Thinking About Things

It’s about two weeks until surgery.  But here is a bit of a rundown of what I being told to expect:

thinker

 

There is no way of knowing at this point if the cancer has spread.  So although the surgery is agressive and radical, the strategy we have agreed on is nonetheless the least option.

 

 

In this round, they will take my penis with its cancerous mass.  They will also take two lymph nodes.  They will leave intact and in situ, my prostate, bladder, kidneys and testicles;

If the lymph biopsies indicate the cancer has spread beyond that which is no longer there, we will develop a further plan of maybe removal of more bits, radiation and/or chemo.  Of course if the cancer has not spread, the champagne corks will pop and I can get on with re-designing my life and reinventing myself.

Obvious questions:

  1. how do I urinate, sans penis ?
  2. what happens to libido?  No penis but in tact and functioning testes.  i.e. my brain will think its business as usual.  But …

(1) is easy.  Its called a perineal urethrostomy.  They install some new plumbing connected to my bladder with an outlet behind my sctotum.  Henceforth I sit down to piss.

Perineal Urethrostomy

Number two is something I have obviously considered (a lot) but to avoid confusion I’ll save discussion of that for another day.

 

the following is an extract from https://www.cancer.org/cancer/penile-cancer/treating/surgery.html  for your reading pleasure

Partial or total penectomy

This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The goal is to remove all of the cancer. To do this the surgeon needs to remove some of the normal looking penis as well. The surgeon will try to leave as much of the shaft as possible.

The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains).

If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the “on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

For advanced tumors, sometimes the penis is removed along with the scrotum (and testicles). This operation is called emasculation. Since this operation removes the testicles, which are the body’s main source of the male hormone testosterone, men who have this procedure must take testosterone supplements for the rest of their lives.

Partial or total penectomy

This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The goal is to remove all of the cancer. To do this the surgeon needs to remove some of the normal looking penis as well. The surgeon will try to leave as much of the shaft as possible.

The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains).

If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the “on-off” valve) in the urethra is left behind, but the man will have to sit down to urinate.

For advanced tumors, sometimes the penis is removed along with the scrotum (and testicles). This operation is called emasculation. Since this operation removes the testicles, which are the body’s main source of the male hormone testosterone, men who have this procedure must take testosterone supplements for the rest of their lives.

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