Medical Oncologist
CION Cancer Clinics
Total penectomy and perineal urethrostomy explained | CION Cancer Clinics
A total penectomy removes the whole penis. In the same operation, a perineal urethrostomy brings the urine tube out to a new opening behind the scrotum, so you pass urine sitting down with normal control. The testicles are usually kept. It is offered when the cancer has grown too far along the shaft for a smaller operation to be safe. This page explains what happens and what changes. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What are a total penectomy and a perineal urethrostomy?
- What changes, and what stays the same?
- What happens from the operation to going home?
- Words you will meet, in plain language
- Four fears we hear, and what is actually true
- What should you watch for in the weeks after?
- Common questions about total penectomy
The short answer
What are a total penectomy and a perineal urethrostomy?
A total penectomy removes the whole penis, including the part that sits inside the body at its base. A perineal urethrostomy is done in the same operation: the urine tube is brought out to a new opening in the skin between the scrotum and the back passage, so you pass urine sitting down. The testicles and scrotum are usually kept.
When it is offered
It is offered when the cancer has grown so far along the shaft that a partial penectomy would either leave cancer behind or leave too little to pass urine standing. It may also be offered when cancer comes back after a smaller operation. It is the largest operation on the penis, and surgeons recommend it only when a smaller one would not be safe.
Who it does not suit
It is not needed when a partial penectomy can remove the cancer with a clear margin and leave a working length. When the cancer has spread widely beyond the groin, surgery on the penis may not be the first treatment, and chemotherapy or radiotherapy may come first. Your team weighs this, and a page like this cannot.
If you have been told this is the operation you need, you are entitled to ask why a smaller one is not possible. A good team will answer that clearly.Life afterwards
What changes, and what stays the same?
These are the questions men and their wives ask most. The answers are typical. Your surgeon can tell you what applies to you.
Passing urine
You sit on the toilet, as a woman does, and urine comes from the new opening behind the scrotum. Control is not affected, because the valve that holds urine in sits deeper, near the bladder.
Hormones and body
The testicles are kept, so male hormones are still made. Beard, voice, muscle and desire are not changed by the operation itself.
Sex and intimacy
Penetrative sex is no longer possible. Many men still feel desire and can reach orgasm through touch around the scrotum and the area of the new opening. Intimacy with a partner remains possible.
What helps
- Talking with your wife early
- Counselling, alone or together
- Asking the team about reconstruction later
Appearance
The area where the penis was is flat, with a scar. The scrotum is still there. Loose underwear and ordinary clothes look the same as before.
Not sure whether this applies to you?
Ask an oncologistIn hospital
What happens from the operation to going home?
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Before the operation
You meet the surgeon and anaesthetist, sign consent, and have blood tests. You are asked not to eat for some hours beforehand. Bring the family member who will be with you afterwards.
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The operation
Under a general or spinal anaesthetic, the penis is removed down to the bone at its base. The urine tube is freed, brought out behind the scrotum and stitched to the skin to make the new opening.
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Waking up
You wake with a catheter, a soft tube draining urine, and a dressing over the wound. There may be a small drain. Pain relief is given regularly at first.
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The first days on the ward
The nurses help you get out of bed early, which lowers the risk of clots. You start eating and drinking. The wound is checked each day.
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The catheter comes out
Once the new opening has healed enough, the catheter is removed and you pass urine sitting down. The nurses stay with you the first few times.
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Going home
You go home when you are walking, passing urine and the wound looks settled. You are given a clinic date to discuss the laboratory report and the plan for the groin glands.
On your report
Words you will meet, in plain language
- Perineum
- The area of skin between the scrotum and the back passage. The new urine opening is made here.
- Urethrostomy
- A new opening for the urine tube made in the skin. Perineal urethrostomy means the opening is in the perineum.
- Meatal stenosis
- Narrowing of the urine opening as it heals. It shows as a weaker or thinner stream and can be treated.
- Inguinal lymph nodes
- The glands in the groin. Penile cancer spreads here first, so they are checked and sometimes removed.
- Margin
- The rim of healthy tissue removed around the cancer. A clear margin means no cancer cells were found at the cut edge.
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Commonly believed
Four fears we hear, and what is actually true
"I will leak urine all the time."
The valve that keeps urine in is near the bladder, not in the penis, and it is not touched. Most men have normal control after healing. You go to the toilet when you need to, sit down, and pass urine as usual.
