Introduction:Lymph node metastasis status is the strongest predictive factor for penile cancer survival. In penile cancer patients with suspected lymph node involvement, inguinal lymph node dissection (ILND) extends disease-free survival. Though video-endoscopic ILND (VEILND) has demonstrated superior surgical outcomes to open ILND (OILND) in the short term, its oncological efficacy long term is unproven. We present our long-term oncological follow-up of our previously published ILND cohort. Methods:A prospectively collected institutional database was used to determine the outcome in 42 consecutive patients treated for penile cancer in a tertiary referral centre between 2008 and 2015. Overall survival and cancer-specific survival (CSS) were calculated using Kaplan-Meier curves and compared via log-rank tests. Results:Forty-two patients underwent 68 ILND (35 OILND vs. 33 VEILND). Thirteen out of 42 patients were alive at a mean follow-up of 12.5 years. Overall survival for OILND and VEILND was 36.4% and 30.0% at 10 years. There was no significant difference between the survival curves (p = 0.91). CSS was equivalent (p = 0.87). Ten-year CSS was 75.3% (OILND) and 65.5% (VEILND). When stratified by nodal status, CSS for OILND was 77.8%, 83.3%, 50% and 66.7% (N0, N1, N2 and N3) compared with VEILND which were 100%, 75%, 75% and 40% respectively at 8 years. Thus, there was no significant difference in CSS between patients undergoing VEILND and OILND stratified by nodal status. Moreover, inguinal or pelvic nodal recurrence rate was equivalent in both groups, occurring in 5/22 OILND and 4/20 VEILND (p = 1.00) patients. Conclusion:To our knowledge, we present the first European report of long-term follow-up demonstrating the oncological safety of VEILND. VEILND has comparable outcomes of recurrence, overall survival and CSS, with significantly reduced complication rates and length of stay, in penile cancer at a median follow-up of 104 months (range 2-213 months).

To critically appraise the safety and efficacy of male genital augmentation and enhancement procedures, and to formulate consensus recommendations for urologists and medical professionals. A systematic search of the literature published between 2000 and 2025 was conducted. Outcomes of interest focused on penile length and girth changes, complications, and validated patient-reported outcomes. Risk of bias was assessed using Cochrane RoB-2 for randomised controlled trials (RCTs) and the Newcastle–Ottawa Scale (NOS) for non-randomised studies. Evidence was synthesised qualitatively by intervention type. Consensus recommendations were generated through structured group appraisal by the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery (AGUS), integrating the evidence base with expert opinion, quality assessments, and patient safety considerations. Thirty-six studies ( n = 3748) were included: 12 injectable fillers and 24 surgical. Injectable fillers produced short-term girth gains with mild, transient complications. Surgical procedures demonstrated modest increases in length and girth, though complicated by infection, fibrosis, and/or device removal. Across the eligible evidence, the risk of bias was high, the quality of evidence was low, and expert opinion was consistently low. Evidence quality remains poor, heterogeneous, and methodologically limited. As such, five key recommendations were generated by the BAUS AGUS committee on genital augmentation and enhancement with either injectable fillers or surgical procedures. 2

