Surgery for penile cancer

The operation you have depends on the stage of the penile cancer (cancer of the penis) and where it is on the penis. Your surgeon will try to remove all the cancer while keeping as much of the penis as possible.

There are different types of operation. Your surgeon or specialist nurse will talk to you about what surgery involves and the possible effects it may have. It is important to ask them any questions you have and talk about any concerns.

Some operations may cause changes to how your penis looks. They may also affect your sex life. This can be difficult to deal with. Your team will explain any possible changes and give you support to help you cope.

Some types of surgery can affect your ability to make someone pregnant. This is called your fertility. If you are worried about your fertility, talk to your doctor or nurse before you start treatment. They may talk to you about storing sperm. We have more information about how cancer treatments can affect your fertility.

There are different types of surgery to remove larger cancers of the penis:

If the cancer has spread over a bigger area, you usually need an operation called a wide local excision. This means removing the cancer and an area of healthy-looking tissue around it. This area of healthy-looking tissue is called a margin. This reduces the risk of the cancer coming back.

You usually have this operation under a general anaesthetic, during a short stay in hospital. The wound is usually closed with stitches. But some people have skin taken from another part of the body to cover the area. This is called a a skin graft.

If the cancer is bigger and on the head of the penis (the glans), you usually need to have this area completely removed. The operation is called a glansectomy.

A glansectomy is usually done under general anaesthetic, during a short stay in hospital.

Once the affected area has been removed, the surgeon takes a skin graft from the thigh. They use this to cover the wound on the penis. This can help make the penis look as similar as possible to how it looked before surgery.

Sometimes, instead of a skin graft, the surgeon might bring skin up from the shaft of the penis to cover the tip. Your surgeon can tell you which option is right for you.

During surgery, you will have a catheter inserted to make it easier to pass urine after surgery. You will also have a dressing on the thigh, covering the site where the skin graft has been taken from.

You need to stay in hospital for a few days after this operation.

The dressings and catheter can usually be removed after 7 to 10 days. This will allow time for the wounds to heal.

Your surgeon will do everything possible to make your penis look as similar as possible to how it looked before. But this type of surgery can change the size and shape of your penis. If you are worried about this and would like some support, let your doctor or specialist nurse know.

If the cancer is large, or affecting too much of the penis, your surgeon may advise you to have:

• a partial penectomy, where part of the penis is removed
• a total penectomy, where all of the penis is removed.

They will talk to you about what is involved and how the operation will affect you.

Having a penectomy

If all of the penis is removed, the surgeon usually makes a small cut between the scrotum and anus (opening at the end of the bowel). This cut may be called an incision. 

They may redirect the tube that carries urine to the incision. This tube is called the urethra. You are still in control of passing urine but you do this sitting down. 

Sometimes it is not possible to redirect the urethra. Some people may need to have a tube that goes into the bladder through the tummy (abdomen). This is called a supra-pubic catheter. You attach a bag to the tube on the tummy to collect urine.

Having surgery to remove part or all of the penis can be upsetting. The team looking after you will give you lots of support. It is important to talk to your doctor or nurse about your feelings and concerns.

If the cancer has not spread anywhere else in the body, it may be possible to have an operation to form a new penis. This is called reconstructive surgery. It may be done a year or more after treatment is finished. This is when you have recovered and there are no signs of the cancer coming back. It is very specialised surgery and is only done in a few hospitals in the UK.

The surgeon may take skin and other tissue from the arm or thigh to form a new penis. They can also put a small device called a penile prosthesis into the new penis. This will help you get an erection. Your surgeon or nurse will explain what the operation involves, so you know what to expect.

If the penile cancer has spread to the lymph nodes in your groin, you may have an operation to remove them. This operation is called an inguinal lymph node dissection. It can be in one or both sides of the groin. The surgeon makes a cut in the groin and removes the lymph nodes.

This surgery is usually done under general anaesthetic, during a short stay in hospital.

During surgery, a small plastic tube called a wound drain is inserted near the operation site. This lets extra fluid drain away and helps the wound heal. It is usually removed after 2 weeks. But sometimes it may need to stay in place for up to 4 weeks.

The wound will have dissolving stitches, which take 4 to 6 weeks to dissolve.

After this operation, there is a risk of developing swelling in one or both legs, the scrotum and the penis. This is called lymphoedema. The risk is higher if you also have radiotherapy to the groin.

We have more information about lymphoedema and how it can be managed.

How long it takes to recover depends on the surgery you had. If the cancer is very small, and only a small amount of skin is removed, your wound is likely to heal quickly.

Surgery to remove a small cancer is unlikely to have a direct effect on your sex life. Most people are usually able to have an erection and have sex.

Some people might feel less confident in their ability to have sex after penile cancer treatment. Even having minor surgery can be upsetting. Concerns about your sex life and intimate relationships are normal. If you are worried, speak to your doctor or specialist nurse. They can help you get the support you need.

If you have surgery to remove part or all of the penis, you may worry about the effect on your sex life. Your cancer team will give you lots of support. They will explain what can help with sexual difficulties.

If you have had part of the penis removed, you may still get erections. This will depend on how much tissue has been taken away during surgery. Your doctor or nurse can talk to you about this.

If the whole penis has been removed (total penectomy), your sex life will be directly affected. Not having a penis can be very difficult to come to terms with. But you may find new ways to enjoy sex. The areas around the scrotum and testicles will still be sensitive. You may still be able to have orgasms through stroking and other stimulation.

Organisations such as Orchid have further information about sex after penile surgery. They offer support for anyone affected by penile cancer.

The Macmillan Online Community also has a penile cancer forum. You can talk to other people affected by penile cancer to support one another, ask questions, and share experiences.