Penile Cancer Reconstruction After Surgery
Penile cancer surgery can change penile skin, the glans, urethral position, sensation, penile length and sexual or urinary function.
Reconstructive surgery aims to address these changes where clinically appropriate while keeping cancer treatment and surveillance as the priority.
What does penile cancer reconstruction involve?
Penile cancer reconstruction includes a range of procedures used to restore coverage, contour, urinary function or useful penile anatomy after cancer has been removed.
Reconstruction may be performed at the same time as the cancer operation or considered later after healing and review of the final pathology.
The appropriate approach depends on:
- the cancer operation previously performed
- how much penile or genital tissue remains
- the location of the urethral opening
- skin and graft quality
- previous radiotherapy or wound complications
- erectile function
- urinary function
- ongoing cancer surveillance requirements
The first step is understanding exactly what tissue was removed, what the final pathology showed and whether further cancer treatment or surveillance remains necessary.
What can need reconstruction after penile cancer surgery?
The reconstructive problem depends on the original tumour and the operation required to remove it.
Glans surface
After glans resurfacing, the exposed glans surface is commonly reconstructed using a skin graft.
Loss of the glans
Following glansectomy, a reconstructed distal surface or neoglans may be created over the preserved penile shaft.
Penile skin deficiency
Local excision, recurrent cancer, infection or previous operations can leave inadequate healthy skin for coverage.
Urethral position
Partial penile removal may leave the urethral opening in a different position or require urethral reconstruction.
Scarred or altered anatomy
Previous surgery, grafting, radiotherapy or wound problems can produce fibrosis, tethering and altered tissue planes.
Larger genital defects
Extensive locally advanced cancers may occasionally require flap-based reconstruction or more complex staged treatment.
Reconstruction is about function as well as appearance
A reconstructive plan is generally built around three practical goals rather than trying to recreate anatomy exactly as it was before cancer.
Reliable urinary function
Where possible, reconstruction aims for a practical urinary stream and a urethral opening that remains accessible and stable.
Stable tissue coverage
Exposed or scarred tissue may require durable skin or graft coverage that can heal and tolerate everyday activity.
Preserve useful function
Penile length, erections, sensation and sexual function are considered where sufficient tissue and oncological safety allow.
What types of reconstruction may be used?
There is no single operation called “penile cancer reconstruction”. The technique depends on the defect left after cancer treatment.
Skin grafting
Skin grafts can be used to provide coverage after glans resurfacing, glansectomy or selected penile skin excisions.
Split-thickness skin grafts are commonly used because they can cover a relatively large area and generally take well on a suitable vascular wound bed.
The graft donor site is commonly the thigh.
Neoglans reconstruction
After partial or total removal of the glans, the distal penile shaft can sometimes be reconstructed with a graft to create a new surface or neoglans.
This does not recreate the original sensory glans but can provide a healed distal contour and maintain the urethral opening at the end of the preserved shaft.
Urethral centralisation & distal reconstruction
Following selected partial penile resections, reconstruction may help position the urethral opening more centrally and improve the distal contour of the remaining penis.
A graft can sometimes be used to create a smoother neoglans appearance where appropriate.
Local or flap reconstruction
Larger skin or soft-tissue defects may require advancement flaps, local tissue rearrangement or other reconstructive techniques.
This is particularly relevant when tissue has been removed extensively, scarred by previous surgery or affected by infection or radiotherapy.
Reconstruction after glans resurfacing
Glans resurfacing removes abnormal surface epithelium while retaining the deeper glans.
The exposed surface is then commonly covered using a split-thickness skin graft.
Early care focuses on:
- keeping the graft in close contact with the wound bed
- protecting the graft from movement
- monitoring for bleeding or infection
- reviewing graft take
- reviewing final cancer pathology
Reconstruction after glansectomy
Glansectomy removes part or all of the natural glans while preserving the shaft when cancer anatomy allows.
