Surgical resection has been the mainstay treatment of primary tumour in patients with penile cancer. Radical and partial penile amputation surgery has historically been the surgical treatment of choice for patients with penile cancer, owing to its excellent long-term oncological control. However, such an approach is associated with significant psychological, sexual, and urinary functional morbidities. With the continual rise in the incidence and experience gained through centralisation in the management of this rare disease at specialist units, surgical approaches to penile cancer have advanced considerably over the past two decades. Organ-preserving surgery, in correctly selected patients, has been developed to minimise anatomical and functional disruption but at the same time provides good loco-regional oncological control. This chapter aims to review the basis for penile-preserving surgery for patients with penile cancer, patient selection, and surgical techniques available.