Penile cancer is a rare cancer, with the majority treated with penile preserving methods.There remains a role for partial and totally penectomy for advanced and more proximal penile cancers.Significant functional and psychological morbidity can ensue for patients undergoing surgical management.Recent studies and guidelines are changing the way Urologists approach surgical management of penile malignancies. Reductions in safe surgical margin recommendations from 2 cm to 3-5 mm provide surgeons with the ability to perform penile preserving techniques to maximise patient functionality. These guidelines are reflected by recent studies showing that smaller surgical margins; although heralding higher rates of local recurrence, have no detriment on cancer specific or overall survival rate. Although oncological clearance remains the primary outcome for surgical management of penile cancer, the ability to perform radical salvage surgery at a later date means patients are more likely to experience a longer period of functionality without sacrificing oncologic outcomes. The importance of patient education on regular self-examination as well as clinic follow up are key in identifying local recurrence and planning salvage surgery if needed to maintain oncologic control. Ongoing studies into the functional and psychological outcomes of patients undergoing partial penectomy show encouraging results however further studies are needed to elucidate long-term outcomes. The evolving paradigm of surgical management in penile malignancy is shifting to favour organ preserving techniques in order to maximise functional, psychological and aesthetic outcomes without compromising patients' oncologic outcomes-however a role still exists for radical surgery in advanced penile malignancy.

Robotic technology and new surgical adjuncts are continually evolving to aid the operating surgeon and improve patient outcomes. Retroperitoneal access in renal surgery has clear benefits over traditional transperitoneal surgery with robotics augmenting the surgeon's ability to operate in this anatomically confined space. Traditionally, the retroperitoneal approach was reserved for patients with posterior or laterally located tumors, or in patients with hostile abdomens; however, more streamlined surgical robots, improvements in port placement and increased utilization of the retroperitoneal approach has meant that the vast majority of small renal masses can be safely accessed via the retroperitoneum. This chapter aims to explore this paradigm shift further, while also exploring the use of added technologies and variations in surgical techniques.Note to the Reader: This chapter is part of the book Urologic Cancers (ISBN: 978-0-6453320-5-6), scheduled for publication in July 2022. The book is being published by Exon Publications,