Introduction According to EAU guidelines, the indication for extended pelvic lymph-node dissection(ePLND) at the time of radical-prostatectomy (RP) should be based on validated nomograms. The Briganti 2017(B17) nomogram is considered the most appropriate to predict lymph-node invasion (LNI) in our cohort because most patients were diagnosed via systematic biopsies. We aim to perform the first UK-based external validation of B17 and improve its accuracy using machine learning approaches through development of an updated UK-tailored Briganti Nomogram 2025 (UKB25). Methods From a retrospective cohort of 1551 prostate cancer patients who underwent RP, 286 had ePLND between 2010 and 2021 in a tertiary referral centre. The B17 variables - preoperative PSA; clinical stage; biopsy Gleason grade group; percentage of positive cores with highest-grade PCa; and percentage of positive cores with lower grade PCa - were analysed with univariate and multivariate logistic-regression models predicting LNI. All variables with an OR > 1 were included in the subsequent model. The UKB25 nomogram was developed using penalised logistic-regression of the Briganti variables with elastic-net-regularisation. An optimal threshold was selected to maximise accuracy without increasing false negative rate. Performance metrics were compared between UKB25 and retrospective application of the B17 nomogram. Results Of 286 patients, 23(8.0%) had LNI. Application of the B17 nomogram, with a 7% threshold, to our population results in 8.7% of patients below the cut-off having LNI. This is unsatisfactory as per Briganti’s definition. Instead, using a 5.8% cutoff, the refined machine-learning-based UKB25 nomogram outperforms the Briganti 2017 nomogram in classification accuracy (McNemar’s test statistic χ2 = 34.2, p < 0.001). Importantly, UKB25 would have spared 52 patients from unnecessary ePLND (162 vs 214) with a lower rate of missed LNI (4.2%), thereby enhancing specificity (38.4% vs 18.6%) and PPV (11.9% vs 8.9%), while maintaining NPV (99% vs 96.1%), sensitivity (95.6% vs 91.3%) and area under ROC (0.785 vs 0.763). Conclusions Although the B17 predicts LNI reliably in other populations, its accuracy is limited in the UK. The updated UKB25 nomogram shows superior predictive performance in the UK, reducing the number of unnecessary ePLNDs by one quarter without missing additional LNI-positive patients. Further external validation is warranted.

OBJECTIVES:To evaluate the incidence of venous thromboembolism (VTE) after penile cancer surgery using national hospital data and to assess current thromboprophylaxis practices across UK specialist centres. SUBJECTS/PATIENTS AND METHODS:A retrospective cohort study was conducted using Secondary Uses Service (SUS) data on penile cancer surgeries performed in NHS hospitals in England between 2015 and 2024. A national survey of UK Penile Cancer Network (UK PeCaN) surgeons was undertaken to assess current thromboprophylaxis practice. The primary outcome was symptomatic VTE within 180 days of surgery, identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Cumulative incidence of first postoperative VTE was analysed using patient-level time-to-event methods, with censoring at second surgery, 180 days or administrative end of follow-up. Survey responses were summarised using descriptive statistics. RESULTS:In this observational population-level study, 4310 patients underwent 5903 penile cancer-related procedures. A total of 143 VTE episodes were recorded over the 9-year period, corresponding to an overall crude incidence of 2.5%. In patient-level time-to-event analysis, the cumulative incidence of first postoperative symptomatic VTE was 0.21% at 30 days, 0.69% at 90 days and 1.08% at 180 days. Descriptive procedure-level analyses suggested higher unadjusted VTE rates following more extensive procedures, including lymph node dissection and total penectomy, although these estimates should be interpreted cautiously because of staged procedures and unmeasured patient-level confounding. Most VTE events occurred after hospital discharge. The survey, comprising 24 responses from 10 specialist centres, revealed substantial variation in thromboprophylaxis practice, with 71% of surgeons not using formal VTE risk assessment tools. CONCLUSIONS:Venous thromboembolism is an important postoperative complication after penile cancer surgery, particularly after more extensive procedures and staged treatment pathways. Current prophylaxis practices are inconsistent. These findings support the further collection and analysis of disease-specific and the development of procedure-specific guidelines recommending extended thromboprophylaxis in high-risk patients.

