total penileectomy

Total penile resection is a surgical procedure for the treatment of advanced penile cancer. It cuts the corpus cavernosum at the foot of the penis, frees the urethra and reconstructs the urethra outside the perineum. Treating diseases: penile cancer Indication Total penile resection is available for: 1. In the advanced stage (T2 or higher) of penile cancer, the cancer infiltration has reached more than half of the penis, and the residual penis is less than 2 cm. Or although the performance of cancer is limited, but the penis sponge has been infiltrated, if the penile remnant is barely preserved, it can not preserve sexual function, and there is the possibility of residual cancer. Total penile resection should be performed. 2. Late penile cancer, cancer has distant metastasis, can not be radical surgery, in order to eliminate malodor, pain, bleeding and dysuria, can also perform total penile resection. Tumor invasion of the penis has been extensive, and the proximal penis of the tumor is less than 3cm. Total penile resection should be performed to reduce the chance of recurrence. 3. The penis is cut off at the proximal end of the penis or the bullet is wounded, causing the entire penis to be completely isolated or substantially ex vivo, unconditionally or unable to perform penile replantation. 4. If the cancer has spread to the scrotum, the penis scrotum should be removed together. Contraindications The inguinal lymph node metastasis has oppressed the blood vessels of the place and edema of the lower extremities, or has been transferred to the blood. Preoperative preparation 1. 2d before the operation, enter the slag and semi-flow diet, and enema one time before the operation and the morning of the operation. 2. Apply antibacterial drugs to control infection. 3. 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. 4. Suspected penile cancer should be examined by biopsy before surgery. 5. Patients with suspected lymphatic metastasis should have a biopsy of the inguinal lymph nodes before surgery. 6. Explain the need for surgery to patients and their families, and eliminate concerns. 7. Shave the pubic hair 1d before surgery and wash the penis and scrotum with soapy water and water. Surgical procedure 1. Wrap the penile tumor Rinse 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 prevent tumor tissue from contaminating 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 A 2 cm longitudinal incision was made above the pubic symphysis of the penis root, and then a fusiform incision was made around the root of the penis, and the medial scrotal mediastinum was extended 2 cm in length from the medial side of the lower end. 3. Free penis A fusiform incision along the base of the penis, the penis skin and fascia are cut, and the penile suspensory ligament is separated and cut off on the dorsal side, and the lymphoid tissue between the superficial layer of the lower abdomen muscle layer and the spermatic cords on both sides is removed. The dorsal artery, vein, and nerve of the penis are then separated, and the root is cut at its root and the vascular end is double ligated. 4. Cut the urethra The penis was turned upside down, and the urethral sponge was cut at a distance of 2.5 cm from the ventral side of the penis. The distal end was ligated, and the proximal end was temporarily clamped with tissue forceps to stop bleeding. The urethral sponge was freed from the surface of the corpus cavernosum by scissors and continued to be separated to the proximal end, reaching the urethra of the ball. 5. Cut the corpus cavernosum The penis is turned down, and the corpus cavernosum is free along the surface of the corpus cavernosum on both sides, reaching the pubic branch. Use a vascular clamp to pass between the penis and foot, and make a blunt dissection. Clamp and close the penis foot near the pubic branch. The stumps of the two penis feet were sutured with a 4th wire. 6. Urethral perineal transplantation A straight incision about 2 cm long was made in the middle of the perineal area. The skin and fascia were incised, and the incision was communicated with the original incision, and the urethral stump was pulled out from the incision so that the urethra protruded outward by about 1 cm. The urethra was examined without angular distortion, and the anterior layer of the urethral sponge and the fascial tissue of the perineal incision were intermittently sutured with a thin wire. The outer urethral opening is cut into upper and lower or left and right lobes, and the urethral mucosa valgus is aligned with the incision skin edge, and the filaments are intermittently sutured to form an outwardly protruding urethral orifice, and a double-chamber balloon catheter is placed. 7. Suture incision The wound was repeatedly washed with distilled water to check for bleeding, and a rubber drainage strip was placed in the incision, and the incision was sutured longitudinally or horizontally. complication 1. Bleeding: Due to incomplete hemostasis during operation, vascular ligation line slippage, improper treatment of the corpus cavernosum residue, severe cases can form scrotal hematoma. Mild hemorrhage can be used to stop bleeding, local hot compress after hot compress, and strengthen anti-infection measures. If there is more bleeding or scrotal hematoma formation, the suture should be removed, the hematoma should be removed, the bleeding should be completely stopped, and the drainage should be smooth. 2. Infection: Many infections were not controlled due to preoperative infection, intraoperative wound infection, postoperative bleeding and poor drainage caused infection. In severe cases, scrotal skin necrosis and scrotal abscess may occur. If the infection occurs, the application of antibacterial drugs should be strengthened, local physiotherapy should be maintained, and wounds should be kept flowing. If an abscess is formed, the drainage should be cut open. 3. urethral stricture: due to necrosis or too short urethral orifice, perineal wound bleeding, infection and so on. If stenosis has occurred, regular urethral dilatation or urethral opening may be performed.