Partial penile resection

Partial penectomy is a surgical procedure for the treatment of early penile cancer. It is transverse to the corpus cavernosum at a distance of more than 2 cm from the proximal end of the tumor. The urethra is traversed 1 to 1.5 cm distal to the incision, the corpus cavernosum and the skin are sutured, and the urethral orifice is shaped. Treating diseases: penile cancer Indication Partial penectomy is indicated for early penile cancer (T1 or Jackson I), the tumor is confined to the penis head or coronary sulcus, and the corpus cavernosum and urethra have not been violated. Contraindications Penile cancer is more widely infringed, and the residual normal penis length is less than 2cm. Preoperative preparation 1. Apply antibacterial drugs to control infection. 2. Soak the penis with 1:5000 potassium permanganate solution 2 days before surgery, 2 to 3 times a day, 15 to 20 minutes each time. 3. Suspected penile cancer should be examined by biopsy before surgery. 4. Patients with suspected lymphatic metastasis should have a biopsy of the inguinal lymph nodes before surgery. 5. Explain the need for surgery to patients and their families, and eliminate concerns. 6. Shave the pubic hair 1d before surgery and wash the penis and scrotum with soapy water and water. Surgical procedure 1. Wrap the tumor: Wash the lesion thoroughly with soapy water and water. After disinfection, wrap the distal part of the penis and the tumor part with a sterile condom or sterile dry gauze, and then use a thick thread or rubber band to ligature the proximal end of the package to avoid Tumor tissue contaminates the surgical field. Re-sterilize the surgical field, use a rubber tourniquet or rubber band to circumscribe the root of the penis, block the blood circulation of the penis, and reduce intraoperative bleeding. 2. Incision: 2.0 to 2.5 cm from the proximal edge of the tumor, making a fish-mouth incision in the penis skin. 3. Isolation of the penile vascular nerve: the penile skin and the penile fascia are cut along the circular incision to reveal the dorsal vessels and nerves of the penis. The penile superficial vein, the dorsal deep vein, the dorsal artery and the dorsal nerve were isolated, severed, and ligated. 4. Transect the corpus cavernosum: traverse the corpus cavernosum along the skin incision line and ligature the deep dorsal artery of the penis in the cavernous body. When cutting the corpus cavernosum, pay attention to the preservation of the corpus cavernosum adjacent to the urethra. 5. Transverse urethra: the distal part of the corpus cavernosum is separated from the distal side, and the urethra is transversely cut from the 1.0 to 1.5 cm section of the corpus cavernosum. 6. Stitching the corpus cavernosum: suture the corpus cavernosum with a 4th thread transversely, and the suture should pass through the septum of the corpus cavernosum. 7. Suture the skin: Loosen the tourniquet at the root of the penis, check whether there is bleeding in the broken end of the corpus cavernosum, and suture if there is bleeding. The penile fascia was sutured longitudinally with a No. 0 silk thread, and the skin was sutured again. The ventral incision should be kept about 1.0 cm in order to reconstruct the external urethra. 8. Reconstruction of the external urethra: Cut the urethral stump into upper and lower or left and right lobes to make the urethral mucosa eversion. The edge of the urethral valve was sutured intermittently with the edge of the skin flap with a No. 0 silk thread to form an outwardly protruding urethral orifice. The balloon catheter is placed in the urethra and the dressing is used to dress the wound. complication 1. Bleeding: mainly caused by the loosening of the dorsal vascular ligation line of the penis, the rupture of the corpus cavernosum and the rupture of the corpus cavernosum. Skin ecchymosis, subcutaneous hematoma or bleeding at the skin suture may occur after surgery. If the reconstructed urethral marginal hemorrhage, hemostatic hemostasis, or "8" suture on the edge of the skin urethra can be used to stop bleeding. Subcutaneous small hematoma can be used to stop bleeding, or cold compress and then hot compress. If the hematoma is larger or gradually increased, the suture should be removed. Line, remove the hematoma, completely stop bleeding. 2. Infection: Wound infection or acute cavernositis can occur. Mainly caused by insufficient control of preoperative infection, postoperative bleeding and urine contaminated wounds. Wound infection should strengthen antibacterial treatment, local hot compress or physiotherapy, and if necessary, disassemble part of the suture to keep the circulation smooth. Acute corpus cavernosum, clinical manifestations of postoperative hyperthermia and penile pain, penile corpus cavernosum tenderness and induration, white blood cells increased, should strengthen the application of antibacterial drugs in time to prevent the spread of infection. 3. Penile scrotal dermatitis: mainly for the urethra is too short, or the penile skin is reserved too much, so that the outer urethra is trapped inside the penis skin, and the urine stimulates the penis scrotum skin after urinating. If the penis is too short, the external urethra can be transplanted into the perineum, such as excessive penis skin, and if necessary, surgical removal of excess skin. 4. Outer urethral stricture: mainly caused by short retention of the urethra, ischemic necrosis of the urethra, no valgus eversion of the urethra and suture of the skin and scar contracture of the incision infection. If the urethral stricture has occurred, the urethra can be dilated first. If necessary, the urethra can be opened, the scar can be removed and the external urethra can be reconstructed, or the external urethra can be transplanted into the perineum.