1 Background: Platinum-based combination chemotherapy remains the Standard of Care (SoC) treatment for patients with locally advanced/metastatic penile cancer (la/mPC). Prognosis is poor and treatment options are limited. PDL1 is upregulated in 40–60% of cases making a case for immunotherapy as a treatment option for la/mPC. PD-1 inhibitor cemiplimab is approved for patients with locally advanced or metastatic cutaneous SCC. We evaluated efficacy and safety of cemiplimab in combination with SoC chemotherapy in patients with la/mPC. Methods: EPIC-A is a National Cancer Research Network badged phase II non-randomised multi-centre trial evaluating the efficacy and safety of cemiplimab plus platinum-based chemotherapy as first-line treatment in la/mPC. Patients with la/mPC (Tany,N2-3,M0 or T4,Nany,M0 or M1) not amenable for radical treatment received: cemiplimab 350mg IV D1 every 3 weeks (Q3W) + SoC chemotherapy cisplatin/5FU (PF, 27 patients) or docetaxel, ifosfamide, cisplatin (TIP, 2 patients) for 4 cycles followed by cemiplimab alone 350mg IV Q3W up to a total of 34 cycles. The primary end point was investigator assessed Clinical Benefit Rate (CBR) at 12 weeks using RECIST 1.1. The study was designed as an A’Hern (2001) study α=0.05 + power (1-β)=0.8, assuming 25% meeting the clinical end point is a poor treatment (p0=0.25) and 50% is a good treatment (p1=0.5). Assuming a 10% drop out rate, 29 patients were recruited. Results: 29 patients from 11 UK sites were enrolled from Jan 2022- Dec 2023. Median age was 61 years (range 38-76). 93% were ECOG 0-1 and 7% ECOG 2. 76% had metastatic disease (6 bone 23%, 2 liver 6.9%, 16 lung 55.2%). Median number of cycles was 5 (range 1-34) and median follow-up was 8.3 (IQR 5.5-11.5) months. At 12 weeks CBR was 62.1% (95%CI 44.4%, 79.7%) and Objective Response Rate (ORR) was 51.7% (95%CI 34.4%, 68.6%) with 15 PR and no CR. Benefit was maintained at 21 weeks with CBR 48.3% (95%CI 31.4%, 65.6%) and ORR 44.8% (95%CI 28.4%, 62.4%) with 12 PR and 1 CR. Median Progression Free Survival (PFS) was 6.2 (95%CI 3.7, 8.7) months and Overall Survival (OS) is currently estimated to be 15.5 (95%CI 6.0, 25.0) months. Of the reported adverse events (AEs) of any grade, 23% were related to cemiplimab and 31% to chemotherapy. Safety profile is in keeping with reported data on cisplatin based chemotherapy and immunotherapy. There were 2 grade 5 AEs, neither related to cemiplimab but 1 related to chemotherapy. 7 patients discontinued treatment due to an AE, 4 related to cemiplimab (14%). Conclusions: The EPIC-A Trial demonstrates the efficacy and safety of cemiplimab in combination with platinum-based chemotherapy as a treatment for la/mPC. Investigations into potential biomarkers and Quality of Life analysis is ongoing. These data support cisplatin based combination chemotherapy + cemiplimab as a first line SoC treatment option in this rare cancer. Clinical trial information: 95561634.

IntroductionAccording to EAU guidelines, the indication for extended pelvic lymph-node dissection(ePLND) at the time of radical prostatectomy (RP) should be based on validated nomograms. The Briganti 2017(B17) nomogram is considered the most appropriate to predict lymph node invasion (LNI) in our cohort because most patients were diagnosed via systematic biopsies. We aim to perform the first UK-based external validation of B17 and improve its accuracy using machine learning approaches through development of an updated UK-tailored Briganti Nomogram 2025 (UKB25).MethodsFrom 1551 prostate cancer patients who underwent RP, 286 had ePLND between 2010 and 2021 in a tertiary referral centre. The Briganti 2017 variables were analysed with univariate and multivariate logistic regression models predicting LNI. All variables with an OR > 1 were included in the subsequent model. The UKB25 nomogram was developed using penalised logistic regression of the Briganti variables with elastic net regularisation. An optimal threshold was selected to maximise accuracy without increasing false negative rate. Performance metrics were compared between UKB25 and retrospective application of the Briganti 2017 nomogram.ResultsOf 286 patients, 23(8.0%) had LNI. Application of the Briganti 2017 nomogram, with a 7% threshold, to our population results in 8.7% of patients below the cut-off having LNI. This is unsatisfactory as per Briganti’s definition.Instead, using a 5.8% cutoff, the refined machine-learning-based UKB25 nomogram outperforms the Briganti 2017 nomogram in classification accuracy (McNemar’s test statistic χ2 = 34.2, p < 0.001). Importantly, UKB25 would have spared 52 patients from unnecessary ePLND (162 vs 214), thereby enhancing specificity (38.4% vs 18.6%) and PPV (11.9% vs 8.9%), while maintaining NPV (99% vs 96.1%), sensitivity (95.6% vs 91.3%) and area under ROC (0.785 vs 0.763). This improvement was achieved with a lower rate of missed LNI (4.2%), highlighting its clinical utility in balancing oncological safety with surgical morbidity.ConclusionsAlthough the Briganti nomogram predicts LNI reliably in other populations, its accuracy is limited in the UK. The updated UKB25 nomogram shows superior predictive performance in the UK, reducing the number of unnecessary ePLNDs by one quarter without missing additional LNI-positive patients. Further external validation is warranted before widespread adoption.

