[Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases 
for August, 1896.] 
COMPLETE EXTIRPATION OF THE PENIS FOR EPITHELIAL 
CARCINOMA. 
By ORVILLE HORWITZ, B. S., M. D., 
Clinical Professor of Genito-Urinary Diseases, Jefferson Medical College; Surgeon to the Phila- 
delphia Hospital; Consulting Surgeon to the State Hospital for the Insane. 
EPITHELIAL carcinoma of the penis, though rarely encoun- 
tered, is one of the gravest diseases that can attack that 
organ. 
It usually begins on the glans or prepuce; later both structures 
become involved. As a rule its appearance is as a warty excrescence; 
in some instances it is soft, but more commonly it is hard and dry. It 
may be single, multiple, sessile, or pedunculated. The base is fixed 
and indurated; later on becoming cracked, fissured, and the seat of 
ulceration; thus differing from the benign venereal wart. 
Epithelial carcinoma may have its origin as an ordinary persistent 
pimple, which is dangerous from being, as a rule, deeply seated in the 
neighborhood of the lymphatics; it is early followed by involvement 
of the secondary glands. Later it breaks down and becomes a chronic 
ulcer. 
Individuals who have passed middle life, who have a long foreskin 
and suffer from chronic balanitis are most liable to carcinoma. Its 
first appearance is as a raw patch, which, not yielding to treatment, 
gradually becomes covered with a crust under which the ulcerating 
process goes on. A few cases are reported where cancer made its ap- 
pearance in the urethra; and it has sometimes followed chancre or 
chancroid occurring later in life. In rare instances it has been de- 
veloped from an infected wound, and in persons subject to constant 
irritation of the glans penis due to a tight or adherent foreskin. 
The case which I wish to report is that of an individual sixty-one 
years of age, by occupation a laborer, with a negative family history. 
It appears that his general health was good up to August, 1895, 
when he suffered from an attack of balanitis, to which affection he 
had long been subject, his foreskin being long and redundant. 
Copyright. IfCG, by I>. AfPLjTvx ajw 2 
Original Communications. 
The inflammation of the glans was persistent and did not yield 
to treatment. A raw surface about the size of a ten-cent piece made 
its appearance on the center and posterior portion of the glans, 
which was the seat of intolerable itching, making constant scratching 
an absolute necessity. The irritation of the finger nails produced 
swelling, and ultimately ulceration of the part, slowly extending and 
at the same time surrounded by large exuberant warts, accompanied 
by a bloody discharge. 
This person presented himself at the genito-urinary department of 
Jefferson Hospital in October last, when an amputation back of the 
corona glandis was advised, but to this treatment he refused to submit 
Fig. 1.-Carcinoma of the Penis before Operation. 
and left the institution. He returned on the 27th of April, and re- 
quested that the operation be performed. On examination the penis 
was found to be enormously enlarged, measuring, throughout its length, 
seven inches in circumference, with deep, foul-smelling ulcerations 
around the penile portion of the member (Fig. 1). There was great 
difficulty in passing his urine, and there were lancinating pains extend- 
ing to the perineum. Phimosis was complete. 
The patient had lost a great deal of flesh since last seen, and he was 
altogether below par. 
It was decided that complete extirpation of the organ, after the 
manner recommended by Mr. Pearce Gould, was the only remedy. 
It was determined to leave the extirpation of the glands of the groin 
for a future operation. Complete Extirpation of the Penis for Epithelial Carcinoma. 
3 
The patient was etherized and the skin split on the dorsum of the 
penis, in order to expose the glans and enable me, if possible, to pass 
a catheter into the urethra; but I was unable to discover the outlet, 
immeshed as it was among the warty mass which surrounded the glans. 
He was placed in a lithotomy position, and the scrotum split from 
the root of the penis to the perineum along the raphe; the corpus 
spongiosum was then exposed and carefully separated from the corpora 
cavernosa, and dissected back as far as the triangular ligament. The 
urethra was now cut across and isolated until a sufficient length was 
assured to enable me to fasten it to the perineum, when the incision 
was carried around the root of the penis. The suspensory ligament 
was divided and the corpora cavernosa were detached in like manner, 
until the crura alone remained on each side, which were then cut 
Fig. 2 -Carcinoma of the Penis after Operation. 
through by means of a raspatory. Some little difficulty was ex- 
perienced in controlling haemorrhage from the crura on the right 
side, and it became necessary to retain two haemostatic forceps in situ 
for forty-eight hours. 
The urethra was stitched to the perineum, the wound irrigated, 
a drainage tube inserted, a catheter passed on to the bladder, and the 
parts approximated by means of silkworm-gut sutures. 
The patient made an uninterrupted recovery (Fig. 2). It was 
found on examination that the enlarged glands of the groin had re- 
sumed their natural size and required no further attention. 
When carcinoma involves the glans only, amputation directly back 
of the corona will be found sufficient. In two cases of the kind in 
which I performed the operation, one dating back two years and the 4 
Original Communications. 
other nine months, not only has there been no return of the disease, 
but the individuals have been enabled to indulge in the act of coition 
without apparently missing the absent glans. 
When the body of the penis is involved, and amputation becomes 
necessary, and the resulting stump is too short to permit of sexual inter- 
course, it is in my opinion safer, and accompanied with less risk, to 
perform a complete extirpation instead of operating in the neighbor- 
hood of the peno-scrotal junction. 
In cases where carcinoma originates in the urethra a complete ex- 
tirpation is the safest procedure, as they are more likely to be followed 
by secondary involvement than when the disease has its beginning 
in some other portion of the organ. After the patient has convalesced 
he should be instructed to daily insert a meatus bougie into the urethral 
opening, which will prevent a contraction of the orifice, to which there 
is always a tendency.