Reconstructive surgery helps restore the function and appearance of the penis. It may also be used to cover a defect in the skin if penile cancer has spread to the skin overlying lymph nodes. Reconstructive surgery may be planned shortly after surgery to remove the cancer or it may be done later. The risk of recurrence of penile cancer is highest within the first year after surgery. Therefore, men will often wait until they are told that they are disease-free before they have reconstructive surgery. A man with penile cancer may be offered the following reconstructive procedures:
Men who have had surgery that partially or completely removes the penis may be offered penile reconstruction. Surgeons use microsurgery (surgery that uses a microscope) techniques to reconstruct the penis. The goals of penile reconstruction are to:
Skin grafts or tissue flaps may be used to reconstruct the penis after a partial or total penectomy. Skin grafts and tissue flaps used to reconstruct the penis may be taken from the leg, abdomen, forearm, scrotum or groin area.
Penile reconstruction often involves more than one operation. Sometimes as many as 6 operations are needed to get the desired results.
During a partial penectomy, the surgeon tries to leave enough of the shaft of the penis to allow the man to urinate standing up. If only the head of the penis (glans) is removed, the surgeon may use a skin graft to reconstruct it. After this operation, the penis looks like it is circumcised. The man can usually pass urine normally and have sexual intercourse with penetration.
Some men may also be eligible for other reconstruction techniques that try to preserve urination while standing up and that allow sexual intercourse with penetration.
Cutting the suspensory ligament and removing suprapubic fat may both be offered to achieve the best possible results.
It may be possible to reconstruct the penis after a total penectomy using skin and tissue from another part of the body. Various techniques may be used to create a penis.
Sometimes it may be possible for a surgeon to reconnect nerves so a man has feeling in the reconstructed penis. The reconstructed penis may also be able to get an erection if the surgeon can reconnect blood vessels.
A penile implant (prosthesis) may be used to restore a man’s ability to have penetrative sexual intercourse. Unless a bone graft from the man’s body is implanted, skin graft techniques may not provide enough rigidity. Bone grafts are not ideal because the penis will always be erect. A semi-rigid or inflatable penile implant (prosthesis) may be preferred. Penile implant surgery is usually done 6–12 months after penile reconstruction surgery, once some sensation has returned to the skin of the reconstructed penis.
Skin grafts may also be used when cancer in the lymph nodes of the groin has spread to the overlying skin. In this case, a skin graft is needed because a large area of skin is removed. Skin and muscle is often taken from the outer part of the thigh or abdomen.
Side effects can occur with penile reconstructive surgery, but not everyone has them or experiences them in the same way. The side effects are similar for the different types of skin graft and tissue flap surgeries. Side effects of penile reconstructive surgery will depend mainly on the:
It is strongly recommended that men stop smoking at least 3–4 weeks before having penile reconstructive surgery. Smoking affects blood flow to the skin and underlying tissues, which can lead to infection, delay healing and increase the risk of dead tissue in the skin graft or tissue flap (flap necrosis). Many surgeons will not offer reconstruction to men who do not quit smoking.
Side effects can happen any time during, immediately after, or a few days or weeks after penile reconstructive surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent. It is important to report side effects to the healthcare team.
Some potential side effects of penile reconstructive surgery include:
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