While surgical margins can be minimal (3-5 mm) in penile cancer (PC) there is still a substantial group of patients with locally advanced or anatomically unfavorable PC in whom aggressive surgical intervention is necessary.1 In cases with bulky primary tumors total penectomy is indicated. In these patients, perineal urethrostomy is often the definitive form of urinary diversion. Perineal urethrostomy has been described quite thoroughly for benign urethral disease. However, the combination with penectomy has 2 major differences. First of all, the surgery is lengthier and causes increased surgical trauma. Secondly, the urethra is completely transected in the case of a total penectomy. These two differences make it difficult to extrapolate the post-operative complications and outcomes of the benign perineal urethrostomy to a total penectomy with perineal urethrostomy. Therefore, this study aimed to describe the complications and outcomes of this procedure.