Penile cancer is one of those diseases that men try their best to avoid even thinking about. For many men in India, even from when they first see something that doesn’t seem right, that delay can be many months, sometimes even years. The delay caused by the stigma, and the fear and embarrassment around the particular diagnosis is what makes the situation worse. Like all other cancers, the treatment and outcome of penile cancer is far better if it is detected and treated early. Advanced stages of penile cancer make treatment difficult.
Change or sore or ulcer or lump of the penis your or someone else’s penile health. The most important treatment to help you is to visit a hospital. Dr. Vikas Singh has a completely private room, and the team from Kokilaben Dhirubhai Ambani Hospital, Nipania, Indore, take great care in consulting and treating you.
Dr. Vikas Singh, Senior Consultant Urologist and Genito-Uro Oncologist has the experience of treating each and every stage of penile cancer. Like the other cancers, early removal of the affected part of the private organ is a good treatment. If you see something abnormal in your genital organs, seek medical help without delay.
The penis is a part of the male anatomy that is used during urination and sexual reproduction. It also contains the urethra and is made up of corpora cavernosa and the corpus spongiosum, all of which is covered by skin and the glans. It also contains a retractable male foreskin. The foreskin has an important link to the development of penile cancer because it can become a warm and moist region that harbors carcinogens and promotes HPV infections.
Penile cancer occurs when the DNA in the penile skin or tissue undergoes abnormal mutations leading to tumor development. These cancers mostly form in the glans and in the foreskin, and along the shaft of the penis because they are most exposed to carcinogens. Further, they also have a higher vapour pressure and higher turnover cell time. Penile cancer can develop in the corpora cavernosa and other deeper structures but this is very rare.
Penile cancer is rare, peaking at under 1% of male cancers in Western countries. However, in places in Asia, Africa, and South America where circumcision is less common, healthcare is less accessible, and HPV vaccinations are less common, penile cancer is diagnosed much more frequently. In India, penile cancer makes up 1-2% of male cancers, and rates fluctuate from region to region. Though rare, penile cancer should be treated and is deserving of awareness and management.
The most important fact to know is that when detected at Stage 0, Stage 1, or Stage 2, which is before the cancer has spread to the lymph nodes, the penis can usually be saved and the cure rate is high. Embarrassment and stigma are the real tragedies of penile cancer because they allow an early stage disease of a curable nature to be treated only by more extensive surgeries.
Squamous Cell Carcinoma (SCC) is responsible for around 95% of penile cancers. SCC is cancer of the squamous cells (flat, scaly cells) that form the skin on the penis, more specifically the glans and the inner prepuce (foreskin). SCC can be poorly differentiated (abnormal, faster growth with higher metastasis) or well-differentiated (normal-looking squamous cells, slower growth, less risk of spreading).
SCC of the penis is linked to HPV (Human Papillomavirus) infection (HPV 16 and 18) and other etiologies like chronic phimosis, poor genital hygiene, lichen sclerosus, and tobacco use. Invasive SCC is proceeded by many premalignant lesions. When they are present on the internal foreskin, they are called Penile Intraepithelial Neoplasia (PeIN) or erythroplasia of Queyrat when they are on the glans. These changes can be treated and identified early, preventing cancer from becoming invasive.
Penile melanoma is an aggressive cancer type and comprises about 1 to 2% of all penile cancers. Melanomas arise from pigment-producing cells (melanocytes) and can be characterized by a dark, irregularly shaped, pigmented lesion located on the glans and/or the foreskin. Melanomas have also been noted to have an aggressive trait of rapidly spreading to the surrounding lymphatics and other organs through the blood. Because of the nature of this disease, early surgical excision and assessment of the sentinel lymph nodes is indicated. For metastatic penile melanomas, as with other metastasized melanoma types, systemic immunotherapy and targeted therapies are utilized. These include checkpoint inhibitors and therapies directed against BRAF mutations.
