Penectomy is the surgical removal of part or all of the penis, most commonly performed to treat penile cancer. The procedure divides into two broad categories: partial penectomy, which removes the distal portion while preserving as much of the shaft as possible, and total penectomy, which removes the entire organ and reroutes the urethra so the patient can still urinate. Though the word alone can provoke alarm, penectomy remains a well-established, sometimes life-saving operation with outcomes that are more nuanced than most people assume.
Why Penectomy Is Performed
Squamous cell carcinoma accounts for the vast majority of penile cancers and is the primary reason penectomy is performed. Surgeons choose between partial and total removal based on the stage and location of the tumor. For tumors confined to the glans or distal shaft (stage T1 and T2), partial penectomy is often sufficient, while more advanced or proximally located disease may require total removal with creation of a perineal urethrostomy, an opening between the legs through which urine exits the body.1PubMed Central. Partial penectomy or total penectomy for T1 and T2 squamous cell carcinoma of the penis?
Cancer is not the only indication. Severe trauma, including gunshot wounds, can destroy enough tissue that surgical amputation becomes necessary. One classification system grades penile gunshot injuries on a five-point scale, with the most severe grades (extensive tissue loss or complete destruction) requiring partial or total penectomy.2International Braz J Urol. Penile lesion from gunshot wound: a 43-case experience In rare cases, conditions unrelated to cancer or trauma can lead to penectomy. Calciphylaxis, a disorder in which calcium deposits block small blood vessels and cause tissue death, occasionally affects the penis in patients with end-stage kidney disease. When the tissue becomes gangrenous, amputation may be the only viable option.3PubMed Central. Penectomy to manage penile gangrene caused by calciphylaxis, a case report
Total Penectomy and Perineal Urethrostomy
When the cancer is too advanced or too close to the base for a partial procedure, total penectomy is performed. The surgeon removes the entire penis and creates a perineal urethrostomy so the patient can urinate through a new opening in the perineum. A study of 15 men who underwent this procedure found a median operating time of about two and a half hours and a median hospital stay of six days. No local cancer recurrence was observed during follow-up, and the overall complication rate was roughly a third, with only one patient needing a return to the operating room.4PubMed Central. Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: oncological, surgical and functional outcomes These numbers reflect a procedure that, while significant, is considered safe in experienced hands.
Lymph node management is an important part of the surgical plan. Depending on the cancer’s aggressiveness and whether it has spread, surgeons may remove inguinal lymph nodes at the same time as the penectomy or a few weeks afterward. Pelvic lymph node dissection is recommended when there is substantial inguinal involvement, such as multiple positive nodes or cancer growing beyond the node capsule.5PubMed. Management of the lymph nodes in penile cancer
Urinary Function After Surgery
One of the first questions patients have after penectomy is whether they will be able to urinate normally. After partial penectomy, the urethra is refashioned at the new tip of the shortened penis. Alternative techniques for creating this new urethral opening have been developed to reduce complications; one approach involves slitting the urethra on its underside and suturing it in a way that creates a wider, less stricture-prone opening.6PubMed Central. Modified “parachute technique” of partial penectomy: A penile preservation surgery for carcinoma penis
A French study comparing outcomes between conservative and non-conservative penile cancer surgeries found that about half of all patients maintained the ability to urinate while standing. Among those who had non-conservative surgery (partial or total penectomy), standing urination was preserved in about 28%, compared with roughly two-thirds of those who had more conservative procedures. When patients with a perineal urethrostomy were excluded, the standing urination rate climbed to about 60%. Urethral strictures, a narrowing of the urinary channel, developed in about 16% of all patients and sometimes required additional procedures to correct.7The French Journal of Urology. Functional and surgical outcomes after penile surgery for cancer: Comparison between conservative and non-conservative surgery
Sexual Function and Erectile Recovery
Sexual function after partial penectomy is better than many people expect, though it is rarely the same as before. A Brazilian study of roughly 80 patients found that about 62% had some degree of erectile dysfunction afterward, with about 30% experiencing moderate or severe impairment. Older age, shorter remaining penile shaft length, and the presence of lymph node disease were the strongest predictors of erectile problems. The authors emphasized that preserving as much penile length as possible leads to better erectile recovery.8PubMed Central. Erectile function after partial penectomy for penile cancer
A Chinese study offered a somewhat more encouraging picture. Among 43 patients followed prospectively, about half reported erections that “most times” or “always” allowed sexual intercourse. Another quarter had erections that sometimes permitted penetration, while the remaining quarter reported little or no sexual activity. Anxiety and age were the strongest negative factors.9Scientific Reports. Sexual Function after Partial Penectomy: A Prospectively Study From China Multi-institutional data broadly confirm this pattern: penile cancer and its treatment cause several sexual and psychological difficulties, but patients who undergo partial penectomy often maintain sexual function at levels only somewhat lower than before surgery.10PubMed Central. Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study