Reconstruction may then aim to:
- cover the exposed distal erectile bodies
- create a stable distal penile surface
- position the urethral opening appropriately
- preserve as much useful shaft length as is safe
- facilitate hygiene and urination
A split-thickness skin graft is commonly used to form a neoglans.
What can be done after partial penectomy?
When cancer invades more deeply, removal of part of the penile shaft may be required.
Reconstruction cannot replace the erectile tissue that has been removed, but selected techniques may improve the function and contour of the remaining penis.
Options can include:
- centralising the urethral opening
- reshaping the distal end of the remaining shaft
- skin-graft neoglans formation in selected cases
- scar revision or additional skin coverage
- treatment of subsequent meatal or urethral narrowing
The oncological resection is determined first. Reconstruction is then designed around the anatomy that can safely remain.
What can happen to urination after penile cancer surgery?
The urinary pathway depends strongly on how much penile and urethral tissue has been removed.
Distal urethral opening preserved
After resurfacing or glansectomy, the urethral opening can often remain at the distal penis.
Temporary spraying or irritation can occur during healing.
Meatal or urethral narrowing
Scarring can sometimes narrow the urinary opening after glansectomy, grafting or partial penile surgery.
Persistent reduced flow, straining or spraying may require further assessment.
Perineal urethrostomy
After total penectomy, urination is usually redirected through a new urethral opening in the perineum.
This generally means sitting to pass urine.
Can sexual function be improved after penile cancer surgery?
Sexual outcomes vary substantially according to the original tumour and the amount of penile tissue removed.
Reconstructive assessment can consider:
- remaining penile length
- erection rigidity
- penile shaft sensation
- pain or scar tethering
- skin mobility and coverage
- ability to achieve penetration
- psychological effects of cancer treatment
Where erectile dysfunction persists, treatment can be considered separately once cancer treatment, tissue healing and individual circumstances have been reviewed.
When should reconstruction be performed?
Some reconstruction is naturally performed during the cancer operation. Other problems are better assessed after healing and final pathology are available.
Immediate reconstruction
Examples can include:
- skin grafting after glans resurfacing
- neoglans reconstruction after glansectomy
- coverage of a larger surgical defect
- urethral positioning after selected resections
The reconstructive plan is designed around the tissue that can safely remain after tumour removal.
Delayed or revision reconstruction
Later reconstruction may be considered for:
- scar contracture
- poor graft contour
- skin deficiency
- meatal or urethral narrowing
- pain or tethering
- functional difficulty after previous surgery
Waiting can allow tissues to mature and clarify whether further oncological treatment is required.
What if the initial reconstruction has healed poorly?
Revision surgery can be more complex because previous operations change normal tissue planes and blood supply.
Problems that may warrant assessment include:
- persistent graft contraction
- areas of graft loss or unstable coverage
- painful or tethered scars
- distal penile distortion
- urinary spraying or poor urinary direction
- meatal or urethral stenosis
- difficulty with hygiene
- functional problems during erection or intercourse
What about reconstruction after major penile loss?
Some locally advanced tumours require subtotal or total penile removal.
In selected patients, more extensive reconstructive options may be discussed after cancer treatment. These are substantially different from simple skin grafting or neoglans reconstruction.
Potential considerations can include:
- total or subtotal phallic reconstruction in selected cases
- staged soft-tissue reconstruction
- local or regional flap coverage
- management of the perineal urethrostomy
- treatment of genital scarring or lymphoedema
How is reconstruction planned?
Review the cancer treatment
Pathology, operative reports, previous radiotherapy and any further cancer treatment are reviewed.
Define the current anatomy
Examination focuses on remaining penile tissue, skin, urethral position, grafts, scars and surrounding genital structures.
Identify the functional problem
Urinary difficulty, wound problems, pain, hygiene, erections, penetration and other functional concerns are considered.
Plan realistic reconstruction
Treatment options are discussed in the context of the available tissue, cancer surveillance, risks and realistic reconstructive goals.