BCC (Basal Cell Carcinoma) is not a common case and is approximately 2% of all penile cancers. It usually develops on the penile shaft and, like other year BCC cancers, will not metastasize. Surgical excision is the preferred treatment method. BCC is non-metastatic and the prognosis for BCC of the penis is excellent.
Adenocarcinoma of the penis is thought arise largely from glandular or accessory urethral glands (Tyson’s or Littre’s) or possibly from ectopic prostate tissue in the penis. It is an exceedingly uncommon subtype of penile cancers and often accounts for less than 1%. It may have different biological behavior ranging from SCC as it also may express PSA (prostate-specific antigen) from ectopic prostate tissue which carries treatment considerations. The mainstay treatment remains surgical.
Penile sarcomas come from mesenchymal tissue of the penis instead of skin cells. Common subtypes of penile sarcomas are leiomyosarcoma (from smooth muscle), rhabdomyosarcoma (from striated muscle; more common in children and adolescents), and Kaposi’s sarcoma (from vascular endothelium, usually associated with HIV/AIDS). Though rare, penile sarcomas are aggressive and require various modes of treatment including surgery, chemotherapy, and possibly radiation. The uro-oncologist should be contacted at the earliest opportunity for the best chance of successful treatment.
Penile cancer staging follows the TNM system. This includes the depth of the Tumour, the involvement of Nodes, and Metastasis. Prognosis mostly hinges on the depth of tumour invasion and the extent of inguinal lymph node involvement. A bare bones schematic is as follows:
Stage | Tumour Depth / Extent | Lymph Nodes | 5-Year Survival |
Stage 0 (Tis) | Carcinoma in situ – cancer cells on surface only, no invasion | None | Above 95% |
Stage 1 | T1a – into subepithelial connective tissue, no LVI; low grade | None | 80–90% |
Stage 2 | T1b (LVI or high grade) or T2 (corpus spongiosum) or T3 (urethra) | None | 70–80% |
Stage 3A | Any T with invasion of corpora cavernosa | Mobile inguinal nodes (N1–N2) | 50–65% |
Stage 3B | Any T | Fixed inguinal or pelvic nodes (N3) | 30–40% |
Stage 4 | Any T, any N | Distant metastasis (M1) | Below 20% |
Stage 0 penile cancer, also known as carcinoma in situ (CIS), Penile Intraepithelial Neoplasia (PeIN), or when affecting the glans, erythroplasia of Queyrat, means cancer cells are located on the surface of the skin of the penis without evidence of invasion into other areas of the penile tissues. Red, velvety patches are typical of peniloepithelial carcinoma CIS and are flat, well-defined areas that can appear as lesions on the glans penis or on the inner layer of the foreskin and may or may not be symptomatic. Organ-preserving local treatments (e.g. Imiquimod cream, 5-Fluorouracil topical, circumcision, laser ablation) can be performed. CIS is curable and the removal of the penis is not indicated. Before treatment, Hopkins’ guidelines suggest biopsy of all Stage 0 lesions to confirm the diagnosis and to rule out any disease that is not CIS and is invasive within the tissues.
Stage 1 (T1) describes cancer that has penetrated the surface skin and extended into the subepithelial connective tissue. This is the connective tissue that is immediately below the skin. There are two subgroups of Stage 1, T1a (which has neither LVI or LVI with low grade) and T1b (which has LVI and is high grade). Surgery that preserves the organ affected by cancer provides an excellent chance of survival for T1a patients. On the other hand, patients with a T1b grade have a significant chance that the cancer will spread to the lymph nodes. Because of this, T1b patients are recommended to have a DSNB or sentinel lymph node biopsy even though the lymph nodes are in the inguinal area are not affected and appear normal.
Stage 2 includes T1b tumors with LVI (unless classified Stage 1b in some systems), T2 tumors, and T3 tumors. L2 and T3 tumors (especially T3 tumors) grow into the urethra. As the tumor extends further into the erectile tissue and urethra, the lymph nodes are more likely to be involved; this risk grows from around 15%-20% for T1a tumors to 35%-50% for T2/T3 tumors. At Stage 2, inguinal lymph node assessment is warranted, even when the nodes are clinically examined and appear normal.
