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García-Perdomo HA, Dávila-Raigoza AM, Summers E, Billingham L, Necchi A, Griffiths G, Spiess PE. Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours. BJU Int 2024. [PMID: 38587299 DOI: 10.1111/bju.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT). METHODS A comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprised individuals aged 16 years and older diagnosed with urethral tumours at any stage who underwent either isolated urethrectomy or urethrectomy as an integral component of MMT. RESULTS Ninety-two studies comprising 25 480 patients met the inclusion criteria. Surgical outcomes for urethral cancer vary considerably, with 5-year overall survival (OS) ranging from 10% to 68% based on disease extent, approach, and gender. Radiotherapy (RT) alone provides 5-year OS of approximately 40%. Combined regimens provide better outcomes compared to single modalities, including reduced recurrence and enhanced survival. However, trimodal therapy showed survival benefits only for urothelial subtypes, indicating the need to tailor management according to cancer type. MMT with neoadjuvant chemotherapy prior to surgery demonstrated the most consistent survival gains. CONCLUSIONS The management of urethral cancer demands a nuanced, personalised approach, accounting for factors such as tumour location, sex, and tumour stage. MMT combining surgery, chemotherapy and RT has shown the ability to enhance outcomes in advanced disease. More extensive collaborative studies through specialised centres are imperative to advance evidence-based protocols and refine treatment in order to improve survival.
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Affiliation(s)
- Herney Andrés García-Perdomo
- UROGIV Research Group, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | | | - Ellie Summers
- Cancer Research U.K., Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lucinda Billingham
- Cancer Research U.K., Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Andrea Necchi
- Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Gareth Griffiths
- Cancer Research U.K., Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Philippe E Spiess
- Department of Genitourinary Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Urology and Oncology, University of South Florida, Tampa, FL, USA
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Cimadamore A, Lopez-Beltran A, Cheng L, Montironi R. Morphologic spectrum of the epithelial tumors of the male and female urethra. Virchows Arch 2023; 483:751-764. [PMID: 37233807 DOI: 10.1007/s00428-023-03565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
The classification of the epithelial tumors of the male and female urethra includes benign and malignant neoplasms. Primary urethral carcinomas and adenocarcinomas of the accessory glands are the most relevant tumors, both from the morphologic and clinical point of view. An accurate diagnosis, grading and staging are essential for determining adequate treatment strategies and outcome. Information on anatomy and histology of the urethra is of fundamental importance in understanding the morphology of the tumors, including the clinical importance of their location and origin.
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Affiliation(s)
- Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, Udine, Italy.
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, c/o Polytechnic University of the Marche Region, Via Tronto 10, 60126, Ancona, Italy.
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Balagobi B, Abiharan P, Nalini R, Chrishanthi R, Theepan J, Heerthikan K. A case report: Female primary urethral carcinoma presenting as vulval mass. Int J Surg Case Rep 2023; 109:108505. [PMID: 37467644 PMCID: PMC10372737 DOI: 10.1016/j.ijscr.2023.108505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Primary urethral carcinoma is a rare disease with overall poorer outcomes in the past. It is relatively more uncommon in female sex. CLINICAL PRESENTATION We present a case of a female with primary urethral carcinoma that presented atypically as a vulval mass without any features of storage, voiding lower urinary tract symptoms, or gross haematuria. DISCUSSION As primary urethral carcinoma is rare in occurrence, prospective studies are limited so as the recommendations to guide treatment options. Treatment recommendations are still on development from different small-scale studies as well as from data in higher volume centers. Management options depends on location, extent, histology of the lesion as well as on sex of the patient and fitness of the patient. CONCLUSION Early diagnosis and treatment with multidisciplinary consult and multimodality will improve the overall survival rate and quality of life of the patients.
