Purpose: We present a new alternative to amputating penectomy, subcuta
neous penectomy, in the male patient with urethral cancer. Materials a
nd Methods: The surgical management and followup of 3 men with squamou
s cell cancers of the urethra are reviewed. Results: At 22, 9 and 6 mo
nths postoperatively all patients were without evidence of local recur
rence and were satisfied with phallic appearance. In 1 of 2 patients i
n whom the dorsal neurovascular bundle was not preserved there was dis
tal glans necrosis and wound separation which resolved after conservat
ive management. One of the 3 patients is contemplating phallus reconst
ruction. The patient who had pelvic lymph node metastases before penec
tomy died of metastatic complications without local failure 9 months p
ostoperatively. 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 su
perior to amputation without sacrificing cancer therapy in the appropr
iately selected patient.