Stage 3 cancer means it has metastasized into the inguinal lymph nodes. In Stage 3A, the cancer has spread into mobile (surgically removable) inguinal lymph nodes. In Stage 3B, the cancer has metastasized into pelvic lymph nodes, and inguinal lymph nodes are either fixed or matted. Inguinal lymph nodes are the most significant prognostic element for penile cancer. The five-year survival rates for those with resectable inguinal node involvement is 50 to 65%, while survival is reduced to 30 to 40% if pelvic lymph nodes are involved. Stage 3 cancer will always need ILND, and large or fixed lymph nodes may require neoadjuvant chemotherapy prior to surgery.
Stage 4 penile cancer refers to metastasis beyond regional lymph nodes, including to the lungs, liver, bones, or brain. Distant metastasis is always associated with an unfavorable prognosis. This is largely due to the fact that, for most patients, there is no systemic therapy that has been proven to be associated with durable long-term remission. Treatment is mainly palliative, including managing symptoms and improving/ prolonging the patient’s quality of life. For metastatic squamous cell carcinoma of the penis, the use of cisplatin-based chemotherapy (TIP – paclitaxel, ifosfamide, cisplatin, or BMP – bleomycin, methotrexate, cisplatin) is the standard. Research in the field of immunotherapy remains in the early stages. Palliative radiation is used to target symptomatic metastatic disease and to manage symptoms related to local disease.
The cancer with the longest late reporting in terms of seeking treatment for symptoms in India, is Penile cancer. There have been documented cases that stated an average delay of 6-12 months from the time the symptoms are first identified followed by reporting to a medical practitioner. The delay is almost exclusively owing to the hope that the issue is temporary, embarrassment and the social stigma that is associated. Do not make this mistake. Penile cancer in its first stage and that which is yet to metastasize to the Cervical LymphNodes, can with almost a 100% guarantee be treated with procedures that will not be detrimental to the organ. Delay reporting of Penile cancer is a lot more complicated and will require even more extensive procedures.
Perhaps the largest red flag for the presence of penile cancer is a new growth on the penis that keeps coming back, is raised, and is ulcerated or sore and that persists for longer than 3 weeks despite good hygiene. This may be a sore that develops on the glans, the foreskin or the coronal sulcus, which is the area between the shaft and glans of the penis, and does not go away. These can be warty or resemble cauliflower, a flat red patch, a white plaque, or irregular, open sores that may have abnormal edges. In it’s early stages, this growth is typically painless which may give men false assurance that is it not dangerous. It is strongly recommended that any nonhealing ulcerated or sore growth that is raised and persists on the penis should be urgently assessed and evaluated by a urologist.
A gradual thickening, hardening, or discoloration – especially the appearance of red, white or dark colored patches – of the glans or of the foreskin, which do not respond to hygiene care, could be indicative of lichen sclerosus, penile intraepithelial neoplasia (PeIN) or early invasive cancer. The appearance of white patches on the glans (leukoplakia) or red, velvety patches (Queyrat erythroplasia) are alarming. These lesions are pre-cancerous or incipient cancer lesions which can be cured in their early stage and which need to be biopsied without delay.
Chronic redness, irritation, or a rash on the glans or foreskin are other symptoms. When these symptoms are present and do not respond to antifungal or antibiotic creams, these should not be assumed to be infections. Cancer of the penis may present as a skin area resembling a chronic dermatitis or balanitis. If the skin of the penis changes and does not respond to treatments within the standard 4 to 6 weeks, testing to exclude the possibility of malignancy must be done through a biopsy. Dr. Vikas Singh provides a service of performing a penile biopsy with local anaesthesia. It is a quick and easy procedure that allows a definite diagnosis to be made through histopathological examination.
If a man has not been circumcised, foul-smelling, purulent, or blood-stained discharge from beneath the foreskin may be caused by advanced penile cancer if a tumor develops under the foreskin and is either infected or is necrotic. This symptom is more commonly the result of balanitis or the build-up of smegma from inadequate hygiene. However, in the case of a non-healing lesion or unnaturally thickened foreskin, immediate assessment is required. Diagnosis-related circumcision allows full assessment of the glans and inner foreskin and allows confirmation or exclusion of an underlying tumor.
For men with a penile lesion and inguinal lymphadenopathy, enlarged lymph nodes in the groin indicate metastasis to regional lymph nodes and stage 3 disease. The swollen lymph nodes typically present as firm or hard masses in the groin. Most importantly, inguinal lymphadenopathy does not necessarily mean cancer has spread in the case of a penile lesion. It may indicate a case of reactive lymphadenopathy to a penile infection or inflammation. Nevertheless, it should be taken seriously. A computed tomography (CT) scan and, in some cases, a lymph node biopsy should be performed to identify whether the inguinal lymphadenopathy is reactive and benign or if it is metastasis.
Particularly the oncogenic HPV-16 and HPV-18, HPV infections are the main risk factor leading to the development of penile cancer. HPV is a common sexually transmitted virus worldwide and is likely to be encountered at least once by most sexually active males and females worldwide. Most HPV infections are self-limiting and are cleared by the immune system within 1 to 2 years. In some males, however, chronic HPV infection results in genetic changes in the penile skin cells which culminates firstly in the development of penile intraepithelial neoplasia and finally invasive squamous cell carcinoma.
About 40 to 50% of squamous cell carcinoma of the penis (SCC) is due to HPV infection. The development of such cancers is more likely to occur in individuals with more than one sexual partner, those with an early age of first sexual experience, those with a personal history of any HPV associated disease (i.e., genital warts, anal dysplasia, head and neck HPV cancers) as well as those with a poor immune status. The best preventive measure against HPV-associated penile cancer is the vaccination of boys and young men before they become sexually active.
Phimosis is where the foreskin cannot retract over the glans, and is a leading non-HPV related cause of penile cancer. The mechanism is complex. Smegma is a mixture of shed cells and various biological fluids that accumulate under the foreskin. When circumscribed, the smegma causes local irritation and inflammation, and a breeding ground for bacteria is released and allowed to grow. Circumcision removes the environment that harbors smegma, bacteria and HPV, and studies show that it radically reduces the incidence of penile cancer. Phimosis is found in up to 75% of patients with penile cancer.
The risk of getting penile cancer is 3 to 5 times greater with cigarette smoking; tobacco carcinogens circulate in the blood and urine which may impact the urogenital epithelium. Further, smoking cigarettes and HPV infection have a synergistic role in carcinogenesis through DNA damage in penile epithelial cells. There is no safe age to quit smoking. Quit smoking to reduce the risk of penile cancer. This is part of the total risk counselling Dr. Vikas Singh provides to all penile cancer patients.
Whether caused by HIV/AIDS or other factors, a weakened immune system increases a person’s risk for a number of cancers related to the Human Papilloma Virus (HPV), including cancer of the penis. HIV/AIDS increases the risk of developing cancer of the penis by many times when compared to those who do not have the disease, and the tumors that develop may be even more aggressive. The treatment of this type of cancer in HIV/AIDS patients has to be done by a number of different specialties in a coordinated manner, with particular emphasis on the improvement (optimization) of the antiretroviral drugs.
Lichen sclerosus (LS) is called Balanitis Xerotica Obliterans (BXO) when it occurs on the penis. As a chronic inflammatory skin condition, LS causes white scarring plaques on the foreskin and glans. There is a high risk of developing penile cancer with LS since 30 to 50% of penile cancers are linked with LS. LS progressively causes phimosis, destroys the glans, and creates a chronically inflamed cellular environment which can cause cancerous changes. Men with lichen sclerosus need dermatology and urology check-ups on a regular basis and any new skin changes on LS should be biopsied without delay.
Management of penile cancer is influenced by the extent, site, and dimension of the primary tumour, the histological grade of the cancer and the patient’s age and general condition, as well as their preferences. Dr. Vikas Singh aims for total clearance of the cancer with maximum preservation of penile tissue if it is oncologically safe. This goal balances cancer eradication and quality of life.
Penile-preserving surgery, also known as organ-sparing surgery, keeps as much of the remains of the penile anatomy intact as possible, and keeps functionality as well. While organ-sparing surgical techniques are all able to treat penile cancer, they are the preferred techniques, especially for small and early stage tumors of the glans or the foreskin.
With this procedure, the tumor along with some surrounding normal tissue, is removed. It is also used for small and superficial lesions along the penile shaft. Reconstruction is performed to the best cosmetic effect along the penis shaft after removal.
For tumors that are only located in the glans, surgery will allow the removal of some or all of the outer surface of the glans. The underlying structures of the glans and the glans organ itself are preserved, and the opening will be covered with a skin graft. For the majority of patients, sexual function is preserved.
For tumors that are located only in the foreskin, circumcision is rectifying and removes the the foreskin. It is also performed as part of diagnostic evaluation for all patients suspected of having penile cancer and are uncircumcised.
Partial penectomy is a surgical procedure that removes the distal (outer) part of the penis and a surrounding margin of healthy tissue, as well as penial tumors, and retains the proximal (inner) part of penis. In some cases, (with a stump that is only about 3 or 4 cm) post partial penectomy, the patient remains able to urinate while standing and may keep some sexual feeling or the ability to engage in sexual activities.
Those who have T2-T3 tumors that have grown into the corpora cavernosa or the penis’s urethra and have made organ-salvaging surgeries impossible should have a partial penectomy performed. Recurrence of cancer in the area (less than 5%) is rare when surgery is performed with a safe margin. After a partial penectomy, surgery can also reshape the urethra (meatoplasty) to allow better control of urination.
Total penectomy means removing the whole penis. This is applicable for penile cancers that have advanced to the entire shaft and/or base, and where penectomy is performed to leave tumor-free surgical margins. After total penectomy, the urethra is diverted to the perineum with a perineal urethrostomy. After this surgery, patients urinate through this new opening, and are left with the option of using the toilet in a sitting or squatting position.
Total penectomy is a long and psychologically challenging procedure. Doctor Vikas Singh also believes that the best way to approach the surgery is to give ample time to both the patient and family for discussion, aiming to address all concerns, especially the concerns pertaining to the future of elevation and function of urine, the function and absence of normal operation of coitus, and the available psychological supports. The support and rehabilitation will include post-operative therapy, counselling, and sex therapy. Where appropriate, the indications for total penectomy mean the procedure is life-saving, and many patients do remarkably well, particularly with the support.
Inguinal Lymph Node Dissection (ILND) involves the surgical removal of lymph nodes located in the groin and is necessary for managing penile cancer if patients show clinical and/or pathological lymph node involvement. The prognosis of penile cancer is most heavily influenced by the condition of the inguinal lymph nodes.
Sentinel Lymph Node Biopsy (SLNB) / Dynamic Sentinel Node Biopsy (DSNB): For patients without enlarged lymph nodes on examination or CT, who have intermediate or high-risk primary tumors, sentinel lymph node biopsy is done to check for metastasized lymph node cancer. Near the tumor site, a radioactive tracer and blue dye are injected to flow through the lymphatics and reach the sentinel lymph nodes. These nodes are surgically removed to check for metastasis through a pathological examination. If no cancer is found in the sentinel lymph nodes, a complete inguinal lymph node dissection (ILND) is not needed. If the nodes are positive, a complete ILND is performed.
Bilateral Inguinal Lymph Node Dissection: Since the penis drains to both inguinal regions, patients are usually bilateral inguinal lymph node dissection (ILND) recipients. A modified ILND (with smaller template, nerve sparing) involves fewer complications than the classic radical ILND, but remains oncologically adequate for patients with lower stages of node involvement. In cases with extensive, fixed inguinal node disease, the full radical ILND is warranted.
