Question 6#

Which of the following is NOT an anatomical boundary of the femoral triangle?

A. The inguinal ligament

Answer B

Medial border of adductor longus muscle is not an anatomical boundary it’s the lateral border. The inguinal ligament superiorly, the medial border of sartorius muscle laterally, the lateral border of adductor longus muscle and tendon medially. The floor comprises the iliopsoas muscle laterally, the pectineus muscle medially and the femoral vessels.

Question 7#

Which primary tumour pathological feature is NOT associated with increased risk of lymph node metastases and poorer prognosis?

A. Stage T2 or greater

Answer E

Tumour location does not influence risk of metastatic disease, all the others do. The most important risk factors appear to be sarcomatoid and basaloid variants, higher grade, perineural and vascular invasion.

Question 8#

With regards to the EAU guidelines on penile cancer 2013. How frequently should a man be followed up during the first 2 years following penile preserving surgery and a negative sentinel lymph node biopsy?

A. Monthly

Answer C

It is known that the majority of local, regional and distant recurrence occurs in the first 2 years following initial treatment. Follow up is therefore intense for this period and then relaxed to every 6 months out to 5 years when the majority of patients can be discharged. It’s vital that patients are taught self-examination from the outset.

Question 9#

Which of the following is NOT a recognised treatment option for penile intraepithelial neoplasia (PeIN)?

A. Wide local excision (WLE) with circumcision

Answer D

All of the answers except radiotherapy are genuine treatment options in contemporary urological practice. Small areas of disease can be managed by either WLE or topical therapy with 5 FU or Imiquimod creams. Laser therapy with CO2 or Nd:YAG has been well reported. Total glans resurfacing surgery tends to be reserved for disease refractory to the above or extensive PeIN on the glans penis. Circumcision is strongly recommended in these patients as it removes a potential site of recurrence, makes surveillance and topical treatment easier. 

Question 10#

Which of the following stages of penile SCC should be recommended adjuvant chemotherapy?

A. pN2 and pN3 disease

Answer A

Adjuvant chemotherapy is recommended for patients with good performance status and either pN2, pN3, M1 disease. Three cycles of cisplatin and fluorouracil are recommended as per 2013 EAU guidelines. Several other regimes have been tried in small series including taxanes and carboplatin.