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Leaflet No: 16/085 | Page 1
This booklet includes advice from consensus panels, the British Association of Urological
Surgeons, the Department of Health and other sources. As such, it is a reflection of best
urological practice in the UK. You should read this booklet with any advice your GP or
other healthcare professional may already have given you. We have outlined alternative
treatments below that you can discuss in more detail with your urologist or specialist
What does the procedure involve?
Removal of all or part of the penis which, in most cases, is
cancerous. If possible, part of the penis is preserved and
covered either with surrounding skin or with a skin graft
taken from elsewhere.
If the entire penis has to be removed, the urethra (water
means you will need to pass urine in a sitting position. If this
is not possible, a catheter will be placed into the bladder
through the abdominal wall (suprapubic catheter)
Alternatives to this procedure, because the lesions are usually cancerous or pre-‐‑
cancerous, include radiation therapy, laser treatment and topical anti-‐‑cancer creams.
These are only suitable for small and surface tumours; larger tumours require either
radiation treatment or surgical removal.
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery. You will
normally receive an appointment for a “pre-‐‑assessment” to assess your general fitness, to
screen you for MRSA and to do some baseline investigations. Once you have been
admitted, you will be seen by members of the medical team which may include the
consultant, specialist registrar, house officer and your named nurse.
AMPUTATION OF THE PENIS (PARTIAL OR COMPLETE) FOR CANCER
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You will be asked not to eat and drink for six hours before surgery. Immediately before
the operation, the anaesthetist may give you a pre-‐‑medication which will make you dry-‐‑
mouthed and pleasantly sleepy.
You will be given an injection of a drug called Clexane under your skin. Together with
(clots in your legs)
Please tell your surgeon (before your surgery) if you have any of the following:
An artificial heart valve
A coronary artery stent
A heart pacemaker or defibrillator
An artificial joint
An artificial blood-‐‑vessel graft
A neurosurgical shunt
Any other implanted foreign body
A regular prescription for a blood thinning agent such as warfarin, aspirin,
clopidogrel (Plavix®), rivaroxaban, prasugrel or dabigatran
A previous or current MRSA infection
A high risk of variant-‐‑CJD (if you have had a corneal transplant, a neurosurgical
dural transplant or injections of human-‐‑derived growth hormone).
When you are admitted to hospital, you will be asked to sign the second part of your
understand what is to be done and confirming that you want to go ahead. Make sure that
you are given the opportunity to discuss any concerns and to ask any questions you may
still have before signing the form.
Either a full general anaesthetic will be
used (where you are asleep) or a spinal
anaesthetic (where you are unable to feel
anything from the waist down) will be
used. All methods reduce the level of pain
afterwards. Your anaesthetist will explain
the pros and cons of each type of
anaesthetic to you.
We will try to preserve as much of your
preserve the penis, the defect after
removal of the tumour is covered by any skin that may be available; this can be from the
remaining penis or a skin graft (usually from the thigh).
The graft should heal (“take”) on to the penis because of an underlying blood supply. The
position (pictured). This keeps adequate penile length, allows you to pass urine in a
standing position and preserves sexual function.
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If the surgeon cannot preserve the penis without leaving cancer behind, the entire penis
will need to be removed and the urethra brought out through the skin behind the scrotum.
In some men, a catheter may need to be placed permanently into the bladder through the
What happens immediately after the procedure?
You should be told how the procedure went and you should:
let the medical staff know if you are in any discomfort;
ask what you can and cannot do;
feel free to ask any questions or discuss any concerns with the ward staff and
make sure that you are clear about what has been done and what happens
If the penis has been preserved, you will have a pressure dressing around the penis with
after the procedure but you will be given painkillers in the the ward and to take home
with you. Absorbable stitches are normally used and do not require removal.
A catheter may need to be left in the bladder for one to two weeks to prevent any problems
Most procedures have possible side-‐‑effects. But, although the complications listed below
are well-‐‑recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
There will be some shortening of the penis.
Temporary swelling and bruising of the penis and
scrotum, lasting several days.
Stitches under the skin which you may be able to feel.
Possible remaining, microscopic tumour needing further
Recurrence of the tumour at a later stage needing further
Significant bleeding or infection needing further
The opening of your new urethra may narrow down and close off; this is usually
Failure of the skin graft to “take” on the penile stump, needing another graft.
