A-Z

Penile Cancer

Preparation and anaesthetics for penile cancer surgery

Preparing for Surgery

Having decided to be treated with surgery, men should receive a detailed explanation of the operation and how it may impact on their quality of life. Men will also be given information stating when and where the surgery will take place.
 
At the hospital patients will have pre-operative tests conducted. These may include:
  • Blood tests
  • A chest X-ray
  • An electrocardiogram (ECG)

For these tests to happen, the patient will usually have to go a hospital a week or more before their operation. When it comes to the operation, the man may need to arrive at the hospital early on the day, or the night before it is due to take place. Before going into the operating theatre, men will be visited by the surgeon, the anaesthetist, a nurse specialist and possibly a physiotherapist. In these pre-operative meetings, professionals will confirm that the patient understands what is happening, that they are aware of the risks and are happy to continue. The patient will also be given the opportunity to ask questions and discuss any concerns that they have about the procedure. Before surgery, men will have to sign a consent form stating that they give their permission for the operation to proceed. The surgeon can rarely be sure how much tissue they will have to remove until they begin the operation, therefore men may be asked to consent for more to be removed than actually at first planned.
 

Jordon went into hospital the night before surgery, he had a general anaesthetic and woke up...

Jordon went into hospital the night before surgery, he had a general anaesthetic and woke up...

Age at interview: 58
Sex: Male
Age at diagnosis: 57
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September the 27th admitted to the hospital on the 26th on the Monday night about 7 o’clock. They allowed me to eat up till 10 o’clock and then no food, and didn’t sleep very well that night. They told me I’d be in about 11 o’clock in the morning and I was there at a quarter to 11.Pre-med, the… usual sort of thing - straight in, terrific staff at the hospital, couldn’t be faulted. I had my own little room, which was really nice [laugh], my own telly [laugh]. That was great. And then, so I went in and I saw the clock, quarter to 11 as I was dropping off. And I woke up again about 4 o’clock, and that was it, all done and dusted. A catheter in the end and a little bag and I could hardly move. I was – and they said, ‘Just lay on your back.’ And sort of dozing in and out of sleep for the rest of the day. I think I… yeah I had visitors that night. So that was quite amazing. My wife is not too good at driving in the dark, so her sister came over to stay with her and they shared the driving. So she had the support there, which was very nice and she came, sort of just a little… to check that I was still alive [laugh]. The night after the operation, so that was good. And so after that I was getting better each and every day, which was good.

And how long did you stay in hospital?

After the operation is, was... 5 nights after that. Yep. And they said as soon as the graft had taken properly and as soon as I could get the catheter out and urinate as normal, they’d let me go home, so they took the catheter out about 7 o’clock on Sunday morning and I was home by half past 4 in the afternoon. Glad to be out. But they were fantastic. Whole staff. It was a really good set-up and… well couldn’t fault it.
 

Frosty had pre-operative tests on his heart and lungs a week before he was due in the hospital and further tests immediately before the operation. Men may feel anxious before surgery, and the day itself can be long and tiring; it is therefore important that men try to rest before going into hospital. Before surgery, Tim had several tests conducted on him, including a radioactive trace of his lymph nodes. This test allows the surgeon to see the flow of lymph fluid draining through the nodes, which indicates whether any nodes have been affected by the cancer.
 

Frosty had preoperative tests on his heart and lungs a week before the operation and further MRI...

Frosty had preoperative tests on his heart and lungs a week before the operation and further MRI...

Age at interview: 68
Sex: Male
Age at diagnosis: 65
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I had a pre operational checks i.e. heart and lungs and things to make sure that you’re quite able to have the operation and about a week later I went back in with my wife, and my son took me and we went in and I went and had tests. I had... not electron, atomic scan or something… I had some other scans, I think they were MRI scans, I had another ECG and everything and I was occupied for about two and a half hours. So then I went back up to the, to the ward and then they said, “Right we’re coming to take you down,” which is what happened. I went down and went through the usual bits and pieces, being given the nurse all date of birth and all that sort of thing. Then I was taken into this outside of the actual surgery or yes surgery is it where they do the operation? Operating theatre – sorry, get in right. And was a very nice anaesthetist who we were chatting and then the next thing I remember I came round in the recovery room, with a very nice nurse sitting there beside me and she said, “Well we’ll move you up to your ward in about an hour.”

