Total penectomy and perineal urethrostomy

This means that the whole of the penis must be removed in order to remove the cancer and prevent the risk of the cancer spreading.

In order to maintain urine flow, the urethra is reshaped and repositioned underneath in the perineal area (behind the scrotum) to form a special urinary drainage system which is called a perineal urethrostomy. This will enable normal sensation to pass urine, giving full control of the bladder.

We undertake this operation for confirmed cancer in the penis with the overall aim of removing all cancer from this area. Surgery is the main treatment to remove the cancer and prevent it spreading to other organs.

Unfortunately, it is not believed that penile preserving surgery would be in your best interests, hence why we have recommended removal of the whole penis.

There are some risks in having this treatment, which you should consider before consenting for the operation. These potential complications are rare. You should discuss these with your doctor when you visit the hospital.

All operations carry risks, such as bleeding, infection and DVT, and we will explain all of these risks to you in detail before you sign the consent form.

The main consequence of the surgery is the shortening of the urethra water pipe and repositioning it behind the scrotal area, which will mean that when there is the urge to pass urine, you will have to sit down on the toilet.

There are a number of issues that affect the chances of suffering complications, including: age, weight, lifestyle issues and your general state of health. Your anaesthetist and/or your surgeon can give further details. The Royal College of Anaesthetists have provided the information below on risks:

Very common (1 in 10) and common (1 in 100) side effects

• feeling sick and vomiting after surgery
• sore throat
• dizziness, blurred vision
• headache
• itching
• aches, pains and backache
• pain during injection of drugs
• bruising and soreness
• confusion or memory loss.

Uncommon side effects and complications (1 in 1,000)

• chest infection
• bladder problems
• muscle pains
• slow breathing (depressed respiration)
• damage to teeth, lips or tongue
• an existing medical condition getting worse
• awareness (becoming conscious during your operation).

Rare (1 in 10,000) or very rare (1 in 100,000 or less) complications

• damage to the eyes
• serious allergy to drugs
• nerve damage
• death
• equipment failure.

Deaths caused by anaesthesia are very rare, and are usually caused by a combination of four or five complications together. There are about five deaths for every million anaesthetics in the UK.

This is not something we would recommend. 

With regards to managing your cancer and to stop the spread of cancer to other parts of the body, surgery is the most appropriate treatment with the best outcome. 

If you choose not to undergo surgery and refuse treatment then the cancer will increase in size. You may also find difficulty in passing urine and the wounds may ‘fungate’, which means they become infected and malodouress (smelly). If the tumour increases in size, more treatment that is radical may be required and/or it becomes untreatable.

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can mean the use of one drug or several drugs used together. However, it is not commonly used in the initial treatment of penile cancer.

Small early stage cancers on the foreskin or end of the penis may be treated with chemotherapy cream. This cream only destroys the cancer cells near the surface of the skin so it is not used to treat deeper cancers. Chemotherapy may also be given in tablet form, or by injection into a vein for more advanced cancer. It may be given in conjunction with surgery or radiotherapy (or both). 

Side effects of chemotherapy

Side effects are more severe and more common with chemotherapy given by injection or into a vein. Many of these side effects can be controlled with drugs and almost all are only short-term and will gradually disappear once the treatment has stopped.

Different chemotherapy drugs cause different side effects. Everyone is different and will react to chemotherapy treatment in a different way. Some people may have very few side effects while others will suffer many.

If topical chemotherapy cream is prescribed, the skin may become sore, red and inflamed. Other creams and painkillers may be prescribed to reduce any pain and inflammation. These side effects should wear off within a couple of weeks after stopping treatment.

If having chemotherapy as an injection or into a vein, the main areas of your body that may be affected are those where normal cells rapidly divide and grow, such as the lining of your mouth, the digestive system, your skin, hair and bone marrow (the spongy material that fills the bones and produces new blood cells).

Common side effects of chemotherapy may include:

• lowered resistance to infection
• bruising or bleeding – the production of platelets which make blood clot can drop, causing bruising or bleeding
• anaemia
• nausea and vomiting – anti-sickness drugs can help this
• sore mouth – may cause small ulcers
• poor appetite
• hair loss – hair should grow back within three to six months of finishing treatment.

Your doctor or nurse specialist will be able to tell you what side effects may be caused by your chemotherapy treatment. Although the side effects of chemotherapy can be unpleasant, they need to be weighed against the benefits of the treatment.

It is important to tell your doctor or chemotherapy nurse if the treatment is making you feel unwell. You may be able to have medicines to help you, or adjustments can be made to your treatment to lessen any side effects.

Before your surgery, you will attend an appointment at pre-assessment to assess your fitness for surgery. Here you will be advised of any medications that may need to be omitted prior to, or on the day of your surgery. You will need to stop eating from midnight before the day of your operation. You may drink water until 6am unless advised otherwise.  

