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Inguinal Node Dissection (Uniteral/Bilateral)
What is
Inguinal Node Dissection (Uniteral/Bilateral)?
Inguinal lymphadenectomy is commonly performed
for treatment of metastases from penile
carcinoma. This involves removal of the lymph
nodes in the groin. This operation is used for
men with penile cancer who have palpable masses
in their groins after taking 6 weeks of
antibiotics.
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Effects
of Inguinal Node Dissection (Uniteral/Bilateral)
Lymph
node dissection is the most effective means of
eradicating minimal lymphatic disease and of
accurately staging the disease.
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Candidates for Inguinal Node Dissection (Uniteral/Bilateral)
Carcinoma of the penis accounts for less than 1%
of all malignancies in male patients. For the
majority of patients, surgical excision is the
most effective means of controlling the local
penile tumor.
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Your Consultation
After
a comprehensive medical history has been
obtained, the patient should be thoroughly
clinically examined, including the site of the
primary tumor. For examination of the inguinal
nodes, the patient should be positioned supine
and appropriately exposed from umbilicus to the
mid thigh. Both femoral triangles should be
systematically palpated firmly but gently, to
detect any underlying lymphadenopathy; the
affected lymph nodes often have a firm,
bean-like consistency.
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The
Inguinal Node Dissection (Uniteral/Bilateral)
Procedure
If the
inguinal lymph nodes are enlarged at
presentation, a course of antibiotics should be
given with the intention that inflammatory
changes will resolve. The inguinal nodes are
reassessed four to six weeks later by clinical
palpation which has been noted to be practical
and acceptably accurate. By then the
pathological stage and grade would have been
known also and this information may help in
deciding on further surgery.
Whether the palpable nodes are unilateral or
bilateral, it is advocated that a bilateral
lympadenectomy be done due to the fact that 50 %
of the lymphatics have cross-over drainage. The
radical lymphadenectomy entails the removal of
both the superficial and deep inguinal lymphatic
chains.
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Recovery
No
robust evidence exists for the optimal period
for maintaining post-operative suction drainage.
Some authorities advocate early drain removal at
24 hours after surgery, whereas others recommend
removal once drainage falls beneath a specific
threshold (30-50 ml over 24 hours)-which may
take some weeks. Early ambulation is encouraged
to minimize the risk of deep vein thrombosis,
although mobilization accelerates lymph flow
from the lower extremity and may augment lymph
drainage. Patients are unlikely to be fit to
drive for at least four to six weeks after
surgery.
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Risks
Complications include lymphocoele, substantial
lower limb lymphedema, skin loss, and infection.
Although rarely fatal, postoperative
complications after inguinal surgery are
extremely debilitating and harbour considerable
socioeconomic costs. Wound infection or
dehiscence is more likely in elderly or obese
patients. In addition, smoking, poor nutrition,
and treatment with immunosuppressant drugs
represent independent risk factors for impaired
wound healing.
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Frequently Asked Questions
Q:
What are inguinal nodes?
A:
The inguinal nodes are divided into two groups,
superficial and deep. The superficial nodes are
located beneath the subcutaneous fascia and
above the fascia lata covering the muscles of
the upper leg; 8 to 25 superficial nodes are
present. The deep inguinal nodes are those
around the fossa ovalis, the opening in the
fascia lata where the saphenous vein drains into
the femoral vein; 3 to 5 deep nodes are present.
These nodes form the link to the second-line
regional nodes, ie, the pelvic nodes. The deep
nodes receive their afferents from the
superficial ones and directly from the deeper
structures of the penis.
Q: What are the common complications to this
procedure?
A:
Other
common complications include seroma formation (a
collection of serous tissue fluid),
development of lymphocele (a collection
of lymphatic fluid), and lymphoedema of
the lower limb. Wound cellulitis
requiring readmission for treatment with
intravenous antibiotics is not
uncommon, and occasionally an abscess requires
drainage under general anesthesia.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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