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Partial Glansectomy and Penectomy: Procedure Steps and Complications

Partial Glansectomy Procedure

Indications:

Partial glansectomy is the preferred option for local control of small penile tumors (Ta–T1).

Contraindications:

Bleeding disorders. Large poorly differentiated penile carcinoma with risk of incomplete removal.

Surgical Technique of Partial Glansectomy

Preoperative patient preparation:

Exclude or treat urinary tract infection. Perioperative antibiotic prophylaxis. Supine position. Spinal or general anesthesia. Transurethral catheter. Apply a tourniquet (e.g., vessel loop with a clamp) around the base of the penis to reduce bleeding.

Partial glansectomy:

Wedge-shaped excision of the tumor with a small safety margin of a few millimeters. If necessary, close the opened corpora cavernosa with interrupted sutures. Cover the defect with subcutaneous tissue. Wound closure.

Postoperative care:

Catheter for one day. Regular wound examination. Further therapy depends on the histology of the specimen (tumor type? grading? safety margin?).

Complications

Hematoma, infection, meatal stenosis.

Partial Penectomy Procedure

Indications for Partial Penectomy

Partial penectomy is indicated for local control of penile carcinoma with infiltration of the corpora cavernosa (T2–3) or when preservation of the glans penis is not possible.

Contraindications

Bleeding disorders. Consider radical penectomy for large, poorly differentiated tumors with a risk of incomplete removal or if the remaining penile length after partial penectomy is too short to control the urinary stream.

Preoperative Patient Preparation

• Exclude or treat urinary tract infection
• Perioperative antibiotic prophylaxis
• Supine position
• Spinal or general anesthesia
• Insertion of a transurethral catheter
• Apply a tourniquet (e.g., vessel loop with a clamp) around the base of the penis to reduce bleeding.

Surgical Steps of Partial Penectomy:

Partial penectomy, schematic illustration: circular skin incision around the penile shaft, transection and closure of the corpora cavernosa, wound closure with interrupted sutures.

Skin incision:

The recommendations for the surgical margin for adequate oncological control have been reduced to 0.5–1 cm in recent publications. A circular skin incision is made around the penile shaft at the appropriate distance from the tumor. Superficial veins and the dorsal neurovascular bundle are isolated and ligated.

Division of the corpora cavernosa:

The corpora cavernosa are transected at the appropriate safety distance to the tumor. The urethra is isolated and transected 1~cm further distally. Margin biopsies and the specimen are sent to frozen section evaluation to confirm complete excision.

Closure of the corpora cavernosa:

Sutures (2-0) are placed through the tunica albuginea and the septum penis, which close the corpus cavernosus vertically. Pay attention to the urethral width when suturing near the urethra. The urethral end is spatulated at the 12 o'clock position. Release the tourniquet and check for bleeding.

Wound closure:

Place a subcutaneous suction drain. Vertical closure of the shaft skin with interrupted sutures 4-0. The meatus is reconstructed by additional interrupted sutures between the skin and the spatulated urethra. Alternatively, the glans can be reconstructed with a split-thickness skin graft covering the distal corpora.

Inguinal Lymphadenectomy

Please see section penile cancer for indications and section inguinal lymphadenectomy for surgical technique.

Postoperative Care after Partial Penectomy

General measures:

Early mobilization. Thrombosis prophylaxis. Wound inspections.

Analgesia:

Analgesics with a combination of NSAIDs and opioids.

Drains and catheters:

• Wound drainage 1–2 days
• Bladder catheter 2–5 days

Complications

Hematoma, infection, meatal stenosis.

References

J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

  Deutsche Version: Technik und Komplikationen der partiellen Penektomie