"I will need a bag for urine."
The catheter is only for the first days after the operation. After it comes out, urine comes through the new opening with no bag. A urine bag is not part of this operation.
"It is better to refuse and try other treatment first."
When a total penectomy is advised, it is usually because the cancer is too far along the shaft for anything smaller. Delay lets it spread to the groin, which is harder to treat. You can and should ask for a second opinion, but ask for it quickly.
"My marriage will not survive this."
Many couples find their relationship holds, and sometimes grows closer, once the fear of the unknown is gone. Talking early, including with a counsellor, makes a real difference. Your wife is welcome at every appointment.
At home
What should you watch for in the weeks after?
Recovery takes several weeks. The wound heals first. The emotional adjustment often takes longer, and that is normal.
The wound and the new opening
Keep the area clean and dry, and follow the dressing advice you are given. Wear loose underwear. Avoid heavy lifting and long periods of sitting on hard surfaces until the surgeon says the wound has healed. Call the team if the wound becomes red, hot or swollen, if it leaks pus or smells, or if you have a fever.
The stream
Urine may spray at first. Leaning forward on the toilet helps direct it. If the stream becomes thinner or you have to strain over the weeks, the opening may be narrowing. That is common and can be treated, so report it early. If you cannot pass urine at all, go to an emergency department the same day.
Your mind
Low mood, anger and grief are common after this operation. They are not weakness. Ask the team about counselling for yourself and your wife. Talking to someone who is not family can make it easier to say what you are feeling.
Did you know
Building a new penis, called phalloplasty, is possible for some men after a total penectomy. It is a separate, staged operation done well after cancer treatment has finished and follow-up is settled, and it is not right for everyone.
Questions we are asked
Common questions about total penectomy
Why can I not have a partial penectomy instead?
Usually because the cancer has grown too far along the shaft. A partial operation would either leave cancer behind or leave too little to pass urine standing. Ask your surgeon to show you on the scan where the cancer reaches. A second opinion is reasonable, as long as it does not cause long delay.
Will the testicles be removed?
Usually not. The testicles and scrotum are kept in most total penectomies, so male hormones continue as before. Very rarely, if the cancer has grown into the scrotum, more has to be removed. Your surgeon will tell you beforehand if that is being considered.
How long will I be in hospital?
Longer than for smaller operations on the penis, and longer again if the groin glands are removed at the same time. Ask your team for the typical stay for your planned operation. Arrange for a family member to be with you when you are discharged.
Can I still have an orgasm?
Many men can. The nerves and sensitive tissue around the scrotum and perineum remain, and orgasm can come from touch there. Semen comes out through the new opening. It takes time and patience, and it is worth talking about openly with your wife and the team.
Will people be able to tell?
Not when you are dressed. The scrotum remains, so the shape under ordinary clothes looks much the same. You decide who knows. Some men choose to use a cubicle rather than a urinal in public places, which nobody notices.
What happens with the groin glands?
This is a separate decision. Because the cancer was large enough to need a total penectomy, the groin glands are very often checked, and many men need them sampled or removed. This can be done at the same time or later. Ask your surgeon what is planned.
Can the penis be rebuilt later?
For some men, yes, with an operation called phalloplasty that uses skin and tissue from the forearm or thigh. It is a staged, specialised operation done well after cancer treatment. It is not suitable for everyone. Ask about it at follow-up rather than before the cancer operation.
Is it covered by Aarogyasri or my insurance?
Cancer surgery is usually covered under Aarogyasri, CGHS, ECHS and EHS, and most cashless insurers are empanelled at CION. Cover depends on the scheme and whether groin surgery is included, so call the helpline with your card details and we will check before you travel.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- Cancer Research UK — Penile cancer: treatment
- Macmillan Cancer Support — Penile cancer
- American Cancer Society — Penile cancer
- National Cancer Institute — Penile Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Passing urine after penectomySitting to pass urine and what to reportPhalloplasty after penile cancerWhether rebuilding is possible laterBody image and identity after penile surgeryThe emotional side of recoveryGroin node surgery in penile cancerThe separate decision about the groin glandsPartial penectomy: what is removedThe smaller operation, and when it is enough
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Been told you need a total penectomy?
Send us the biopsy report and scans, or call the helpline. A surgical oncologist will go through why it has been advised and what to expect. One helpline serves every CION centre.