Phallectomy

Penile amputation, Penectomy, Peotomy
Surgical removal of a part of penis or whole penis

1. Phallectomy Shahzad Hur University Of Veterinary And Animal Sciences

2. Phallectomy Synonyms : Penile amputation, Penectomy, Peotomy Surgical removal of a part of penis or penis(whole organ) or Phallectomy is the surgical removal of the distal extremity of the penis, but the organ remains in the preputial cavity.

3. Indications Malignant Diseases ( when neoplasia has invaded the tunica albuginea or is so extensive that more conservative treatment by cryosurgery, hyperthermia , local excision is impossible.) Traumatic Injury Irreparable Injury Permanent Paralysis Urethral stenosis (distal aspect)

4. Anatomy of Penis Three major parts of penis root (radix penis) body (corpus penis) glans (glands penis ) Functionally triad of structures (three columns of erectile tissue) Two corpora cavernosa penis (CCP; cavernous bodies) One corpus spongiosum penis (CSP; spongy body)

5. Conti…… Muscle of the penis Paired striated Ischiocavernosus Bulbocavernosus (bulbospongiosus) Paired smooth Retractor penis Urethralis muscle Blood Vessels Arteries supplying the penis include the terminal branches of the internal pudendal (or internal pudic), obturator , and external pudendal (or external pudic) arteries Veins are external pudic, perineal and internal pudic vessels

6. Anesthesia General Anesthesia Dorsal or drso-ventral recumbency Ketamine ( Ketarol®) @ 4mg/kg Diazepam (Diazepam ®, Valium ®) @ 0.02-0.4 mg/kg Ketamine : Diazepam (6 ml:4 ml) 1:1 Good results

7. Techniques Williums Technique Vinsot Technique Scott Technique

8. Williums Technique The Glans penis is hooked out of the sheath by the tip of index finger introduced into Navicular fossa (Urethral sinus). A catheter is introduced into urethra and one tourniquet is applied about at the base of penis and one posterior to level of amputation. Triangular urethrostomy is made on the ventral portion of the penis removing the skin, bulbospongiosus muscle and CSP. The triangle is oriented so the apex point proximally and base of the triangle is the site of penile transection.

9. Williums Technique The urethra is split on its midline from the base to the apex of the triangle, and the edges of the urethra and the triangle’s epithelial edges are apposed with simple-interrupted absorbable sutures . After that transect the glans penis circumferentially in gradual way and apposed the sheath or skin with muscular part at the same time by interrupted suture. At the end part of penis is removed and last suture is placed. Remove the tourniquet which was tied at proximal part (base).

10. Vinsot Technique

11. Scott Technique

12. catheterization

13. Triangular urethrostomy

14. Triangle’s epithelial edges are apposed with urethal edges

15. Transect Circumferentially along with perform Suturing

16. Post operative care Fluid therapy Antibiotic therapy for 5 to 7 days Anti-inflammatory therapy for 5 days Transamine injection (avoid hemorrhages or bleeding) Prophylactic dose of ATT Daily Use of Antiseptic Agent

17. Complications B leeding (during surgery….be calm…..no nervousness) Hemorrhage from the penile stump, especially at the end of urination , should be expected for at least several days after Phallectomy. Dehiscence of sutured erectile tissue may lead to the formation of a large hematoma. Other complications of phallectomy in the immediate postoperative period include pain, infection of the surgical wound, edema of the prepuce , and acute urinary obstruction caused by edema of the urethra.

18. Complications Long-term complications include cystitis, dysuria caused by urethral stricture, recurrence of neoplasia at the site of amputation, and neoplastic metastases to inguinal lymph nodes and internal organs.