on top of that I had to go back and they did a skin graft. Took it from my thigh and put it on to the penis to make it look a bit normal, and after the initial procedure life got back to more or less what it normally is. Keep going for the scans and every scan you got and it was clear, it was like oh, I’ve scored a goal, I’m past that part there.

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Some of the men we spoke to talked about experiencing problems with the skin graft. David found it awkward keeping the dressing on his thigh. He solved this problem by using a pair of tights to keep the dressing in place.

David found it awkward to keep a dressing in place after his reconstruction operation; his…

Age at interview 70

Gender Male

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The most awkward thing because they do a skin graft onto the end of the penis they take a patch of skin off your thigh and that then has to heal up. So keeping the bandage on, finding a way of maintaining the bandage because I think I was in for it overnight. I can’t remember exactly. I think it was overnight one night And then you come home. So the issue then was, as I remember it, was keeping the bandage in place. Anyway that was that was solved because my family are very friendly with a with an ex-district nurse who lived next door but one or two and she was able to solve the problem with a with a which involved I think the use of pair of tights or one leg of a pair of tights to hold it in place. So that was a slight a slight macho issue.

But the, I think I went in about a week later and the stitches were removed and also the dressing was removed from the from the where skin graft had been taken because that started to heal very quickly. So the recovery from that was remarkably quick.

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Reconstructive surgery is sometimes possible after a total penectomy by using tissue taken from the forearm to create a ‘new’ penis. When we spoke to Mark, he was awaiting a decision from his specialist as to whether this might be possible in his case.

Having at first been told that reconstruction of a new penis would not be possible, after his…

Age at interview 48

Gender Male

Age at diagnosis 46

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How would you say you view the future now? You mentioned before about the reconstruction. Are you optimistic?

I’ve always, I’ve always tried to be. There were occasions whereand this would have been a bit up and down as well. When I was in hospital ne of my surgeon’s understudies came to see me and I were having a particularly bad time. It was to do with the lymph glands hey had to drain it and we had to administer some drugs or something, I can’t remember. And I broached the subject of reconstruction with him and that I wouldI would like at some juncture to be able to go ahead with it. And he was very sure in what he said. And he said, Well I was present for the operation Mark, for your penectomy, and there’s no chance that you’ll ever have any reconstruction. And I was so deflated, you know on top of everything else, and I said, Well why is that?’ He said, Well they because had to’ When I first came out I felt so hollow. You know like when you get a tooth out and you’re forever sticking your tongue and you feel there’s something missing. I felt hollow like they’d taken loads away. And I explained this to him. He said, They had to Mark. And he said, it’s just like having a light switch on the wall. If there’s no wires at the back of the light switch, you can flick it on and off all you want, the light’s not going to come on. He said, all your workingsrsquo; So I got on a real downer about that and I just put it to the back of my mind. I never considered it. I never broached the subject again.

Up until I was seeing my counsellor and I mentioned to my counsellor that I wouldn’t mind some reconstruction but it’s not possible. And she sort of took it on board. And she found out, unbeknown to me and between that meeting and the next meeting, she’d been in touch with the relevant people- the surgeon and the his entourage. Well of course it is. Of course it can be done. Flippantly, of course it can be done. So she couldn’t wait to tell me the good news and I went back. So I was, I was delighted. And I remain optimistic. I’ve made some enquiries. The last time I saw the gentleman at the hospital he’s going to make me an appointment to have another scan very soon. He’s going to make me an appointment to see the plastic surgeon as well. it’s fraught with problems. it’s absolutely fraught with problems. But I have seen the finished article and it is just truly remarkable. it’s just remarkable. so I’m going to I’m going to go ahead and with Lady Luck perched on my shoulder, which I haven’t had for a couple of years, I’m hoping thatthey tell me it’s all dependent on how successful the first operation is. Whether there is any touch sensation to the new phallus. If there’s no touch sensation, it doesn’t happen overnight, it takes a while because they have to reconnect the nerves and what have you. But if there’s touch sensation then they can go on and complete it. If there’s no touch sensation I’m left with an enormous scar on my forearm and nothing to show for it. That’s the worst case scenario. But in answer to your question I remain optimistic, yes.

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Among the men we interviewed, several had undergone more than one operation to treat their cancer. Some men may need multiple operations before all the cancer is successfully removed. For instance, at first Colin had the end of his penis (the glans) removed and it was reconstructed with a skin graft. However, subsequently more cancerous lumps developed in the penis so he went on to have a total penectomy. Other men had reconstructive work done in a separate operation (as mentioned above). Because penile cancer may spread to the lymph nodes in the groin and beyond, additional surgery may also include removal of one or more lymph nodes (see ‘Lymph node removal‘).

Further information resources on surgery.

Telling others

Once a diagnosis has been given, some of the men we spoke to were very open and were happy to talk about their diagnosis with...

Lymph node removal

Lymph nodes (sometimes called 'lymph glands') are small oval shaped organs that form part of a network, called the 'lymphatic system', for moving fluid around...