Urology

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Partial, complete amputation

What does this procedure entail?

It involves the removal of a part or all of the penis – in most cases due to cancer. This procedure is less commonly performed in benign diseases/tumours, e.g., because of their size, inability to urinate, but sometimes also due to the risk of malignant transformation of these diseases. If possible, part of the penis is left and covered by the surrounding skin and a new urethral orifice is created. If the whole penis has to be removed, a new urethral office will usually be created in the perineum (between the scrotum and the rectum) – urination in sitting position. If even this approach is not possible, a catheter is inserted into the bladder through the skin of the lower abdomen.

What are the alternatives to this procedure?

Since these findings are mostly malignant or potentially malignant, it is an alternative

for small and surface foci
- Irradiation
- Laser treatment
- Local ointment application
in major affection
- Irradiation
- Surgical treatment – removal

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

artificial heart valve
coronary artery stent
pacemaker
artificial joint
artificial vascular graft
neurosurgical bypass
other implanted foreign body
use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
drug and other allergies
any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first. The procedure is performed under general anaesthesia.

We always try to keep at least a part of the penis – to enable urination while standing, sometimes even sexual activities. A tourniquet is put on the root of the penis at the beginning of the surgery due to bleeding at this stage of the surgery. After the affected tissue is removed, the stump of the penis is covered with the surrounding skin and a new urethral orifice is created. A balloon catheter is inserted into the bladder through the urethra before the end of the surgery. If a sufficient part of the penis cannot be preserved, the entire penis is removed and the urethral orifice is created on the perineum (between the scrotum and the rectum). If even this variant of the urethral orifice is not possible, a permanent catheter is inserted into the bladder through the skin of the lower abdomen.

The surgery takes about 60-90 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

As soon as your medical condition allows, you will be allowed to sit down and then stand up. After that, you will be able to walk slowly and carefully around the room, initially accompanied by medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.

You will have a compression bandage around your penis and urine will be drained through a catheter. You may experience a slight pain or discomfort in this area, which can be managed with painkillers as needed. The wound is closed with absorbable sutures, so there is no need to remove them. The catheter will be left there for 1-2 weeks after the surgery to prevent problems with urination. The total length of hospitalisation is 7 to 9 days. The sick leave is usually 2 to 3 weeks (possibly longer depending on the nature of your occupation).

Once you are fully conscious, you should:

ask if the planned outcome was achieved
inform the medical staff about any problems
ask what you can and cannot do
ask all the questions you have for the healthcare professionals and members of the medical team.
remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

Shortening of the penis by the removed part
Swelling and haemorrhage at the site of surgery – usually lasting several days
Sutures under the skin that you can feel
A bladder catheter is usually necessary

Occasional (2-10% of procedures of this type)

Residual tumour or tumour relapses that require a new surgery
Significant bleeding or infection requiring further treatment.
Scarring and narrowing of the new urethral orifice – usually resolved by dilation or surgical revision
Problem with skin sticking to the stump of the penis, sometimes requiring repeated surgery
Possible dissatisfaction with the cosmetic and functional effect

Rare (may occur in 2% of procedures of this type)

None

Hospital infections

MRSA colonisation (0.9% – 1 of 110)
Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

Get recommendations on recovery at home.
Ask when you can return to normal activities such as work, exercise, driving, housework.
Get a contact number for further questions after returning home or in case of trouble.
Ask about the date and place of subsequent check-ups (hospital or your doctor).
Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

The wound should be clean and dry for a full 24 hours. If clothes stick to it, they can be removed after a short bath or shower. You should not bathe or shower until the area has healed, as this could lead to quick dissolution of the sutures and infection. Sometimes it is recommended to apply antibiotic ointment to the area around the urethra.

You should stay at home for 10-14 days and avoid any strenuous exercises to enable the wound to heal. You should avoid sexual intercourse for about 6 weeks, or until all eventual problems improve.

What else should I watch out for?

There may be swelling around the wound after the surgery, it will subside after 10 days. You do not have to worry about it, as it is an expected development.

If you experience more frequent problems, fever, redness, pulsation or discharge from the wound, see your attending physician. Skin adhesion to the stump of the penis may fail (immediately or even a few days after the surgery) – the skin may be reddish or blackish and a scab may appear during healing. If this reaches a larger extent, surgical treatment and new skin graft coverage are necessary.

Important information?

The date and place of the outpatient check-up will be scheduled before your discharge from the hospital – usually to have the result of the histological examination at that time. The next steps will be agreed upon – monitoring, or further treatment during this check-up.