Local Anaesthetic Surgery For Penile Cancer - An Under-Utilised Option?

Abstract Introduction Surgery is the treatment of choice for penile cancer. Patients with advanced penile cancer are commonly co-morbid and require prolonged medical optimisation prior to general and regional anaesthesia. Local anaesthetic (LA) is often used in benign conditions and biopsies but is under-utilised in primary penile cancer surgery. Method Twenty-eight penile cancer patients underwent partial penectomy or glansectomy using LA. A penile dorsal and ventral block with 1% lignocaine and 0.5% Levobupivicaine was placed and 22ml of Instillagel© was instilled. Results Over 8 years nine partial penectomies, 17 glansectomies and one distal urethrectomy (n = 28) were done. The block was successful in 27/28 (96%) of cases. In a single case the block failed due to significant oedema. The patient elected for non-operative palliative care. In one case use of LA enabled emergency palliative surgery of a large profusely bleeding penile cancer, which successfully palliated local symptoms. Conclusions Partial penectomy and glansectomy can be effectively performed under LA. Penile cancer patients with high anaesthetic risk should be considered for surgery under LA with curative and palliative intent. LA is safer, requires less peri-operative optimisation and enables surgery on those who would otherwise be denied a GA and should be considered as an option in these patients.