 

Tim had a radioactive trace of his lymph nodes on the morning of his surgery and had to have it...

Tim had a radioactive trace of his lymph nodes on the morning of his surgery and had to have it...

Age at interview: 54
Sex: Male
Age at diagnosis: 53
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The actual operation day, the operation was timed for the afternoon. But they wanted me in the hospital early in the morning because they were going to do a radioactive trace on my lymph nodes. So rather than take all the lymph nodes out, they were going to just find the ones that were going to be affected on those. So I had to be in the hospital ready to go at 8 o’clock in the morning, which was – which meant a very early start. And again at that stage it was quite fun because I had to go around and find the department of nuclear medicine and told all my friends that’s where I was going, where I was going to be, and that sounds really impressive . So that went, that went through, I had to have that scan early in the morning, and then it was off to the opera – off to the, off to check in for the actual operation. The... that all went smoothly, meeting the, meeting the consultant again, going through what the operation would be, meeting the anaesthetist who was, you know, very keen to explain what anaesthetics I’d have and what pain killers they’d give me, during and after the operation – no that was fine. So we got ready for the operation, got dressed in my gown, it was and the... at the hospital – they actually like you to walk to the operating theatre. So there I was in my slippers and gown walking down, or being guided down these corridors, and then got onto the what felt like a trolley to, just to be in the antechamber to the operating theatre, waiting for the anaesthetist to come out. And at that point the anaesthetist came out, and I thought, ‘Here we go; I’m going to go have the operation. Next thing I know I’ll wake up in the bed and it will all be over.’ And he said, ‘There’s been a slight hitch. We were talking to the consultant and he didn’t like the results of your – of the trace on your lymph nodes. Apparently they’d only shown up as draining to one side, rather than the other, rather than both. So what he wanted me to do was to go back and have that trace redone, which meant I had to get off the trolley, back walk around the hospital in my nightgown and slippers, back to the department of nuclear medicine, have all the trace redone, wait for the results and get back up, get back up to things. And at that point it started to cease to be fun, cause I hadn’t, I obviously hadn’t had anything to eat or drink since the night before. It was getting to 3 o’clock in the afternoon and I was getting a bit tired and a bit fed up and just wanted it to be over at that point. . Anyway from there we got back, and persuaded the consultant that this was generally - was what was happening, he was happy, and we went in and had the operation. And the next thing I knew was, you know, about five hours later I was, you know, coming round in the recovery room and back then wheeled back to the hospital ward, which was, which fine, back in the, back in the ward, and quite nice with a catheter in and a nice hospital bed with pain killers and drugs; everything, everything you wanted – a morphine drip if you wanted it, under my control. And that was the, that was the hospital.

Anaesthetics
Anaesthetics refer to a procedure that takes away your ability to feel pain and there are a number of types of anaesthetic. A ‘general anaesthetic’ will leave the patient unconscious for the duration of the operation. A ‘local anaesthetic’ will render the area of the body operated on completely numb for the duration of the operation. A ‘regional anaesthetic’, such as an epidural or spinal block where the anaesthetic goes into the spine, will block sensation below the point of administration. All types of anaesthetic can take several hours to wear off. Men undergoing surgery for penile cancer usually have a general anaesthetic or a regional anaesthetic. Before having a general or regional anaesthetic, it is necessary to refrain from eating and drinking for around six hours.
 
Many of the men we spoke to had their operations under a general anaesthetic. This can be administered by an injection into the arm, or by inhaling a gas through a mask. Some men, but not all, may experience side effects from a General Anaesthetic. Rodger talked about feeling slightly sick afterwards, but soon felt fine. After the operation, the man will be moved from the operating theatre to the recovery room, where they gradually come around following the operation.
 

Rodger had his operation under general anaesthetic; he was slightly sick afterwards.