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Affiliation(s)
- B Balagobi
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
| | - P Abiharan
- University Surgical Unit, Teaching Hospital Jaffna, Sri Lanka
| | - R Nalini
- Department of Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - R Chrishanthi
- Department of Oncology, Teaching Hospital Jaffna, Sri Lanka
| | - J Theepan
- Department of Pathology, Teaching Hospital Jaffna, Sri Lanka
| | - K Heerthikan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
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Al Barajraji M, Holz S, Moussa I, Naudin M, Coscarella M, Martin Martinez MD, Dingenen S, Baize A, Taylor S. Advanced Female Primary Urethral Carcinoma with Nodal Extension Managed with Exclusive Use of Chemoradiotherapy: Report of a Case and Review of the Relevant Current Literature. Case Rep Oncol 2023; 16:946-953. [PMID: 37900838 PMCID: PMC10601767 DOI: 10.1159/000532121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Primary urethral carcinoma (PUC) is a rare disease with frequent nodal metastasis at the time of diagnosis. Few risk factors have been established and overall prognosis remains poor. As of now, no clear therapeutic guidelines are established and management of advanced PUC often involves surgery which can have negative functional and psychological outcomes for the patient. Few authors have already reported the use of chemoradiotherapy alone to avoid surgery with some good short-term results. We report the case of a 48-year-old woman with advanced high-grade urothelial carcinoma of distal urethra associated to bilateral inguinal nodal metastasis. She was similarly and successfully treated using chemoradiotherapy exclusively without significant adverse effects. This experience reinforces benefits of a surgery-sparing management, when possible, as recommended in current guidelines.
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Affiliation(s)
| | - Serge Holz
- Department of Urology, Ambroise Pare Hospital, Mons, Belgium
| | - Ilan Moussa
- Department of Urology, Ambroise Pare Hospital, Mons, Belgium
| | - Michel Naudin
- Department of Urology, Ambroise Pare Hospital, Mons, Belgium
| | | | | | | | - Adèle Baize
- Department of Oncology, Ambroise Pare Hospital, Mons, Belgium
| | - Stephen Taylor
- Department of Radiology, Ambroise Pare Hospital, Mons, Belgium
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5
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Su HC, Zhu Y, Ye DW. A brief review on the diagnostic and therapeutic principles of primary urethral cancer. Asian J Urol 2022; 9:423-429. [PMID: 36381601 PMCID: PMC9643286 DOI: 10.1016/j.ajur.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/19/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on this patient settings. Methods Recent literature ranging from January 1987 and December 2021 was assessed through PubMed search to assess the diagnostic and therapeutic principles of PUC. Results A complete of examination including cystoscopy, imaging, and biopsy should be conducted for these patients. Once diagnosed, the clinical decision of PUC should be made according to the tumor location, pathological pattern, and extent of the tumor. For patients with superficial and distal urethral lesions, organ sparing approaches or radical reconstructive procedures can be utilized. While for more advanced disease or nodal involvement, an optimal multimodal treatment strategy consisted of surgery and radiochemotherapy should be adopted. For patients with urothelial carcinoma of the prostate, the management including transurethral resection of the prostate followed by bacille Calmette-Guerin or radical cystoprostatectomy should depend on the infiltration depth of PUC. Conclusion A complete of examination is important for the diagnosis of PUC. The management of PUC should be determined by the location, pathological pattern, and extent of the tumor. More multi-institutional collaborations should be held to investigate better treatment modalities for PUC.
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Lee W, Yu J, Lee J, Kim YS, Hong B. Clinical features and oncological outcomes of primary female urethral cancer. J Surg Oncol 2022; 125:907-915. [DOI: 10.1002/jso.26790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Wonchul Lee
- Department of Urology Hallym University Dongtan Sacred Heart Hospital Hwaseong Korea
| | - Jesang Yu
- Department of Radiation Oncology Kosin University Gospel Hospital Busan Korea
| | - Jae‐Lyun Lee
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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O'Kelly JA, Browne E, Murray P, Keane J, Daly P, Cullen IM. Distal urethral carcinoma: Contemporary management with phallus preserving techniques. Surgeon 2022; 20:e282-e287. [PMID: 35012866 DOI: 10.1016/j.surge.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma. METHODS Seven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020. RESULTS The mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date. CONCLUSION Penile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.
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Affiliation(s)
- J A O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - E Browne
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Murray
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Keane
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - I M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; National Cancer Control Programme (NCCP), Dublin, Ireland
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Leptomeningeal Disease as a Rare Complication of Primary Penile Urethral Cancer. Case Rep Oncol Med 2020; 2020:6349456. [PMID: 32257477 PMCID: PMC7128049 DOI: 10.1155/2020/6349456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
Primary penile urethral cancer is a rare genitourinary malignancy arising from the epithelial lining of the urethra. Our patient is a 63-year-old male with newly diagnosed penile urethral carcinoma who presented with headache and was found to have leptomeningeal disease on imaging and cerebral spinal fluid analysis. He was treated with systemic and intrathecal chemotherapy with some response and improvement in symptoms. This is the first reported case of leptomeningeal disease as a complication of penile urethral carcinoma. Recognition and prompt treatment are important; however, overall prognosis of this entity remains poor.