9 Background: Patients with locally advanced or metastatic penile squamous cell carcinoma (la/mPC) have a poor prognosis with very limited therapeutic treatment options. Standard of Care (SoC) treatment remains platinum-based combination chemotherapy with modest outcomes. Some patients are ineligible for chemotherapy and have very limited options for management. PDL1 is upregulated in 40–60% of PC, making a case for immunotherapy as a treatment for la/mPC. We describe the results from the EPIC-B trial, evaluating the efficacy and safety of cemiplimab as first line treatment in la/mPC. Methods: EPIC-B is a National Cancer Research Network badged single arm, multi-center phase II trial, in treatment naïve la/mPC. Patients received cemiplimab 350mg IV D1 every 3 weeks (Q3W) up to a total of 34 cycles. The primary end point was investigator assessed Clinical Benefit Rate (CBR) at 12 weeks using RECIST 1.1. The study was designed as an A’Hern (2001) study α=0.05 + power (1-β)=0.8 assuming 5% meeting the primary end point is a poor treatment (p0=0.05) and 25% is a good treatment (p1=0.25). Assuming a 10% drop out rate, 18 patients were recruited to test this hypothesis. Results: From November 2021, 18 patients from 11 UK sites were enrolled onto EPIC-B over 29 months. Median age was 72 years (range 44-88). Patients with ECOG 0-2 were allowed onto the trial, the majority having ECOG 1 or 2 (0=5%, 1=56% and 2=39%). 83% had metastatic disease (1 bone 5.6%, 1 liver 5.6%, 6 lung 33.3%). Median number of cycles was 4 (range 1-32) and median follow-up was 5.5 (IQR 2.3-8.1) months. At 12 weeks CBR was 38.9% (95%CI 20.3%, 61.4%) and Objective Response Rate (ORR) was 16.6% (95%CI 5.8%, 39.2%) with 3 partial response (PR) and 4 stable disease (SD). Over the full course of treatment 27.7% of patients showed a response to treatment including 1 complete response (1 CR, 4 PR) and 4 patients had SD as their best response. Median Progression Free Survival (PFS) was calculated to be 2.3 (95%CI 1.0, 3.8) months and median Overall Survival (OS) is currently estimated at 6.8 (95%CI 3.7, 9.8) months. For adverse events (AEs) of any grade, 31% were judged related to cemiplimab and for grade 3 AEs 26% were related, most common being infection (no G4 AEs were recorded). There were 2 grade 5 AEs, (cardiorespiratory event not related and toxic epidermal necrolysis related to treatment). 4 patients discontinued treatment due to toxicity, 2 related to cemiplimab (11%). Conclusions: Single agent cemiplimab as a first line treatment for la/mPC in the EPIC-B trial demonstrates efficacy with a generally manageable toxicity profile. This study adds to the evidence that single agent cemiplimab is a viable treatment for la/mPC patients for whom chemotherapy is not an option. Clinical trial information: 95561634.

