title: The impact of Improving Outcomes Guidance on the management and outcomes of patients with carcinoma of the penis.
abstract: BACKGROUND
  The Improving Outcomes Guidance (IOG) for patients with carcinoma of the penis states that treatment should be provided supraregionally to populations of 4 million or greater who treat over 25 cases of penis cancer each year. This study assesses the impact of this guidance on the management and outcomes of patients with the disease in our region.
  
  
  METHODS
  We retrospectively compared the records of 44 patients with carcinoma of the penis treated in our institution between 1969 and 1990 with 101 patients treated between 2002 and 2006, i.e. after supraregional centralisation of the service.
  
  
  RESULTS
  There was no significant change in the stage or grade of the tumours. However, the results show that, in modern times, there was a significant increase in the amount of penis-preserving and nodal surgery as well as a fall in mortality. The improved survival is greatest in patients with poorly-differentiated disease who may, therefore, have benefited from aggressive nodal surgery.
  
  
  CONCLUSIONS
  The centralisation of surgery for carcinoma of the penis results in improved outcomes both in terms of penis preservation and improved survival and this supports the IOG guidance.
authors.affiliation: Department of Urology, Norfolk and Norwich University NHS Trust, Norwich, UK.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bayles
authors.forename: Krishna K
authors.initials: KK
authors.lastname: Sethia
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D010412:Penile Neoplasms / Q000401:mortality / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome