Total or Radical Penectomy 751 Preoperative Staging

Radical penectomy is reserved for cases where extensive tumor involvement of the penile shaft necessitates complete excision of the penis and crura. Again preopera-tive MRI is useful in order to demonstrate the proximal extension of the tumor as there may be skip lesions extending proximally. Figure 7.11 shows an extensive tumor which has been imaged using MRI confirming that the tumor involves the pendulous penile shaft as well as multiple skip lesions more proximally. Therefore adequate tumor margins can only be obtained by performing a total penectomy. The level of dissection does not have to extend to include the crural attachment with the pubic bone unless there is tumor involvement of the proximal crura. It is useful to preserve the crura in patients who are to be considered for reconstruction using phalloplasty procedures at a later date as they provide a support for the proximal ends of the penile prostheses used during reconstructive surgery (see Chap. 11).

However, in some advanced cases of penile cancer the tumor extends proximally to involve the crura and pubic bones. In these patients a conventional radical penectomy is required which involves detaching the crura from the pubic bone. Patients with extensive sarcomas of the penis or recurrent disease in the penile stump may also require a radical penectomy. Rarely metastatic disease from the genitourinary system presents with nodular lumps within the corpus cavernosum and again MR imaging is useful for diagnostic evaluation (see Chap. 4 for examples of metastatic disease infiltrating the penis).

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