PURPOSETransurethral resection of bladder tumor (TURBT) is the initial staging procedure for new bladder cancers (BCs). For muscle-invasive bladder cancers (MIBCs), TURBT may delay definitive treatment. We investigated whether definitive treatment can be expedited for MIBC using flexible cystoscopic biopsy and multiparametric magnetic resonance imaging (mpMRI) for initial staging.PATIENTS AND METHODSWe conducted a prospective open-label, randomized study conducted within 17 UK hospitals (registered as ISRCTN 35296862). Participants with suspected new BC were randomly assigned 1:1 to TURBT-staged or mpMRI-staged care, with minimization factors of sex, age, and clinician visual assessment of stage. Blinding was not possible. Patients unable/unwilling to undergo mpMRI or with previous BC were ineligible. The study had two stages with separate primary outcomes of feasibility and time to correct treatment (TTCT) for MIBC, respectively.RESULTSBetween May 31, 2018, and December 31, 2021, 638 patients were screened, and 143 participants randomly assigned to TURBT (n = 72; 55 males, 15 MIBCs) or initial mpMRI (n = 71; 53 males, 14 MIBCs). For feasibility, 36 of 39 (92% [95% CI, 79 to 98]) participants with suspected MIBC underwent mpMRI. The median TTCT for participants with MIBC was significantly shorter with initial mpMRI (n = 12, 53 days [95% CI, 20 to 89] v n = 14, 98 days [95% CI, 72 to 125] for TURBT, log-rank P .02). There was no detriment for participants with non-MIBC (median TTCT: n = 30, 17 days [95% CI, 8 to 25] for mpMRI v n = 28, 14 days [95% CI, 10 to 29] for TURBT, log-rank P = .67). No serious adverse events were reported.CONCLUSIONThe mpMRI-directed pathway led to a 45-day reduction in TTCT for MIBC. Incorporating mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected MIBC.

BACKGROUND:Penile cancer is a rare male genital malignancy. Surgical excision of the primary tumour is followed by radical inguinal lymphadenectomy if there is metastatic disease detected by biopsy, fine needle aspiration cytology (FNAC) or following sentinel lymph node biopsy in patients with impalpable disease. However, radical inguinal lymphadenectomy is associated with a high morbidity rate, and there is increasing usage of a videoendoscopic approach as an alternative.METHODS:A pragmatic, UK-wide multicentre feasibility randomised controlled trial (RCT), comparing videoendoscopic radical inguinal lymphadenectomy versus open radical inguinal lymphadenectomy. Patients will be identified and recruited from supraregional multi-disciplinary team meetings (sMDT) and must be aged 18 or over requiring inguinal lymphadenectomy, with no contraindications to surgical intervention for their cancer. Participants will be followed up for 6 months following randomisation. The primary outcome is the ability to recruit patients for randomisation across all selected sites and the rate of loss to follow-up. Other outcomes include acceptability of the trial and intervention to patients and healthcare professionals assessed by qualitative research and obtaining resource utilisation information for health economic analysis.DISCUSSION:There are currently no other published RCTs comparing videoendoscopic versus open radical inguinal lymphadenectomy. Ongoing study is required to determine whether randomising patients to either procedure is feasible and acceptable to patients. The results of this study may determine the design of a subsequent trial.TRIAL REGISTRATION:Clinicaltrials.gov PRS registry, registration number NCT05592639. Date of registration: 13th October 2022, retrospectively registered.