Dissatisfaction with the cosmetic or functional result.
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Colonisation with MRSA (0.9% -‐‑ 1 in 110).
MRSA bloodstream infection (0.02% -‐‑ 1 in 5000).
Clostridium difficile bowel infection (0.01% -‐‑ 1 in 10,000).
patients. This group includes, for example, patients with long-‐‑term drainage tubes,
patients who have had their bladder removed due to cancer, patients who have had a
long stay in hospital or patients who have been admitted to hospital many times.
When you are discharged from hospital, you should:
be given advice about your recovery at home;
ask when you can begin normal activities again, such as work, exercise, driving,
housework and sex;
ask for a contact number if you have any concerns once you return home;
ask when your follow-‐‑up will be and who will do this (the hospital or your GP);
be sure that you know when you get the results of any tests done on tissues or
When you leave hospital, you will be given a “draft” discharge summary. This contains
your GP or if you need to go to another hospital, please take this summary with you so the
staff can see the details of your treatment. This is important if you need to consult another
doctor within a few days of being discharged.
It will be at least 14 days before healing occurs. You may return to work when you are
preserved, you should not have sex for at least six weeks to allow complete healing.
There will be marked swelling of the area; this will last up to 10 days and then subside.
Do not be alarmed because it is to be expected.
If you develop a temperature, increase redness, throbbing or drainage at the site of the
immediately or after a few days, and will then appear black or red. If the affected area is
small, it can be allowed to heal by forming a scab but, if the raw area is large, it may require
Are there any other important points?
A follow-‐‑up appointment will normally be arranged for you at two to four weeks after the
operation. You will receive this appointment either on the ward or shortly after you get
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It will be 14 to 21 days before the biopsy results on the tissue removed are available. All
biopsies are discussed in detail at a multi-‐‑disciplinary meeting before any further
treatment decisions are made. You and your GP will be informed of the results after this
Driving after surgery
It is your responsibility to make sure you are fit to drive following your surgery. You do
not normally need to tell the DVLA that you have had surgery, unless you have a medical
condition that will last for longer than three months after your surgery and may affect
your ability to drive. You should, however, check with your insurance company before
returning to driving. Your doctors will be happy to give you advice on this.
Is any research being carried out in this area?
Before your operation, your surgeon or specialist
nurse will tell you about any relevant research
studies taking place. In particular, they will tell
you if any tissue that is removed during your
surgery will be stored for future study. If you
agree to this research, you will be asked to sign a
special form giving your consent.
All surgical procedures, even those not currently
analyse our results and compare them with those
of other surgeons. In this way, we learn how to improve our techniques and results; this
means that our patients will then get the best treatment available.
Thank you for taking the trouble to read this booklet. If you want to keep a copy for your
own records, please sign below. If you would like a copy of this booklet filed in your
hospital records for future reference, please let your urologist or specialist nurse know.
However, if you do agree to go ahead with the scheduled procedure, you will be asked to
sign a separate consent form that will be filed in your hospital records; we can give you a
copy of this consent form if you ask.
I have read this booklet and I accept the information it provides.
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How can I get information in alternative formats?
Please ask your local NHS Trust or PALS network if you require this information in other
languages, large print, Braille or audio format.
conditions worse and increases the risk of complications after
surgery. For advice on stopping, contact your GP or the free NHS
Smoking Helpline on 0800 169 0 169
While we have made every effort to be sure the information in this booklet is accurate, we
cannot guarantee there are no errors or omissions. We cannot accept responsibility for
any loss resulting from something that anyone has, or has not, done as a result of the
information in this booklet.
Following extensive discussions with staff and the public, the NHS Constitution has set
These rights include:
a right to choice and a right to information that will help you make that choice;
a right to drugs and treatments approved by NICE when it is considered
a right to certain services such as an NHS dentist and access to recommended
the right that any official complaint will be properly and efficiently
the right to compensation and an apology if you have been harmed by poor
The constitution also lists patients’ responsibilities, including:
providing accurate information about their health;
taking positive action to keep yourself and your family healthy.
trying to keep appointments;
treating NHS staff and other patients with respect;
following the course of treatment that you are given; and
giving feedback (both positive and negative) after treatment.