Tuesday, June 24, 2014

Historical Contribution: 1931, Young, Radical Penectomy

HH Young.

HH Young, A Radical Operation for the Cure of Cancer of the Penis.
 J Urol. 1931;26:2:285-94.

Hugh Hampton Young developed the radical penectomy in 1907 but did not publish his work until the 1920's.  This manuscript is a follow-up where he details the refinements he made to improve the surgery and functional outcomes (sexual and urinary) thereafter.

At the turn of the 19th century, penile cancers were treated with complete emasculation (removal of the penis in its entirety, including the corporal bodies from the crura through the shaft; and the scrotum and its contents) and creation of a perineal urethrostomy for volitional voiding control.  Through careful study of lymphatic drainage in clinical practice and autopsy studies, Young concluded that the lymphatic drainage of the penis was through the groin, not the scrotum, and that "total emasculinization was entirely unnecessary and unwise."

Young then developed and described the radical penectomy, that included:

  • portion of the penis amputated for removal of the cancer
  • lymphatics at the base of the penis
  • en bloc dissection and removal of the fat, glands and lymph nodes of the pre-pubic area, both groins and upper portions of the thigh
The surgery, including the penile resection and lymph node dissection was made through a large incision extending through the base of the penis (see below).  

Importantly, Young stressed the importance of preserving a portion of the corpora cavernosa, "and a little more of the urethra, so as to give a spout-like projection which would afford satisfactory micturation without soiling the scrotal skin."  Young states that the urethra should project 1.5-2cm beyond the stump of the ligated corpora cavernosa (illustrated below).

To Young's surprise, these patients were also able to have erections sufficient for intercourse and ejaculation.

This is a fascinating manuscript that details our understanding of penile cancer in the early 1900's and really illustrates the development of the modern penectomy still performed today.  The text, by Young, and the illustrations by William Didusch are not to be missed!

Click here or on the link above to read the entire manuscript.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 


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