Carcinoma of the penis is a rare but aggressive malignancy, with lymphatic metastasis being the most significant prognostic factor.(1) Accurate staging of inguinal lymph nodes is crucial for treatment planning and survival outcomes. Traditional inguinal lymphadenectomy, while effective, is associated with high morbidity, including lymphedema, wound infections, and skin necrosis.(2) Sentinel lymph node biopsy (SLNB) has emerged as a minimally invasive technique to identify nodal metastases in clinically node-negative (cN0) patients, potentially reducing unnecessary lymphadenectomy while maintaining oncological safety. (3)This video displays the role, accuracy, and clinical impact of SLNB in penile cancer management.

This video includes a review of SLNB techniqueperformed on a cN0 patient with carcinoma penis. The procedure involves injection of dual dye around the penile lesion and  intraoperative identification of sentinel lymph nodes using white light & ultraviolet/blue light, and selective excision of the identified nodes. The histopathological evaluation of sentinel nodes, was performed to detect micrometastases. The video presentation demonstrates injection techniques, intraoperative lymphatic mapping, and biopsy retrieval.

SLNB has shown a high sensitivity (80–90%) and a negative predictive value exceeding 90% in detecting micrometastases in cN0 patients. Patients with negative sentinel nodes are able to avoid unnecessary inguinal lymphadenectomy, significantly reducing postoperative complications. The false-negative rate remains a concern, but it has been minimized with refinements such as the use of dual tracers and intraoperative frozen section analysis. Comparative analysis with modified lymphadenectomy suggests that SLNB provides comparable oncological outcomes with significantly lower morbidity.


Cost of methylene blue vial-150 rupee(1.74 U.S Dollar)
Cost of  fluorescein dye vial-100rupee(1,16 U.S Dollar)

Sentinel lymph node biopsy is a valuable tool in the management of carcinoma penis, allowing for accurate lymphatic staging with minimal morbidity. While false negatives remain a challenge, advancements in technique and adjunct diagnostic tools have improved its reliability. SLNB offers a promising alternative to routine lymphadenectomy, reducing complications while ensuring adequate oncological control. Further prospective studies and standardization of protocols are required to optimize its clinical application.

1)	Djajadiningrat RS, Graafland NM, van Werkhoven E, Meinhardt W, Bex A, van der Poel HG, van Boven HH, Valdés Olmos RA, Horenblas S. Contemporary management of regional nodes in penile cancer-improvement of survival? J Urol. 2014 Jan;191(1):68-73
Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009 May;55(5):1075-88.
Kroon BK, Horenblas S, Meinhardt W, van der Poel HG, Bex A, van Tinteren H, Valdés Olmos RA, Nieweg OE. Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol. 2005 May;47(5):601-6; discussion 606.