Rodger had his operation under general anaesthetic; he was slightly sick afterwards.

Age at interview: 65
Sex: Male
Age at diagnosis: 63
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Were you under a general anaesthetic or a local?

General.

Did that have any effects on you?

No...  no...  I was slightly sick afterwards but I was told that that was due to the anaesthetic. When I had the  original biopsy at the local hospital, I was sick then, so basically I told them that, at the specialist hospital and they said, ‘Oh well we’ll sort that out on the … oh now what do you call him? The anaesthetist would sort that out as the amount of drugs or whatever they give you to take the pain away or whatever. And I was slightly sick...  at the teatime after the operation because I had something to eat, but after that there was no problems at all.
 

In some cases, a general anaesthetic may have to be ruled out or may be less preferable than other types. For patients with pre-existing conditions that would be affected by a general anaesthetic, their specialist may recommend a regional anaesthetic. For example, the patient may have an epidural, which is where the anaesthetic is put into the spine via a very small tube called a catheter. Epidurals are often given after the man has swallowed a pill, called an anxiolytic, that helps them relax.
 

Paul was given an epidural into his spine to paralyse him from the top of his chest to the bottom...

Paul was given an epidural into his spine to paralyse him from the top of his chest to the bottom...

Age at interview: 61
Sex: Male
Age at diagnosis: 59
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Now, they didn’t give me a local and they didn’t give me a general and I’ve never been able to find out why but they gave me an epidural, into my spine and then from the top of your chest to the bottom of your toes you’re totally paralysed which I think now it must have been because of the kind of surgery I was going to have and where it was and I think I was down in theatre about two and a half hours. They gave me a sedative to try and get me off to go to sleep but I was wide awake through all the surgery, with this epidural you can’t feel anything anyway because it was about must have been eight or nine hours after the surgery when I started to feel a little bit of tingling in my toes and then it started to, because you’re completely paralysed but I don’t know why I was given an epidural.

To be honest I can’t remember too much about it... think initially at the time when I come up out of theatre I think I seemed more concerned that I couldn’t move my limbs you know and like I say it took about eight or nine hours for all that to wear off and then but for nearly a week you’re in bed and you have to have a bag for your water.
 

 

John Z had his operation under an epidural because he has a lung disease. Under epidural he could hear the staff talking and his legs felt like cement, but he felt no pain.

John Z had his operation under an epidural because he has a lung disease. Under epidural he could hear the staff talking and his legs felt like cement, but he felt no pain.

Age at interview: 68
Sex: Male
Age at diagnosis: 64
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And then the operation was... took place and went down to the… because I’ve COPD they didn’t want to put me out so they said, ‘Would you have the epidural?’ So I said, ‘Yes’. …so I had that. I didn’t know [chuckles] what they that involved but it freezes you from the waist down and I was taken into the operating theatre. I could hear the music playing and the conversation between the consultant and the nurses and doctors, what have you, and the anaesthetist stood just by my side keeping an eye on my pulse

How did it feel being paralysed from the waist down?

Strange [chuckles]. Very strange… obviously after they’d done the operation they put a catheter in so I didn’t need to get out of bed to go to the toilet in that sense so… But …my legs felt as if they was in cement. Very heavy and…yes.

Could you feel anything during the operation?

To start with I could feel them I take it they had a low ...I’d taken a some pubic hairs off myself. Obviously that wasn’t enough and I could feel the electric razors around that area when they was pressing. But that was only for a moment or two. Apart from that I didn’t feel anything.

And how long did it take for the epidural to wear off?

….I suppose until the next morning before I could have… because… I was... I must have slept alright [slight chuckle]. And in the morning I could feel my legs and the constriction of the surgical stockings because they seemed to tighten your legs up anyway [chuckles] don’t they? So yes very, very uncomfortable, I was glad to get rid of those [laughs].
 

Simon had his first operation with a local anaesthetic. While he was fully conscious, he felt no pain and a screen blocked his view of what was happening. A local anaesthetic wears off quickly, which means that the man can return home, either the same day or by at least the next day after surgery.

Last reviewed July 2017.
Last updated January 2015.
 

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