TPS14 Background: Penile cancer is rare, <1% of male malignancies diagnosed each year, but its incidence is increasing with an 18% increase over the last decade projected to rise a further 9% in the next 10 years. Patients with locally advanced/metastatic penile cancer (la/mPC) have very few treatment options and there is a lack of clinical trial data to guide management. Cisplatin containing combination chemotherapy regimens are regarded as the standard of care (SOC) in this setting. However, with response rates of 50% or less there is a need to further improve treatment outcomes. PDL1 is upregulated in 40–60% of PC cases and is correlated with poor prognosis making a case for immunotherapy as a treatment for la/mPC. The PD-1 inhibitor cemiplimab is approved for patients with locally advanced or metastatic cutaneous squamous cell carcinoma (SCC) suggesting efficacy against penile SCC. The EPIC trial was set up to evaluate the benefit and safety of cemiplimab alone, or, in combination with SOC chemotherapy in patients with la/mPC. Methods: This is a non-randomised, 2 arm, phase II multi-centre trial. Arm 1 cemiplimab + SOC chemotherapy (local site choice of cisplatin/5FU, TPF or TIP regimes); Arm 2 single agent cemiplimab. The choice of arm decided by the investigator site based on chemotherapy eligibility. 47 patients will be recruited from 10 UK centres: 29 patients into ARM 1 who will receive 4 cycles of cemiplimab 350mg IV q3 weekly + SOC chemotherapy, followed by single agent cemiplimab x 30 cycles (24 months total). 18 patients into ARM 2 who will receive single agent cemiplimab 350mg IV q3 weekly x 34 cycles (24 months total). The primary endpoint is clinical benefit rate (CBR) of cemiplimab: objective response rate (ORR) plus stable disease as assessed radiologically (RECIST 1.1) at 12 weeks from first dose in patients with la/mPC. Secondary end-points include safety, tolerability, CBR at 1, 2 and 3 years, ORR, progression-free survival, overall survival and assessment of patient health status and quality of life using the patient reported outcome measures EQ-5D-5L and EORTC QLQ-C30. Each arm will be analysed separately as a Fleming A’Hern study α=0.05 + power (1-β)=0.8. Arm 1 assumes 25% meeting the clinical end point is a poor treatment (p0=0.25) and 50% is a good treatment (p1=0.5). Arm 2 assumes 5% meeting the clinical end point is a poor treatment (p0=0.05) and 25% is a good treatment (p1=0.25). Progress: By February 2023 10 UK sites had been opened to recruitment. The first patient entered the trial in November 2021 and to date 25 patients have been recruited into Arm 1 and 10 into Arm 2. Opening sites was slower than anticipated following emergence from the COVID pandemic. However, a recruitment rate of 1-2 patients per month has shown the feasibility of running a trial for this rare patient population. Clinical trial information: ISRCTN95561634 .

VELRAD is the first multicentre feasibility randomised controlled trial comparing videoendoscopic radical inguinal lymphadenectomy versus open dissection for male genital cancer. We have randomised nine patients so far in our attempt to identify the best approach to inguinal lymph node dissection.

Background Lymph node metastasis is the main determinant of survival in penile cancer patients. Conventionally clinical palpability is used to stratify patients to Inguinal Lymph node dissection (ILND) if clinically node positive (cN +) or Dynamic sentinel node biopsy (DSNB) if clinically node negative (cN0). Studies suggest a false negative rate (FNR) of around 10% (5–13%) for DSNB. To our knowledge there are no studies reporting harder end point of survival and outcomes of all clinically node positive (cN +) patients. We present our outcome data of all patients with penile cancer including false negative rates and survival in both DSNB and ILND groups. Methods One hundred fifty-eight consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) ± fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone. Results 11.2% i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient’s request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24–150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% ( p = 0.03). Mean cancer specific survival of all node-positive patients was 105 months. Conclusion The performance of DSNB improved with enhanced radiological stratification of patients to either DSNB or ILND. We for the first time report the comprehensive outcome of all lymph node staging procedures in penile cancer.

Editor , We present the case (Video S1) of a 72- year- old woman who 2 years previously had undergone neoadjuvant long- course radiotherapy followed by low anterior resection with covering ileostomy for treat-ment of primary rectal adenocarcinoma. During follow- up examina-tion, a lesion at the anal verge was noted. Biopsy revealed this to be a circumferential squamous cell carcinoma. MRI of the pelvis revealed a tumour at the anal verge involving the right natal cleft and introitus. CT positron emission tomography (PET) identified a single, metabolically active left inguinal node with no other evidence of distant metastatic disease (Figures 1- 3). After a multidisciplinary team meeting, the decision was made to perform completion robotic abdominoperineal resection, robotic groin node dissection and pedicled flap reconstruction of the perineum. The patient was placed in the Lloyd Davies position and the existing ileostomy was reversed. Bilateral ureteric stents were inserted. Entry to the abdominal cavity and pneumoperitoneum were achieved by an open Hasson technique at the umbilicus. On initial laparoscopy, dense adhesions between the omentum and small bowel from previous surgery were noted, limiting the insertion of standard robotic ports. Two accessory 5 mm ports were sited and laparoscopic adhesiolysis was undertaken using the Olympus Thunderbeat device. Care was taken to avoid iatrogenic injury to the small bowel. Once an adequate surgical field was achieved, robotic ports were inserted