Among complications of ILND are limb lymphedema, which is the most common long-term complication, along with necrosis of the skin flap, wound infections, and seroma. Less invasive laparoscopic or video endoscopic ILND techniques, which Dr. Vikas Singh offers, greatly reduce these complications.
Laser ablation (Nd:YAG and CO2 laser) is a way to vaporize the diseased tissue. Compared to other methods of treating early and superficial penile malignancies, the other techniques either damage the tissue surrounding the malignancy or even remove the tissue completely. Other advantages of laser ablation are that patients can undergo the procedure without having to stay in the hospital overnight, local anesthesia can be used during the procedure, multiple lesions can be treated during a single session, and the sensation of the penile tissue can be preserved. Last, the lesions can be treated with little cosmetic damage.
A disadvantage to laser ablation is that it does not allow for a sample of tissue to be removed for a pathological examination. Thus, a diagnostic biopsy is needed to confirm the diagnosis and to rule out the presence of regional invasive cancer. For PeIN and CIS as well as very superficial Stage 1 malignancies, laser ablation is an appropriate treatment option. If a tumor is clinically or pathologically suspicious for deeper invasion, then histological evaluation after complete surgical tumor removal is the appropriate treatment.
In patients with T1 to T2 tumors of the glans who desire organ preservation and understand the risk of preserving organ functionality, radiation therapy can be a penile preserving option instead of a partial penectomy. There are two main radiotherapy modalities for penile cancer. These include External beam radiation therapy and brachytherapy.
Brachytherapy can be used for small tumors of the glans and can achieve excellent control and preservation of function. External beam radiation therapy can be used for larger tumors and in cases when brachytherapy is not available. Despite the need for brachytherapy, radiotherapy can have multiple sequelae including stricture formation of the urethra, fibrosis of the skin, and an increased rate of local recurrence. These should be discussed with the patient prior to treatment. Adjuvant radiation may be applied post-operatively in cases where surgical margins are positive and in the case where there is extension to the lymph nodes.
Systemic chemotherapy is essential to managing locally advanced and metastatic penile cancer.
For patients with large, fixed, or unresectable inguinal lymph nodes (N3 disease), nodal disease may shrink to make previously unresectable nodes resectable, allowing for ILND. The most common neoadjuvant regimen is TIP (paclitaxel, ifosfamide, cisplatin). Meaningful surgery can be offered to a larger number of patients due to 30-40% response rates.
After Inguinal Lymph Node Dissection (ILND), patients with pN2 or pN3 status (defined by multiple positive nodes or an extension beyond the node’s capsule) benefit from the administration of adjuvant chemotherapy as it significantly lowers the risk of distant metastasis. In this patient population, either the TIP (cisplatin, ifosfamide, and paclitaxel) or TPF (docetaxel, cisplatin, 5-fluorouracil) regimens are offered.
For patients diagnosed with Stage 4 disease, TIP or BMP (cisplatin, methotrexate, and vinblastine) regimens are the principal treatment options. In approximately 25 to 40% of patients, these regimens will result in a significant therapeutic response and, consequently, provide symptom relief along with a temporary respite from disease progression.
Response rates for checkpoint inhibitors in patients with penile SCC are 15-20%, and may be even higher in heavily pretreated patients. Emerging research shows distinct advantages of cetuximab, a cisplatin-resistance therapy for SCC in Penile cancer. These drugs have recently entered India and are part of the treatment regimen of select patients under the care of Dr. Vikas Singh and the medical oncology team.
A powerful penile cancer prevention tool is the vaccination for HPV, which is also helpful in the prevention of HPV-associated cancers of the cervix, anus, and the cancer of the head and neck.
Currently, Gardasil 9 (the nonavalent vaccine) protects against the nine HPV types (high-risk types 16, 18, 31, 33, 45, 52, and 58) and is licensed for both males and females. In boys, HPV vaccination protects against genital warts (caused by HPV types 6 and 11), PeIN and penile cancer (caused by HPV type 16 and 18), respectively.
