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Testo Vitality on to have surgical resection went on to have tumor progression now overall it Association of urology which didn't find any benefit to radiation treatment after removal of the lymph nodes so if there was positive lymph nodes in the cases that they reviewed they found that there was no significant benefit to radiating the area but another much smaller study but a retrospective study with Chanin colleagues reported significantly less regional failure rates in patients who had two or more positive lymph nodes or extra nodal extension who went on to receive external beam radiation after having a pelvic limp are having I want to lift over the section now in patients with bulky England lymph node Metz in England lymph node dissection should really be considered if they're very highly symptomatic and the disease is considered to be receptacle completely respectable otherwise they should undergo chemotherapy or chemo radiation and in cases of epsilon or pelvic lymph node this and it's a lateral pelvic lymph node dissection should be considered in patients that end up having two or more positive lymph nodes on superficial and deep inguinal lymph node dissection now this can be done intraoperatively so where you send
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