We will admit you via the surgical admissions lounge on the day of your surgery. Here, you will see your consultant who will ask you to give your consent for your surgery. You may wish to bring a book or newspaper to read whilst waiting for your appointments. You will need to bring clothes and toiletries for your inpatient stay, which is usually three nights. 

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff again.

The surgery is performed under general or spinal anaesthetic. The whole of the Penis is removed with full closure to the operative area. The urethra is reshaped underneath in the perineal area (behind the scrotum) to form a special urinary drainage system (Perineal Urethrostomy) where a catheter (narrow tube) will be placed to drain the urine for 10-12 days in order for the area to heal appropriately. A dressing will be secured to the wound site post operative, and we will change this before your discharge. As an alternative to applying further dressings,if your wound is intact (skin held together) and dry we often use a male tena pad secured to fairly supportive pants for comfort. 

You will return to the ward with a urethral catheter in place and a wound dressing.  We will secure it very well to make sure it stays in place. We will normally remove your dressing 2-3 days before discharge and all sutures will be dissolvable.  

Sometimes excess blood may gather at the operation site and we may insert a small drain to allow unwanted substances to drain naturally for healing to take place. We will usually remove this drain after 24 hours.  

The urethral catheter is a narrow tube that goes into the newly repositioned urethra to drain out the urine, this will stay in place for 10-12 days and removed in clinic by your nurse specialist. There may be some swelling and bruising to the perineum area however, this will improve within the healing time. We will give you pain relief regularly and you will be discharged with appropriate medication. 

Often after a general anaesthetic the bowel will remain sluggish, therefore inform the surgical team if you are having problems with opening your bowel and we will prescribe you the appropriate medication. We will advise you to wear your anti-embolism stockings, designed to help your circulation. We will also prescribe anticoagulation injections, which will “thin” your blood and prevent blood clots. You will usually remain in hospital for 72 hours and will depend on your surgeon’s instruction.  

The ward will arrange for a district nurse to visit you to make sure the wound site remains clean and healthy. Alternatively you may be asked to see your practice nurse at your GP,s for wound check if you are fully mobile. If there is any visible slough (exudate) then alginate or aquacel dressing will need to be applied to absorb and promote healing. The healing process is normally 4-6 weeks therefore you will need to avoid any strenuous activity for example lifting, gardening and shopping.

Bathing and showering

You will be able to shower, however you must not have a bath until advised after your clinic for removal of your urethral catheter. From day 15, you can have a five-minute ‘salt bath’ to facilitate wound healing.

To do this, run a warm bath and place a handful of table salt in the water. You should not rub the penile wound site, but pat the area dry.

Catheter removal

The catheter will be removed in clinic by the nurse practitioner after about 10–12 days. At this time the wound should be healing well.

UCLH Macmillan Cancer Information Centre

Location: Cancer Centre Huntley Street

Telephone: 020 34478663

Email: uclh.supportandinformation@nhs.net

The Centre provides good quality, comprehensive and appropriate cancer information for anyone affected by cancer. It is staffed by a Macmillan information specialist, supported by cancer nurses and trained volunteers. The service supports patients, their family and friends.

Macmillan Cancer Support

Website: www.macmillan.org.uk

Freefone helpline on 0808 808 0000 (7 days a week 8am–8pm).  

The helpline number is also free from these mobile phone networks: 3, O2, Orange, T-Mobile, Virgin and Vodafone when calls are made from the UK

Cancer Research UK

Website: www.cancerresearch.org.uk

This website provides facts about cancer, including treatment choices.

RNID typetalk (Mon-Fri 8.30-5pm) 

Email: contact@rnid.org.uk  

Telephone: 0808 808 0123 

Orchid – fighting male cancer

Website: www.orchid-cancer.org.uk

NHS Direct  

Telephone: NHS 111 

Other support groups

Penile and urethral Cancer support Group UCLH  

These meetings are held first Tuesday of each month except January and August form 12-1.30pm- we offer hybrid sessions so can attend in person or join online – your keyworker will be able to provide more information regarding these valuable meetings   

See www.patient.co.uk for a list of self-help and support groups for cancer patients.

UCL Hospitals cannot accept responsibility for information provided by other organisations. 

EAU (2023) Penile cancer guidelines: 

https://uroweb.org/guidelines/penile-cancer

University College at Westmoreland Street

Switchboard: 020 3456 7890

Website: www.uclh.nhs.uk

For more information you can contact the Clinical Nurse Practitioners as follows:

Department email: uclh.andrologycancercns@nhs.net or 

Sadie Molloy andrology Cancer CNS/keyworker

Mobile: 07852 219921

Email: uclh.andrologycancercns@nhs.net

Mona Magan Andrology Cancer CNS/keyworker  

Mobile: 07929 710288 

Mona.magan2@nhs.net