Abstract BackgroundLymph node metastasis is the main determinant of survival in penile cancer patients. Conventionally clinical palpability is used to stratify patients to Inguinal Lymph node dissection (ILND) if clinically node positive (cN+) or Dynamic sentinel node biopsy (DSNB) if clinically node negative (cN0). Studies suggest a false negative rate (FNR) of around 10% (5-13%) for DSNB. To our knowledge there are no studies reporting harder end point of survival and outcomes of all clinically node positive (cN+) patients. We present our outcome data of all patients with penile cancer including false negative rates and survival in both DSNB and ILND groups. Methods158 consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) +/-fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone. Results11.2 % i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient’s request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24-150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND.ConclusionCombined clinical and radiological stratification of patients achieved a 0% false-negative rate for DSNB at a mean follow-up of 65 months. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% (p=0.03). Mean cancer specific survival of all node-positive patients was 105 months.

Aims: We report the first UK case series of minimally invasive inguinal lymphadenectomy (MILND) for patients with metastatic cutaneous pathology. Methods: This was a retrospective, single-centre, single-surgeon cohort study. Twenty-one patients who underwent MILND from May 2015 to February 2019 were included. Demographic data, disease burden, and surgical quality assurance parameters were analysed. Results: Median age was 69 (IQR: 58-76) with 14 women (66%) and 7 men (33%). Eighteen (85%) patients had melanoma with the rest having other skin malignancies. The median number of nodes resected was eight (IQR:6-11) and the median N-ratio was 0.18 [0.05-1.00]. The median surgical time for the procedure was 180 minutes (IQR: 147-225) Seven (33%) patients had complications-three trivial and four (19%) grade IIIB. Only one case (the first) was converted to an open procedure. Conclusions: We report the first UK series of MILND in a cutaneous oncology service. Our results show that MILND is a safe technique that can be introduced into a busy NHS practice with a structured training program, with surgical quality assurance outcomes identical to open inguinal lymphadenectomy. Our learning curve was similar to previously published data. (C) 2021 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

R E FE R E N C E S 1. Ogura A, Konishi T, Cunningham C, GarciaAguilar J, Iversen H, Toda S, et al. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol. 2019;37(1):33– 43. https://doi.org/10.1200/jco.18.00032 2. Perez RO, Sao Juliao GP, Vailati BB, Fernandez LM, Mattacheo AE, Konishi T. Lateral node dissection in rectal cancer in the era of minimally invasive surgery: a stepbystep description for the surgeon unacquainted with this complex procedure with the use of the laparoscopic approach. Dis Colon Rectum. 2018;61(10):1237– 40. https://doi.org/10.1097/DCR.00000 00000 001182 3. Manabe T, Koga Y, Kubo H, Baba K, Nagayoshi K, Nagai S, et al. Adverse effects on the postoperative urinary function after combined resection of inferior vesical artery in laparoscopic lateral pelvic lymph node dissection: retrospective analysis of consecutive 95 series. Surg Laparosc Endosc Percutan Tech. 2019;29(6):493– 7. https://doi.org/10.1097/SLE.00000 00000 000681 4. Matsumoto A, Arita K. A technique of laparoscopic lateral pelvic lymph node dissection based on vesicohypogastric fascia and ureterohypogastric nerve fascia for advanced low rectal cancer. Surg Endosc. 2017;31(2):945– 8. https://doi.org/10.1007/s0046 401650147

