Penectomy is the medical term for the surgical removal of part or all of the penis. This procedure is considered a treatment of last resort, reserved only for conditions where preserving the organ would compromise the patient’s immediate health or long-term survival. The decision to proceed with penile amputation is made after careful consideration of all alternative treatments. This major operation fundamentally alters both the physical anatomy and future bodily functions, requiring extensive planning and patient support.
Medical Indications for the Procedure
The most frequent reason for medically necessary penile amputation is the treatment of penile cancer. When cancerous tumors are large, invasive, or located near the base of the organ, surgical removal of the affected tissue is required to prevent the spread of disease. The primary goal is to achieve clear surgical margins, meaning all surrounding tissue removed must be free of cancer cells to maximize the chance of a cure. This necessity dictates the extent of the tissue that must be removed.
Severe, irreparable trauma is another significant indication for penectomy. Injuries resulting from accidents, industrial machinery, or high-velocity impact can cause catastrophic damage to the penile structures. When the blood vessels, nerves, and erectile bodies are extensively destroyed, or if the severed tissue cannot be successfully reattached, amputation becomes necessary. In these acute trauma cases, the procedure is often performed to control life-threatening bleeding and prevent further complications.
A third urgent reason involves rapidly progressing, life-threatening infections, most notably necrotizing fasciitis. This is sometimes referred to as Fournier’s gangrene when it affects the genital region. This severe bacterial infection causes the rapid death of soft tissue. Since the infection spreads quickly and can lead to sepsis and organ failure, immediate and aggressive surgical debridement is mandatory to remove all necrotic tissue. If the infection has destroyed too much penile tissue, amputation is performed to stop the systemic spread of the bacteria.
Surgical Classifications and Techniques
The extent of the surgery is classified based on the amount of tissue removed, defined by the location and size of the underlying disease or injury. A partial penectomy involves removing the head (glans) and a portion of the shaft, typically performed when a tumor is localized to the distal end. The objective is to preserve as much functional length as possible, leaving a stump long enough to allow the patient to urinate while standing.
A total penectomy involves removing the entire external penile structure, usually reserved for large tumors that have spread to the base or proximal shaft. For highly aggressive cancer, a radical penectomy may be performed. This removes the external organ along with parts of the internal structures, such as the corpora cavernosa near the pelvis. This complete removal is necessary when a partial procedure would not achieve the required clear surgical margins for cancer control.
Following a total penectomy, a specific reconstructive technique called a perineal urethrostomy is performed to manage urinary function. This involves rerouting the remaining urethra to an opening created in the perineum, the area between the scrotum and the anus. This new urinary exit point means the patient must sit down to urinate. This anatomical modification is a permanent consequence of the procedure, ensuring safe and functional voiding.
Immediate Post-Surgical Management
The period immediately following penectomy focuses on stabilizing the patient, managing pain, and initiating wound healing. Patients typically have a short hospital stay, often lasting between one and three days, depending on the complexity of the surgery. Pain is managed aggressively using prescribed medications, sometimes delivered through a patient-controlled analgesia (PCA) pump in the initial hours.
Wound care is a significant component of the immediate recovery, involving careful monitoring of the surgical site for signs of infection or fluid accumulation. Drains may be placed temporarily to remove blood and fluid from the surgical area, and specialized dressings are applied. If a skin graft was used to close the defect, those dressings remain undisturbed for five to ten days to allow the new tissue to take hold.
A temporary urinary catheter is used to drain the bladder, allowing the newly created or repaired urethra and surrounding tissue to heal without irritation from urine flow. If a perineal urethrostomy was created, the patient begins adjusting to voiding from the new orifice once the catheter is removed. This initial phase is characterized by restricted activity to prevent strain and promote the successful integration of the surgical changes.
Long-Term Quality of Life and Reconstructive Options
The long-term adjustment after a penectomy extends beyond physical healing, significantly impacting psychological well-being and self-perception. Many individuals experience emotional challenges, including anxiety, depression, and a change in self-image due to the alteration in appearance and function. Counseling and support groups are frequently recommended to help the patient process grief, address body image concerns, and adapt to their changed anatomy.
The impact on sexual health varies depending on the extent of the amputation. After a partial penectomy, some erectile function may be retained if the remaining stump is long enough and the erectile bodies are intact. Patients who undergo a total penectomy lose the ability for penetrative intercourse. However, the capacity for orgasm is often preserved through the stimulation of other sensitive areas, such as the scrotum or the perineum. Sexual expression shifts toward non-penetrative activities, and couples may benefit from sex therapy to redefine intimacy.
Long-term urinary function management depends on the procedure performed. Patients with a preserved penile stump from a partial penectomy maintain the ability to urinate while standing. For those with a perineal urethrostomy, sitting to urinate becomes the permanent routine, requiring a significant lifestyle adaptation. Potential long-term complications include the narrowing of the urethral opening, known as a stricture, which may require further minor surgical procedures.
For patients seeking restoration, phalloplasty, or reconstructive penile surgery, is an option. This is a complex, multi-stage procedure that uses tissue, often from the forearm (radial artery forearm flap) or the thigh (anterolateral thigh flap), to construct a new phallus. The process requires several surgeries and carries a risk of complications, such as a urethral fistula or stricture. If a patient desires penetrative sex, an erectile device is implanted into the neophallus at a later stage of the reconstruction.