The British Association of Urological Surgeons



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The  British  Association  of  Urological  Surgeons  

 

 



35-­‐‑43  Lincoln’s  Inn  Fields  

London  


WC2A  3PE  

 

 



Phone:  

Fax:  

Website:  

E-­‐‑mail:  

 

 



+44  (0)20  7869  6950  

+44  (0)20  7404  5048  

www.baus.org.uk

 

admin@baus.org.uk  



 

 

INFORMATION  FOR  PATIENTS

 

 

Leaflet  No:  16/085  |  Page  1  



 

What  is  the  evidence  base  for  this  information?  

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  

nurse.  

 

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  



pipe)  is  brought  out  on  the  skin  behind  the  scrotum.  This  

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)  



 

What  are  the  alternatives  to  this  

procedure?  

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  

Leaflet  No:  16/085  |  Page  2  

 

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  



elasticated  stockings  provided  by  the  ward,  this  will  help  to  prevent  venous  thrombosis  

(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  



operation  consent  form  giving  permission  for  your  operation  to  take  place,  showing  you  

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.  



 

What  happens  during  the  procedure?

 

 

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  



penis   as   possible.   If   the   surgeon   can  

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  



surgeon  will  attempt  to  bring  the  urethra  (water  pipe)  as  near  as  possible  to  its  natural  

position   (pictured).   This   keeps   adequate   penile   length,   allows   you   to   pass   urine   in   a  

standing  position  and  preserves  sexual  function.  


 

AMPUTATION  OF  THE  PENIS  (PARTIAL  OR  COMPLETE)  FOR  CANCER  

Leaflet  No:  16/085  |  Page  3  

 

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  

abdomen.  

 

What  happens  immediately  after  the  procedure?  

You  should  be  told  how  the  procedure  went  and  you  should:



 

 

• 



ask  the  surgeon  if  it  went  as  planned;  

• 

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  



members  of  the  surgical  team;  and  

• 

make  sure  that  you  are  clear  about  what  has  been  done  and  what  happens  



next.  

 

If  the  penis  has  been  preserved,  you  will  have  a  pressure  dressing  around  the  penis  with  



a  catheter  passing  through  its  tip.    You  may  experience  mild  discomfort  for  a  few  days  

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  



passing  urine.    Some  patients,  particularly  the  elderly,  may  require  a  permanent  catheter.  

 

Are  there  any  side-­‐‑effects?  

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.  



 

Occasional  (between  1  in  10  and  1  in  50)  

• 

Possible  remaining,  microscopic  tumour  needing  further  



surgery  at  a  later  stage.  

• 

Recurrence  of  the  tumour  at  a  later  stage  needing  further  



surgery.  

• 

Significant  bleeding  or  infection  needing  further  



treatment.  

• 

The  opening  of  your  new  urethra  may  narrow  down  and  close  off;  this  is  usually  



dealt  with  by  stretching  or  re-­‐‑fashioning  the  opening.  

• 

Failure  of  the  skin  graft  to  “take”  on  the  penile  stump,  needing  another  graft.  



• 

Dissatisfaction  with  the  cosmetic  or  functional  result.  



 

Rare  (less  than  1  in  50)  

• 

None.  



 

 

AMPUTATION  OF  THE  PENIS  (PARTIAL  OR  COMPLETE)  FOR  CANCER  

Leaflet  No:  16/085  |  Page  4  

 

Hospital-­‐‑acquired  infection  

• 

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).  



 

Please  note:  The  rates  for  hospital-­‐‑acquired  infection  may  be  greater  in  “high-­‐‑risk”  

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.  



 

What  should  I  expect  when  I  get  home?  

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);  

and  

• 

be  sure  that  you  know  when  you  get  the  results  of  any  tests  done  on  tissues  or  



organs  that  have  been  removed.  

 

When  you  leave  hospital,  you  will  be  given  a  “draft”  discharge  summary.    This  contains  



important  information  about  your  stay  in  hospital  and  your  operation.    If  you  need  to  call  

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  



comfortable  enough  and  your  GP  is  satisfied  with  your  progress.    If  your  penis  has  been  

preserved,  you  should  not  have  sex  for  at  least  six  weeks  to  allow  complete  healing.  



 

What  else  should  I  look  out  for?  

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  



operation,   please   contact   your   GP.      The   graft   may   fail   to   take   on   the   penis,   either  

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  

re-­‐‑grafting.  

 

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  

home.    

 


 

AMPUTATION  OF  THE  PENIS  (PARTIAL  OR  COMPLETE)  FOR  CANCER  

Leaflet  No:  16/085  |  Page  5  

 

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  

discussion.  

 

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  



undergoing  research,  are  audited  so  that  we  can  

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.  



 

What  should  I  do  with  this  information?  

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.  



 

Signature...............................................................              Date...........................................  



 

AMPUTATION  OF  THE  PENIS  (PARTIAL  OR  COMPLETE)  FOR  CANCER  

Leaflet  No:  16/085  |  Page  6  

 

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.  

 

 



Most  hospitals  are  smoke-­‐‑free.    Smoking  can  make  some  urological  

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  

 

Disclaimer  

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.  

 

 



The  NHS  Constitution  

Patients’  Rights  &  Responsibilities

 

 

Following  extensive  discussions  with  staff  and  the  public,  the  NHS  Constitution  has  set  



out   new   rights   for   patients   that   will   help   improve   your   experience   within   the   NHS.    

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  

clinically  appropriate;  

• 

a  right  to  certain  services  such  as  an  NHS  dentist  and  access  to  recommended  



vaccinations;  

• 

the  right  that  any  official  complaint  will  be  properly  and  efficiently  



investigated,  and  that  patients  will  be  told  the  outcome  of  the  investigations;  

and  


• 

the  right  to  compensation  and  an  apology  if  you  have  been  harmed  by  poor  

treatment.  

 

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.



 

 

 



©  British  Association  of  Urological  Surgeons  (BAUS)  Limited  

Published:  March  2016.                                          Due  for  review:  March  2018  

 



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