Dorsal slit may be required to expose the glans penis or inner preputial skin.

If possible, adjacent normal tissue should be included to help assess depth of invasion.

Biopsy findings provide prognostic information.

If the lesion involves the urethral meatus, urethroscopy should be performed to evaluate the distal urethra.

Biopsy provides confirmation of the histologic diagnosis.

bowenoid papulosis.

dysplastic penile lesions.

carcinoma in situ.

invasive stage T2 lesions.

superficial stage Ta penile cancers.

frozen-section biopsies.

application of iced saline to the treatment area.

photodynamic diagnosis and autofluorescence.

c and

preparation of the treatment area with 5% acetic acid.

effective therapy for invasive tumors (stage T2 or greater).

compromise of long-term local control.

a technically simple procedure for excision of penile carcinoma.

effective therapy for large lesions.

retention of function and anatomic integrity of the penis.

Glans defects after tumor excision that are not amenable to primary closure may be covered with a split-thickness skin graft or a flap of outer preputial skin.

Frozen-section biopsies are usually not needed during these procedures.

Glansectomy and circumcision remove the entire contents of the preputial cavity.

Careful long-term surveillance following surgery is necessary.

Conservative excision provides tissue for tumor grading and assessment of margins.

History of smoking

Status of inguinal nodes

Cleanliness of the patient

Division of the penis at least 2 cm proximal to the gross tumor

Use of adjuvant chemotherapy

is intended to result in the need for the patient to sit to void.

is required less often than total penectomy.

results in local recurrence rates of less than 10%.

provides for normal sexual function in greater than 70% of men.

requires creation of a perineal urethrostomy.

preoperative inguinal ultrasonography with fine-needle aspiration of any abnormal-appearing nodes.

using an ultrasensitive gamma ray detection probe.

routine inguinal exploration in the absence of radiotracer visualization.

intraoperative palpation of the wound for abnormal nodes.

extended pathologic analysis of excised lymph nodes.

The saphenous vein is preserved.

Decreased morbidity.

The required incision is longer.

The node dissection excludes regions lateral to the femoral artery and caudad to the fossa ovalis.

The transposition of the sartorius muscle is eliminated.

A laparoscopic approach has not been reported.

The fascia lata remains intact.

Rotation of the gracilis muscle is performed to cover the exposed femoral vessels.

The saphenous vein may be preserved in the setting of low-volume disease.

The femoral nerve is visualized superior to the iliacus fascia.

Distal common iliac nodes.

External iliac nodes.

a and b

Obturator group of nodes.

Para-aortic and paracaval node dissection.

Postoperative bed rest and elastic stockings

Preservation of Colles fascia in the flap dissection

Low-dose heparin in the perioperative period

Obliteration of dead space during wound closure

A 6-week delay between treatment of the primary tumor and the node dissection

Pendulous urethra

Bulbomembranous urethra

Prostatic urethra

Urethral meatus

Fossa navicularis

Prognosis depends on histologic cell type.

Conservative surgical therapy is not effective.

Biopsy most commonly demonstrates transitional cell carcinoma.

Penectomy is usually indicated for tumors infiltrating the corpus spongiosum.

Prognosis is worse than for bulbomembranous urethral cancer.

Removal of the fossa navicularis and urethral meatus

Cauterization of the urethral bed

Intraoperative ultrasound imaging

Total penectomy

Bilateral groin dissections