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Kitamura Y, Horiguchi A, Ojima K, Kawamura K, Shinchi M, Asano T, Ito K, Azuma R. Penile-preserving surgery for male distal urethral carcinoma followed by buccal mucosa urethroplasty. IJU Case Rep 2019; 2:198-201. [PMID: 32743412 PMCID: PMC7292118 DOI: 10.1002/iju5.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction We report a case of distal urethral carcinoma treated with segmental urethral excision and reconstruction by staged buccal mucosa urethroplasty. Case presentation A 60‐year‐old man presented with difficulty urinating and a palpable mass on the ventral side of his penis. He was diagnosed as having localized distal urethral carcinoma (cT2N0M0) and underwent penile‐preserving surgery with staged urethroplasty using buccal mucosa as substitute tissue. The pathological diagnosis was squamous cell carcinoma of the urethra (T2) with negative surgical margin. At 2 years of follow‐up, there was no recurrence or metastasis, he could void in a standing position with an acceptable urinary stream, and he found the appearance of his external genitalia acceptable. Conclusion In cases of distal primary urethral carcinoma, urethroplasty using buccal mucosa graft could be alternative treatment option providing a better postoperative quality of life.
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Affiliation(s)
- Yosuke Kitamura
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Akio Horiguchi
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Kenichiro Ojima
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Kazuki Kawamura
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Masayuki Shinchi
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Tomohiko Asano
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Keichi Ito
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery National Defense Medical College Tokorozawa Saitama Japan
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Castiglione F, Alnajjar HM, Christodoulidou M, Albersen M, Parnham A, Freeman A, Jameson C, Mitra A, Nigam R, Malone P, Muneer A. Primary Squamous Cell Carcinoma of the Male Proximal Urethra: Outcomes from a Single Centre. Eur Urol Focus 2019; 7:163-169. [PMID: 30853605 DOI: 10.1016/j.euf.2019.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary squamous cell carcinoma (SCC) of the male proximal urethra is an aggressive and rare urogenital malignancy. OBJECTIVE To review the surgical management and outcomes for male proximal urethral SCCs within a single centre and to suggest an algorithm for the surgical management of these rare tumours. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective study of patients undergoing surgery for male proximal urethral SCC within a single tertiary academic centre managing rare genital tumours. Ten patients with a histological diagnosis of proximal urethral SCC were identified from an institutional database over a period of 10 yr with a median follow-up of 22.5 mo (standard deviation±25.77 mo). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Pathological staging, surgical treatment, and neoadjuvant and adjuvant treatment were recorded. Complications according to the Clavien-Dindo classification and overall survival rates were recorded. Kaplan-Meier curves were used for overall survival. RESULTS AND LIMITATIONS A total of 10 patients were identified of whom eight underwent panurethrectomy and radical prostatectomy. Radical inguinal lymphadenectomy was performed in five patients, which confirmed bilateral metastatic disease. Perioperative complications were reported in six patients (Clavien I and II). Within 6 mo of surgery, 90% of patients developed distant metastatic disease. Nine patients died of urethra cancer during the follow-up. One patient is still on follow-up. The median overall follow-up was 13.92 mo (range: 5-91 mo). At 5 yr, cancer-specific/overall survival was 10%. A limitation of this study is the retrospective design, which is unavoidable for such a rare disease. CONCLUSIONS Radical surgery allows local disease control, but despite neo/adjuvant treatment, proximal urethral SCC is associated with poor survival outcomes and progression to distant metastatic disease within 6 mo. PATIENT SUMMARY Proximal urethral squamous cell carcinoma is a rare cancer in men which is often detected late. Patients often present with problems such as voiding, urethral bleeding, or a palpable mass. Aggressive surgery allows local control, but despite this the overall survival is poor. Adjuvant and neoadjuvant radiochemotherapy can improve survival. Multicentric randomised trials are needed to identify the correct treatment modality.
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Affiliation(s)
- Fabio Castiglione
- Department of Urology, University College London Hospital, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | - Maarten Albersen
- Department of Urology, University College London Hospital, London, UK
| | - Arie Parnham
- Department of Urology, University College London Hospital, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospital, London, UK
| | - Charles Jameson
- Department of Pathology, University College London Hospital, London, UK
| | - Anita Mitra
- Department of Oncology, University College London Hospital, London, UK
| | - Raj Nigam
- Department of Urology, University College London Hospital, London, UK
| | - Peter Malone
- Department of Urology, University College London Hospital, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, UK; NIHR Biomedical Research Centre, University College London Hospital, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
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