Amputation of Penis, Radical; with Bilateral Inguinofemoral Lymphadenectomy

Name of the Procedure:

• Common names: Radical Penile Amputation, Total Penectomy with Bilateral Inguinofemoral Lymphadenectomy
• Medical terms: Penectomy, Bilateral Inguinofemoral Lymph Node Dissection

Summary

Radical amputation of the penis with bilateral inguinofemoral lymphadenectomy is a surgical procedure involving the complete removal of the penis and the dissection of lymph nodes in the groin area. It is typically performed to treat advanced penile cancer that has spread to nearby lymph nodes.

Purpose

This procedure aims to:

• Remove cancerous tissues to prevent the spread of cancer.
• Increase the chances of long-term survival for patients with advanced penile cancer.
• Potentially alleviate symptoms caused by the cancer, such as pain or difficulty urinating.

Indications

• Diagnosed with advanced penile cancer.
• Tumor invasion into surrounding structures or metastasis to lymph nodes.
• Failure of less invasive treatments (radiation, partial penectomy).
• Presence of large or multiple inguinal lymph nodes.

Preparation

• Fasting for at least 8 hours before surgery.
• Medication adjustments as advised by the doctor, possibly stopping blood thinners.
• Pre-operative assessments including blood tests, ECG, and imaging studies like a CT scan or MRI.
• Consultation with anesthesia team and surgical team.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. The penis is removed entirely ("radical amputation") through an incision at its base.
3. Bilateral inguinofemoral lymphadenectomy involves making additional incisions in the groin to access and remove lymph nodes from both sides.
4. Surgeons ensure clear margins, meaning all cancerous tissue is removed.
5. Closure of incisions with sutures.
6. Placement of drains to prevent fluid accumulation.

Tools and equipment used include surgical scalpels, retractors, and specialized instruments for lymph node dissection.

Duration

The procedure typically takes 3 to 5 hours.

Setting

The procedure is conducted in a hospital surgical suite.

Personnel

• Surgeon(s) specialized in urologic oncology.
• Surgical nurses.
• Anesthesiologist.
• Operating room technicians.

Risks and Complications

• Common risks: Infection, bleeding, pain.
• Rare risks: Blood clots, damage to surrounding structures, lymphedema (swelling due to lymph fluid build-up).
• Complications can be managed with medications, additional treatments, or interventions if necessary.

Benefits

• Effective removal of cancerous tissues.
• Reduction in symptoms caused by the cancer.
• Improved survival rates.
• Cancer control, providing a potential cure in some patients.

Recovery

• Hospital stay of 5 to 7 days post-operation.
• Pain management with medications.
• Care of surgical wounds and drains.
• Avoid heavy lifting and strenuous activities for 4 to 6 weeks.
• Follow-up appointments for wound assessment and to monitor for recurrence or complications.

Alternatives

• Partial Penectomy or Mohs Surgery for less advanced cases.
• Radiation therapy.
• Chemotherapy.
• Pros and cons: Less invasive options may not be effective for advanced cancer, but they might preserve more penile structure. Radical surgery is more definitive for advanced cases but comes with greater impact and recovery needs.

Patient Experience

• Under anesthesia during the procedure, so no pain will be felt.
• Post-operative pain managed with medications.
• Experience discomfort and need for assistance in the initial recovery phase.
• Emotional and psychological support may be necessary due to the nature of the surgery and its impact.