After total penectomy, penetrative sexual intercourse is no longer possible in the conventional sense. Some patients report that intimacy shifts to other forms of physical closeness, and some find satisfaction through non-penetrative sexual activity. A small North American study found that even among patients who had partial or total penectomy, 80% reported overall satisfaction with their operation, though satisfaction with sexual life specifically was more mixed, with roughly half being satisfied, a few equivocal, and the rest dissatisfied.11PubMed Central. Sexual function in the penile cancer survivor: a narrative review
Psychological and Emotional Impact
The emotional burden of penectomy is substantial and often under-addressed. Qualitative research with men who have undergone the procedure reveals a profound shift in self-image. Patients describe living with a “cancer-modified me,” where changes in genital anatomy and function reshape their daily lives, sexual relationships, and sense of identity.12PubMed. Men’s experiences of the impact of penile cancer surgery on their lives: A qualitative study Shame about the altered appearance of the penis is a significant barrier: in one study, half of the patients who had stopped having sex cited embarrassment about a smaller penis and missing glans as the main reason.13PubMed Central. Psychosocial impact of penile carcinoma
Interestingly, the psychological landscape is not uniformly bleak. A Polish study of men who had undergone total penectomy found that while sex life and overall quality of life were clearly affected, the procedure did not appear to damage partnership relations, self-assessment, or sense of masculinity to the degree one might assume.14PubMed Central. Quality of life in penile carcinoma patients – post-total penectomy This does not mean the experience is easy; rather, it suggests that with stable relationships and adequate support, many men find ways to adapt. Mental health screening and ongoing psychological support should be considered standard components of care, not afterthoughts.
Organ-Sparing Alternatives
Over the past two decades, the surgical approach to penile cancer has shifted significantly toward preserving as much of the organ as possible. For smaller, localized tumors (T1 and T2), organ-sparing surgery can remove the cancer while maintaining penile length, sexual function, and urinary function. These approaches include wide local excision, glansectomy (removal of just the glans), and laser ablation.15PubMed. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review
The trade-off is straightforward. Organ-sparing surgery has a higher local recurrence rate than penectomy. One study found that about 42% of organ-sparing patients experienced local recurrence, compared with about 10% of those who had penectomy.16PubMed Central. Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival The crucial finding, though, is that this higher recurrence rate does not translate into worse survival. A systematic review concluded that when patients are properly selected and closely followed, cancer-specific survival after organ-sparing surgery is equivalent to that of traditional amputation, with the added benefit of better quality of life and less physical disruption.17PubMed. Organ Sparing Surgery for Penile Cancer: A Systematic Review If the cancer does come back locally, partial or total penectomy remains a viable salvage option without compromising overall survival.18PubMed. Organ-sparing treatment for T1 and T2 penile cancer: an updated literature review
This matters because patient selection is everything. Not every tumor is suitable for organ-sparing treatment. The approach works best for well-defined, superficial tumors that can be removed with clear margins. For larger, deeper, or more aggressive cancers, penectomy remains the more reliable option. The conversation between patient and surgeon about what is oncologically safe versus what preserves the most function is one of the most important discussions in the treatment process.
Reconstruction After Penectomy
Phalloplasty, the surgical construction of a new penis, is possible after penectomy, though it remains technically demanding and rarely performed. The published literature on phalloplasty specifically after cancer-related penectomy is remarkably thin. A 2022 review found just 19 men in the entire published record who had undergone the procedure in this context.19PubMed Central. Phalloplasty following penectomy for penile cancer
Two main techniques have been used. The radial artery forearm free flap involves harvesting skin, fat, and blood vessels from the forearm to build a new phallus, while the anterolateral thigh flap takes tissue from the upper leg. Each has distinct advantages: the forearm flap tends to produce better sensation in the reconstructed penis, while the thigh flap causes less visible scarring at the donor site. Complication rates are high regardless of technique, with urethral strictures and fistulas affecting a large proportion of patients. Despite those risks, functional results including standing urination and even sexual activity have been achieved, and patient satisfaction tends to be high.20International Journal of Impotence Research. Sexual and urological reconstruction following penectomy for penile cancer: phalloplasty In at least one reported case, surgeons combined both flap types in the same patient, using the thigh flap for the shaft and the forearm flap for the urethra and glans, with good cosmetic and functional results at 18 months.21PubMed Central. Total Urethra and Penile Shaft Reconstruction with Combined Pedicled Anterolateral Thigh Flap and Radial Forearm Free Flap after Total Penectomy