What can recovery involve?
Dressings
Skin grafts and larger reconstructions may require supportive dressings while the tissues establish blood supply and heal.
Urinary catheter
A catheter may be required temporarily when surgery involves the distal urethra or urinary opening.
Donor-site care
Skin grafts require a second wound at the donor site, commonly the thigh.
Activity restrictions
Heavy activity, friction and sexual activity are restricted while the reconstruction heals.
Cancer surveillance
Reconstruction does not replace ongoing surveillance of the penis, groins or other relevant cancer sites.
Functional review
Urination, wound healing, graft maturation, erections and sexual function can be reassessed as recovery progresses.
Risks and limitations of reconstruction
Wound & reconstructive risks
- infection
- bleeding or haematoma
- delayed wound healing
- partial or complete graft loss
- scar contraction
- poor contour or asymmetry
- donor-site discomfort or scarring
- need for revision surgery
Urinary & functional risks
- urinary spraying
- meatal or urethral stenosis
- altered sensation
- persistent pain or tethering
- erectile dysfunction
- change in sexual function
- reduced penile length
- result not meeting expectations
From cancer surgery to functional reconstruction
Review the original cancer diagnosis
Pathology and previous cancer treatment are reviewed before reconstructive planning begins.
Understand what surgery has changed
Penile skin, glans anatomy, urethral position, shaft length and surrounding tissues are assessed.
Identify urinary and sexual priorities
Urinary direction, flow, erections, discomfort, hygiene and sexual function are considered.
Decide whether reconstruction is worthwhile
Not every anatomical change needs another operation. Potential benefit is balanced against surgical risk and ongoing cancer surveillance.
Perform reconstruction where appropriate
Surgery may involve grafting, scar revision, urethral reconstruction, local tissue rearrangement or another technique matched to the defect.
Continue cancer and functional follow-up
Reconstruction, urination, sexual function and cancer surveillance are reviewed over time.
Dr Jack Crozier
Dr Jack Crozier is a Brisbane urologist with advanced fellowship experience in uro-oncology, andrology and reconstructive urology.
His practice includes penile cancer, penile-preserving surgery and assessment of complex reconstructive problems affecting penile skin, the urethra, genital tissues and function after previous surgery.
Seeking reconstruction after previous penile cancer treatment?
Previous surgery can make reconstructive assessment more complex, so records can be particularly valuable before major travel arrangements are made.
Useful information includes:
- original penile cancer pathology
- previous operative reports
- details of skin grafts or flaps
- radiotherapy or chemotherapy records
- current cancer surveillance imaging
- photographs of wound healing where clinically relevant
- cystoscopy or urethral investigations if urinary narrowing is present
An in-person examination may still be necessary before deciding whether another operation is appropriate.
Explore related information
Penile Cancer
Understand diagnosis, penile treatment, lymph-node staging and surveillance.
Penile-Preserving Surgery
Compare local excision, resurfacing, glansectomy and more extensive penile surgery.
Glans Resurfacing
Learn about glans preservation and skin-graft reconstruction for PeIN and selected superficial disease.
Glansectomy & Neoglans Reconstruction
Learn about shaft preservation and neoglans formation after removal of the glans.
Groin Lymph Node Staging
Understand sentinel-node staging and regional lymph-node treatment in penile cancer.
Penile, Genital & Urinary Reconstruction
Explore the broader reconstructive urology pathway.
Penile cancer reconstruction FAQs
What is penile cancer reconstruction?
It refers to reconstructive procedures used to restore penile or genital coverage, contour, urinary function or useful anatomy after penile cancer surgery.
Is reconstruction always performed at the same time as cancer surgery?
No. Some reconstruction, such as grafting after glans resurfacing or glansectomy, is usually performed during the cancer operation. Other problems may be better assessed later after healing and review of final pathology.
Can the glans be reconstructed after it has been removed?
