Phallus preservation for urethral cancer: Subcutaneous penectomy

Purpose: We present a new alternative to amputating penectomy, subcutaneous penectomy, in the male patient with urethral cancer. Materials and Methods: The surgical management and followup of 3 men with squamous cell cancers of the urethra are reviewed. Results: At 22, 9 and 6 months postoperatively all patients were without evidence of local recurrence and were satisfied with phallic appearance. In 1 of 2 patients in whom the dorsal neurovascular bundle was not preserved there was distal glans necrosis and wound separation which resolved after conservative management. One of the 3 patients is contemplating phallus reconstruction. The patient who had pelvic lymph node metastases before penectomy died of metastatic complications without local failure 9 months postoperatively. Conclusions: Phallus preservation in men with urethral cancer can be accomplished successfully with this type of procedure. The dorsal neurovascular bundle should be preserved when feasible. We contend that the cosmetic and potential reconstructive outcomes are superior to amputation without sacrificing cancer therapy in the appropriately selected patient.