Glans Resurfacing

What is a glans resurfacing?

A glans resurfacing is a procedure that involves removing some skin from the head of the penis. At your consultation, your surgeon will have explained that this is carried out as there is an area of concern, which required surgical removal, this can be either for benign or cancerous reasons.

The glans of the penis is more commonly known as the head of the penis, the aim of the surgery is to remove part of the superficial skin or all of the skin of the head of the penis, which is then covered with a skin graft to aid with healing.

This aims to only remove the outer layers (usually just the skin layers) from the head of the penis and is less invasive than removing deeper tissues.

Why is this necessary?

The doctor has recommended this treatment, usually because there is pre-cancerous change in the skin or because there is some other significant disease affecting the skin. It is also occasionally used for very early cancers.

Your case will have been discussed by a multidisciplinary team of professionals including surgeons, oncologists, radiologist’s, pathologist and nurses before offering you this operation.

Admission to hospital for your operation

On the day of your clinic appointment you will be asked to attend the pre-assessment clinic to assess whether you are fit for the proposed surgery. You will have questions asked about your general health and fitness, you will have blood tests taken and potentially will have an ECG.

On some occasions it will be necessary for you to return at a separate date to have this pre-assessment appointment.

On the day of your operation you will be admitted to the admission lounge early in the morning, when you will have a further opportunity to talk to the surgeon and the anaesthetist about your procedure. The ward staff will familiarise you with the routine of the ward and show you where the facilities are.

Your operation

The surgery will be performed under a general anaesthetic, where the surgeon will remove the skin layers from your penis. A skin graft will be taken from the upper aspect of your thigh and a dressing will be stitched in place over the skin graft in order to hold it in place. You will have a catheter inserted. There will also be a dressing on your thigh, covering the site where the skin graft has been taken from.

After your operation

When your surgery is finished you will be taken to the recovery area, where you will be monitored until your condition is stable. Then you will be allowed to go back to the ward. When you get back to the ward you will be able to eat and drink normally and you will be given pain killers, as needed on a regular basis.

It is important that you feel as comfortable as possible after the surgery and so you should ask for pain killers if you are feeling any discomfort.

Initially the dressing, which is stitched onto the end of the penis will look bloody and then will become more black and crusty. This is the normal appearance and should not concern you. The dressing on your penis and the catheter will remain in place for 7-10 days to allow the skin graft to heal.

Preparation for discharge

The ward staff will check your wound regularly whilst you are on the ward and the doctors will see you on a daily basis to assess your progress. When they are happy with your recovery you will be allowed to go home.

It is usual to be able to go home on the day after a glans-resurfacing (length of stay 24-48 hours).

You will be given painkillers to take with you and we would advise that you take them as prescribed in order to prevent pain. Please do not exceed the stated dose on the pack. Generally, the discomfort will take a few days to go away and can often be associated with the dressing on the tip of the penis.

The dressing and the catheter will remain in place for 7-10 days. You will return to clinic 7-10 days later for the catheter and for the penile dressing to be removed (the nurse specialist will liaise with you and arrange this, sometimes once you have been discharged).

There is a dressing stitched onto the end of your penis – this will look black and crusty – that is normal.

This information is quite blunt, but is meant to help and reassure you that what looks and smells awful is actually quite normal when you have had this type of surgery.

There is also a dressing on your leg where the skin graft was taken from, it is covered with a bandage.it is important that this is not disturbed until you return to the clinic.

You will be shown how to look after the catheter by the nursing team on the ward before you go home.

Follow up after glans-resurfacing

You will be given an appointment to come to St James University Hospital within 7-10 days of your operation. At that appointment, you will have the catheter and the dressing removed from your penis. The nurse who removes the catheter and dressing will explain to you how to look after the skin graft and will ensure that you are able to pass urine before you go home.

You will be seen seven days later to have the dressing removed from the skin graft site on your thigh. If you travel a long way, there is potential this could be removed by your practice nurse. Discuss with the CNS regarding this.

You will be able to shower once the first dressing on your penis has been removed. However try to avoid direct contact with soap products. It is important that at first you dry the skin graft site very carefully so as not to dislodge the skin graft itself. A hair dryer is often helpful in this respect but if you are drying the wound with a cloth then pat the wound dry with a cloth that does not shed fibres.

The area on your thigh will need a waterproof dressing covering it when you are showering or until the dressing is removed after two weeks.

If the bandage on your leg comes off at home, it can be redressed by a district nurse or a nurse at your GP Practice.

• The dressing closest to the skin on your leg is called Kaltostat and should not be removed as this is helping the wound to heal. Removal of this dressing too soon can sometimes lead to infection in your wound.
• Both the wound on your thigh and the wound on the penis can become smelly. This is part of the normal healing process and is usually nothing to worry about.
• If you do have concerns, please contact either the nurse specialist at the Hospital or your GP.

You will be seen by a consultant to discuss the results of the biopsy and your on-going progress within 3-4 weeks of your surgery.

If you have any problems or worries before that appointment then you can phone the clinical nurse specialist. This is an answer-phone service and please leave a message with your name and NHS number or date of birth and they will call you back. Alternatively you can contact your consultant’s secretary.

How will my body be affected by the operation?

The cosmetic result after this operation can never be perfect but the intention is that the penis looks as close to normal as is possible given that the head of the penis has been removed.

There will be no loss of the length of the penis if you have a glans resurfacing. There will however be a change in the sensitivity of the tip of your penis and there will also likely be some spraying of the urine although this is usually not as severe. This can settle over time as the wound heals.

Contact numbers

Leeds Cancer Support

Leeds Cancer Support complements care provided by your clinical team. We offer access to information and a wide range of support, in a welcoming environment for you, your family and friends. We can be found in the information lounges in Bexley Wing and also in the purpose built Sir Robert Ogden Macmillan Centre. The Centre is on the St James’s Hospital site and offers a variety of support services including counselling, support groups and many complementary therapies. You can just drop in for a coffee and a chat anytime.

Leeds Cancer Support contact numbers:

Health Talk support service

Health Talk is an online service where you can find information and support by seeing and hearing patients real life experiences.

In co-ordination with researchers from the Centre for Men’s Health at Leeds Metropolitan University, who spoke to 27 men in their own homes. You can explore what these people felt about issues such as symptoms, treatment, body image and sex. We hope you find the information helpful and reassuring.

https://healthtalk.org/introduction/penile-cancer/

Where can I find more Information?

References :

Orchid male cancer support 2017. Partial / Total Penectomy
The Christie Patient Information Service May 2015
CHR/SUR/600/17.06.08 version 4