HPV vaccination facts for males:
Recovery after treatment for penile cancer, be it organ-preserving or something more involved, requires recovery of both the mind and body. There is great focus on this by Dr. Vikas Singh and supporting staff for the entire recovery phase.
Yes, most patients with penile cancer will have successful treatment especially when there is no spread to the inguinal lymph nodes. Cure rates with early treatment for stage 0 and 1 are 80% to 95%. Even stage 3 with spread to the inguinal nodes is curable in 50% to 65% with the combination of surgery and chemotherapy. The key factor in achieving cure is early diagnosis and treatment.
Penile cancer is diagnosed with biopsy. That means that some of the tissue from the concerned lesion is taken, and a pathologist examines it under a microscope. It requires local anesthesia and a good amount of time is not necessary. It is performed with the patient being an outpatient. It is common to perform a physical exam and a test to check the scrotum and/or penis with sound waves. When the diagnosis is confirmed, it is common to perform scans with the CT machine for staging the abdomen, pelvis, and chest; and to perform a sentinel lymph node biopsy to check the inguinal lymph nodes.
Penile cancer itself is not contagious. The HPV infection that is linked to penile cancer is contagious through direct sexual contact. Thus HPV related penile cancer patients should inform their partners accordingly. Female partners should get a recent Pap test and HPV vaccine. Males should also get vaccinated for HPV where eligible.
Yes, in several instances, surgery that preserves the penis is both possible and the preferred method of treatment for the early stages of the disease. In cases involving Stage 0 and Stage 1 tumours, many different organ-preserving techniques (e.g., wide local excision, glansectomy with reconstruction, laser ablation, or radiotherapy) can result in a complete cure of the cancer with preservation of the penis. In cases where the tumour is of large size, or of considerable depth and beyond the reach of surgery that preserves the penis, then a partial or total penectomy is the only option. Dr. Vikas Singh aims for the least radical and most surgery-preserving method that is oncologically safe for every single patient.
The major prevention strategies are circumcision (removes the foreskin, where HPV is likely to persist and carcinogenic material is likely to accumulate), the HPV vaccination (before sexual activity begins), maintaining genital hygiene in uncircumcised males, stopping smoking, performing routine penile self-examinations, and seeking medical attention for any penile lesion that does not heal within 2 to 3 weeks and keeping follow-up appointments for routine examinations. For lichen sclerosus patients, prompt specialist follow-up and prompt biopsy for any new lesions are important.
It is surgically dependent. Following a wide local excision, glansectomy, or even a partial penectomy, men can retain sexual functions such as erections and orgasm, and the ability to penetrate. Organ-preserving surgeries can alter the male sexual organs. Remaining tissues, after total penectomy, cannot achieve sexual penetration, but it is possible to have sexual intimacy and relationships. Sexual orgasms can still be achieved through the stimulation of the remaining erogenous zones. Other types of sexual intimacy are also still possible. Dr. Vikas Singh, even with the sexual alterations of surgeries, still provides reconstruction surgery with realistic expectations. Singh also provides a referral for sexual therapy and sexual counseling for patients of his choice.
Following organ-preserving surgery and partial penectomy, patients are able to stand and urinate through the remaining penile stump, or through a reconstructed urethral meatus. Once total penectomy is performed, all urination occurs through the perineum. An artificial, permanent opening for urination is made in the perineum, and thus urination occurs by remaining seated or squatting. Most patients are able to adjust completely to the perineal urethrostomy, and continue to have urinary function throughout (continence, flow, infection free).
Surgery to address primary tumors (wide local excision, glansectomy, penectomy, partial or total) requires open procedures since direct access to the structures of the penis is necessary. Compared to traditional open inguinal dissection, laparoscopic or video-assisted inguinal lymph node dissection (ILND) minimizes the rate of wound complications and lymphoedema, as the surgery is performed through small incisions (keyhole) in the groin. At Kokilaben Hospital, Dr. Vikas Singh carries out video-assisted ILND for cases that require it.
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