Lymphadenectomy for testicular, penile, upper tract urothelial and urethral cancers

The lymph node dissection (LND) is an integral component of many oncologic surgeries. Better understanding of each cancer's behaviour and improvements in surgical techniques necessitate a critical analysis of lymph node disease and the optimal LND template. This review will focus on updates in managing lymph node disease in testicular, penile, upper tract urothelial and urethral cancer.

For testicular and penile cancer, advances have focused on reducing the morbidity associated with the standard templates of dissection while maintaining oncologic efficacy. For upper tract urothelial carcinoma, data continue to be mixed regarding the need for a LND, though it does seem to benefit patients with advanced tumours. Little is known regarding the optimal LND template for urethral cancer.

A thorough LND has an established diagnostic and therapeutic role in testicular and penile cancer. For upper tract urothelial carcinoma, the role of an LND remains controversial, though emerging evidence points to an association with improved outcomes. Due to the rarity of urethral cancer, there are no standard LND templates, though excising clinically positive nodes is recommended. For all these cancers, more sophisticated risk stratification based upon clinical and pathologic factors has helped determine which patients require an LND and how to best manage these patients after surgery.