Penile transplantation represents a newer frontier. Vascularized composite allotransplantation, where a donor penis is surgically attached to the recipient, has been performed in a small number of cases worldwide. Unlike free-flap phalloplasty, transplantation has the potential to restore natural form and function, including erection and sensation, because the transplanted organ contains its own vascular, nerve, and erectile tissue. However, the procedure requires lifelong immunosuppressive medication and carries its own set of ethical, surgical, and medical complications.22PubMed. Penile Transplantation: Lessons Learned and Technical Considerations Fewer than 10 genitourinary transplants have been performed worldwide, so the evidence base is still in its earliest stages.23Current Opinion in Organ Transplantation. Genitourinary vascularized composite allotransplantation: a review of penile transplantation
Traumatic Amputation and Replantation
When the penis is severed by trauma rather than removed in a planned surgical procedure, replantation (reattaching the amputated part) is the goal whenever the tissue is viable. In a large review of replantation cases, the average time the severed part spent without blood flow was roughly six hours, though successful reattachment has been reported after considerably longer periods. About half of the cases used microsurgical technique, reconnecting individual arteries, veins, and nerves under a microscope. Complications were common: skin necrosis in about half of patients, altered sensation in roughly a third, urethral strictures in about 15%, and erectile dysfunction in about 13%. Microsurgical repair resulted in fewer of these complications compared with cruder repairs that did not reconnect individual vessels.24PubMed Central. Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature
In the best-case scenarios, microsurgical replantation can restore near-normal appearance and function. One case report described a total penile amputation successfully reattached using microvascular and microneural techniques, with the patient ultimately regaining good urine flow, erectile capability, and close-to-normal sensation.25PubMed Central. Microneurovascular reimplantation in a case of total penile amputation Speed matters, but even delayed presentations can have good outcomes. A case report of a replantation performed 12 hours after self-inflicted amputation achieved adequate cosmetic and functional results.26PubMed. Klingsor syndrome: A rare surgical emergency
Self-Inflicted Amputation and Psychiatric Context
Self-inflicted penile amputation is rare but documented in psychiatric literature, typically occurring in the setting of severe mental illness. When the act is not a suicide attempt, it is sometimes classified as Klingsor syndrome, named after a character in Wagner’s opera Parsifal. Most reported cases involve patients with schizophrenia, often driven by command hallucinations or intense religious preoccupation.27PubMed Central. Self-penile amputation: A case of Klingsor Syndrome28International Journal of Surgery Case Reports. Partial penile amputation due to Klingsor syndrome: A case report with a successful macroscopic reconstruction
Management of these cases follows three priorities: saving the patient’s life, restoring function (through replantation or reconstruction when possible), and treating the underlying psychiatric condition. The psychiatric component is critical because without effective treatment of the mental illness, the risk of repeated self-harm persists. In some cases, macroscopic or microsurgical replantation has been successfully performed, giving the patient both a physical and psychological recovery path.
Congenital Absence of the Penis
Aphallia, the congenital absence of the penis, is an extremely rare condition that raises related surgical questions from the opposite direction: instead of removing a penis, the challenge is building one. Historically, the recommended approach was to assign the infant female sex and perform feminizing surgery in infancy. That recommendation was based on the assumption that it was better to construct female anatomy than attempt to build a penis that might not function well.
This thinking has shifted substantially. Growing evidence that prenatal testosterone exposure influences gender identity has led to concerns that many of these children, who are genetically male, would develop gender dysphoria if raised female. Current practice increasingly favors male sex assignment with staged construction of a new phallus (neophalloplasty) as the child grows, while allowing the patient to ultimately identify their own sex.29PubMed Central. Congenital aphallia: From embryology to management – a focused minireview30PubMed Central. Aphallia – congenital absence of the penis: a systematic review The evolution in approach reflects a broader shift in how medicine thinks about gender, genital surgery in infancy, and the limits of what a surgeon should decide on behalf of a patient who cannot yet speak for themselves.
Penile Cancer Surgery in Veterinary Medicine
Penectomy is not exclusively a human procedure. Squamous cell carcinoma of the penis is relatively common in horses, particularly older geldings with unpigmented skin in the genital area. Just as in human medicine, the treatment ranges from local excision for small, superficial tumors to partial phallectomy for more advanced disease. One veterinary study reported that local excision cured 10 horses outright, while five required partial phallectomy; of those, two experienced local regrowth and needed a second surgery, after which they recovered without further recurrence.31PubMed Central. Surgical Management of Penile and Preputial Neoplasms in Equine with Special Reference to Partial Phallectomy
A larger veterinary review found that among horses with squamous cell carcinoma of the glans penis treated by penile amputation and urethrostomy, about two-thirds survived beyond 18 months when the tumor had not yet invaded the urethra. When the urethra was already involved, the survival rate dropped considerably. As in human medicine, early detection and intervention dramatically improved outcomes.32PubMed. Squamous cell carcinoma of the equine external genitalia: a review and assessment of penile amputation and urethrostomy as a surgical treatment The parallels between equine and human penile oncology are striking and reinforce the same lesson: catching the disease before it spreads is the single biggest factor in determining prognosis.