A neoglans can be created after glansectomy using a graft or another reconstructive technique. It provides a reconstructed distal surface but does not recreate the original glans tissue or sensation.
Can reconstruction improve urination after penile cancer surgery?
Potentially. Depending on the anatomy, reconstruction can address urethral position, meatal narrowing, scar contracture or another cause of poor urinary direction or flow.
What if the urinary opening has become too narrow?
Meatal or urethral stenosis can occur after penile cancer surgery. Assessment may include examination, urinary flow testing, cystoscopy or urethral imaging depending on the location and severity of the narrowing.
Can penile length be restored after partial penectomy?
Reconstruction cannot replace erectile tissue removed for cancer. Selected techniques may improve distal contour or functional use of the remaining penis, but the original penile length cannot be guaranteed or fully recreated.
Can sexual function return after penile cancer surgery?
Sexual function varies according to the amount of penile tissue retained, baseline erections, sensation, scarring and the surgery performed. Some men retain penetrative function after organ-preserving treatment, while others require additional assessment or treatment.
Can erectile dysfunction be treated after penile cancer surgery?
Potentially. Erectile dysfunction can be assessed after cancer treatment and healing. Treatment depends on the remaining anatomy, tissue quality, cancer status and the individual patient's circumstances.
What if a skin graft has contracted or healed badly?
Graft contraction, poor contour, unstable coverage or scar tethering can be assessed. Revision may involve scar release, replacement grafting, local tissue rearrangement or another technique depending on the defect.
Can previous radiotherapy make reconstruction harder?
Yes. Radiotherapy can affect blood supply, fibrosis and tissue healing, which can change both the available reconstructive options and the risk of complications.
Can reconstruction be performed after total penectomy?
More extensive phallic reconstruction may be considered in selected patients after subtotal or total penile removal, but this is complex surgery and is very different from neoglans or skin-graft reconstruction.
What happens to urination after total penectomy?
Urination is generally redirected through a perineal urethrostomy, which creates a urinary opening in the perineum and usually requires sitting to pass urine.
Does reconstruction affect cancer surveillance?
Cancer surveillance remains essential. Reconstruction is planned so that the previous tumour site, remaining penile tissue and relevant lymph-node areas can continue to be monitored appropriately.
Should I wait until all cancer treatment is finished before seeking reconstructive advice?
Not necessarily. Reconstructive considerations can be discussed during cancer treatment planning, although some revision procedures may be deliberately delayed until pathology, healing and further oncology treatment are clear.
What should I bring to a reconstructive consultation?
Previous pathology reports, operation reports, details of grafts or flaps, radiotherapy records, relevant imaging and current cancer follow-up information can be particularly useful.
Can I seek reconstructive assessment if the original cancer surgery was performed elsewhere?
Yes. Previous operative reports and pathology are especially useful because reconstructive options depend heavily on what tissue was removed and how the first surgery was performed.
Can I be assessed if I live interstate or overseas?
Potentially. Existing records can often be reviewed before travel. An in-person examination may still be required before deciding whether reconstructive surgery is appropriate.
Are you dealing with urinary, skin or functional problems after penile cancer surgery?
Reconstructive assessment can help define the current anatomy, review the previous cancer treatment and determine whether grafting, scar revision, urethral reconstruction, neoglans reconstruction or another approach may be reasonable.
Medical information disclaimer: This page provides general educational information and does not replace individual medical assessment, cancer surveillance or informed consent. Reconstructive options after penile cancer depend on the original tumour, pathology, tissue removed, previous operations, grafts, radiotherapy, wound healing, urinary and sexual function, current cancer status and individual circumstances. Cancer control remains the priority. Further surgery can cause infection, bleeding, graft or wound failure, scar contracture, altered sensation, urinary narrowing, erectile or sexual dysfunction and the need for additional procedures. Reconstruction cannot guarantee restoration of the appearance, penile length, sensation or function present before cancer treatment.