Current practices and variability in dynamic sentinel node biopsy for penile cancer: A survey of European Referral Centers.

Background: Dynamic sentinel node biopsy (DSNB) is the currently preferred staging method of high-risk penile cancer (PeCa) patients with cN0 disease. Recently, there have been advancements in the surgical approach and techniques. This study aims to compare the contemporary DSNB practice and techniques amongst European referral centers.

Materials And Methods: An online survey was sent to members of the EAU YAU Penile and Testis Cancer working group. These questions delved into various facets of DSNB, encompassing imaging techniques, tracers, surgical approaches, and postoperative patient care. Participating centers were also required to provide video-recorded DSNB procedures in a standardized manner for a comparative analysis of technical nuances.

Results: Responses were received from twelve Urologists from nine European centers. Overall, 83% and 42% of surgeons performed >10 and >50 DSNB procedures per year, respectively. There is a broad consensus on the technique and site of tracer injections. Conversely, 50% of centers use lymphoscintigraphy, 17% use SPECT/CT, while 33% utilize both imaging modalities. The predominant choice of dye is Patent V/blue, but 25% of centers use Indocyanine Green (ICG). Notable variability exists in surgical incision sites and lymphatic ligation techniques. The consensus is leaning towards not leaving a wound drain. Overall, 83% of centers adopt antibiotic surgical prophylaxis, with 83% discontinuing it postoperatively. A quarter of centers would advocate for patients to be discharged with thromboprophylaxis, either using low molecular weight heparin or thromboembolic deterrent stockings. On average, the postoperative length of stay in hospital is 1 day.

Conclusions: Variation exists in procedural aspects and postoperative management among centers performing DSNB for PeCa. Newer technologies like fluorescence imaging and SPECT/CT are used in some European centers, but high-quality evidence is sparse, highlighting the need for extensive multicenter research into surgical outcomes and emerging technologies.