Objectives: To develop an international consensus on managing penile cancer patients during the COVID-19 acute waves. A major concern for patients with penile cancer during the coronavirus disease 2019 (COVID-19) pandemic is how the enforced safety measures will affect their disease management. Delays in diagnosis and treatment initiation may have an impact on the extent of the primary lesion as well as the cancer-specific survival because of the development and progression of inguinal lymph node metastases. Materials and methods: A review of the COVID-19 literature was conducted in conjunction with analysis of current international guidelines on the management of penile cancer. Results were presented to an international panel of experts on penile cancer and infection control by a virtual accelerated Delphi process using 4 survey rounds. Consensus opinion was defined as an agreement of >= 80%, which was used to reconfigure management pathways for penile cancer. Results: Limited evidence is available for delaying penile cancer management. The consensus rate of agreement was 100% that penile cancer pathways should be reconfigured, and measures should be developed to prevent perioperative nosocomial transmission of COVID19. The panel also reached a consensus on several statements aimed at reconfiguring the management of penile cancer patients during the COVID-19 pandemic. Conclusions: The international consensus panel proposed a framework for the diagnostic and invasive therapeutic procedures for penile cancer within a low-risk environment for COVID-19. (C) 2020 Published by Elsevier Inc.

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer II (PD53)1 Sep 2021PD53-04 IMAGE DIRECTED STRATIFICATION OF PATIENTS TO LYMPH NODE STAGING PROCEDURES IN PENILE CANCER IMPROVE OUTCOME? 10-YEAR STUDY IN >150 PATIENTS Prakrit Kumar, Arne Juette, Davina Pawaroo, Richard Ball, Krishna Sethia, and Vivekanandan Kumar Prakrit KumarPrakrit Kumar More articles by this author , Arne JuetteArne Juette More articles by this author , Davina PawarooDavina Pawaroo More articles by this author , Richard BallRichard Ball More articles by this author , Krishna SethiaKrishna Sethia More articles by this author , and Vivekanandan KumarVivekanandan Kumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002080.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survival in penile cancer is largely determined by lymph node (LN) metastasis. Dynamic Sentinel Node Biopsy (DSNB) staging procedure has a false negative rate of 5-13%. We use image directed stratification patients to LN staging procedures as opposed to palpability and report the outcomes including survival. METHODS: 158 consecutive patients (316 inguinal basins (IB)), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) +/-fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed to stage their disease. We used combined clinical and radiological criteria to stratify patients for DSNB vs inguinal lymph node dissection (ILND). RESULTS: 241 IBs had DSNB due to clinically node negative disease (cN0) and 71 IBs had ILND due to abnormal nodes (cN+) and 4 IBs were observed due to non-drainage in sentinel node scan. 27(11.2%), 39 (54.9%) and 0 of those had nodes positive for metastasis respectively. The minimum and mean follow-up is 28 and 65 months respectively. FNR is 0%. All the 25 bilateral ILND patients had cross-sectional imaging. 13 had CT, 11 had MRI and 1 had both. Of the 108 DSNB patients, 30 had MRI, 34 had CT, and one both. 43 patients who had normal ultrasound (U1-2) and impalpable nodes did not have any cross-sectional imaging. Interestingly, only 2/43 (4.7%) patients who did not have cross-sectional imaging were DSNB-positive for micro-metastatic disease as opposed to 14/64 (21.9%) of imaged patients (p=0.03). 11 IBs in 9 patients had ILND dictated by cross-sectional imaging despite having negative US+FNAC and impalpable nodes. 3 IBs in 3 patients had metastatic disease on which 2 had CT and one MRI. We believe these 3 cases could have become a false negative in palpability+US FNAC protocols. Mean cancer specific survival (CSS) of all node-positive patients was 105 months. There was a difference in OS depending on which staging investigation was done at the outset (i.e., DSNB vs ILND (108 vs 72 months, p<0.0001). Further pN+ patients identified by DSNB had no significant difference in CSS compared to direct ILND patients (89 vs 92 months, p=0.124). CONCLUSIONS: Our enhanced clinical-radiological stratification criteria eliminated FNR for DSNB. Cross sectional imaging further sub stratifies patients in to 3 risk categories for micro-metastasis. Node positive patients had poor OS compared to node negative patients. However there was no difference in CSS in pN+ patients if either DSNB or ILND is used. This is first report of survival in lymph node staging in penile cancer. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e917-e917 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prakrit Kumar More articles by this author Arne Juette More articles by this author Davina Pawaroo More articles by this author Richard Ball More articles by this author Krishna Sethia More articles by this author Vivekanandan Kumar More articles by this author Expand All Advertisement Loading ...