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March B, Palma CA, Leslie S, Watson G, Lee P, Austin KK, Solomon M, Jeffery N. Phallus Preservation for Locally Advanced Proximal Primary Urethral Carcinoma: Technique and Outcomes. Urology 2023; 173:198-203. [PMID: 36646175 DOI: 10.1016/j.urology.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To describe a novel method of penile sparing perineal urethrectomy for locally advanced proximal primary urethral cancers (PUC). TECHNICAL CONSIDERATIONS In mid-2021, 2 cases underwent pelvic exenterative surgery for pT3 and pT4 PUC. The procedure comprised of a complete urethrectomy, proximal penectomy, en bloc pubectomy and excision of pelvic diaphragm in both cases. One case included a wide excision of scrotum, whilst the other required a prostatectomy and abdominoperineal resection of the rectum to achieve complete tumor resection. A complete R0 resection was achieved in both cases. At 6 months follow up, there is no evidence of ischemic necrosis of the penis and cosmesis is satisfactory to both patients. We provide a comprehensive operative description of both cases, together with illustrations, and discuss the underlying principles of penile preservation in the surgical treatment of locally advanced proximal PUC. CONCLUSION Complete perineal urethrectomy with phallic preservation is feasible in men with locally advanced proximal bulbar urethral cancer in the absence of tumor invasion of the penile shaft. The remnant penis survives off arterial supply from the superficial penile arteries arising from the external pudendal arteries. Phallic preservation may benefit patient's psychological quality of life post-procedure.
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Affiliation(s)
- Brayden March
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Catalina A Palma
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Geoffrey Watson
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Peter Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
| | - Kirk Ks Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia
| | - Michael Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Nicola Jeffery
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Wang M, Yang M, Wu P, Deng S, Wang J, Chen J, Wang J, Liu M. Transperineal-incision urethrectomy combined with laparoscopic prostatectomy for a male patient with squamous cell carcinoma involving distal plus proximal urethra and untypical symptoms-a case report. Transl Androl Urol 2021; 10:976-982. [PMID: 33718098 PMCID: PMC7947435 DOI: 10.21037/tau-20-984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Primary urethral carcinoma (PUC) is a rare malignancy, covering less than 1% of all genitourinary cancers. Different tumor location, classified as tumor in distal or proximal urethra, represents different characteristics and often leads to different treatment modality. However, data on the surgical approach for PUC involving both distal and proximal urethra remains rare. In this case, we presented a 75-year-old man with untypical symptoms of perineal mass and unspecific frequent and painful urination. Results of multiparametric magnetic resonance imaging (mp-MRI), positron emission tomography/computed tomography (PET/CT) scan, and percutaneous biopsy revealed a cT2N1M0 PUC involving both distal and proximal urethra. Given the request of patients for a normal penile appearance after surgery, a transperineal-incision urethrectomy combined with laparoscopic prostatectomy and iliac lymphadenectomy was performed with optimal outcomes. The results of histopathological analysis revealed a moderately-high differentiated PUC with no positive lymph node. Post-operative recovery was uneventful. On first visit 1-month after surgery, physical examination revealed a satisfactory wound healing and appearance of penis and no recurrent lesions were found on mp-MRI. This is a rare case with untypical symptoms indicating that patients with PUC involving both distal and proximal urethra may present with no symptoms of urethral stricture but only non-specific lower urinary symptoms. The surgical approach we proposed in this case proves to be a safe and feasible one to completely resect the tumor and preserve a normal appearance of penis, thus worth to be applied in the specific patient population.
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Affiliation(s)
- Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingzi Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shumin Deng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianlong Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Chen
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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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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Blick C, Sahdev V, Mitra A, Nigam R, Muneer A. The contemporary management of primary urethral carcinoma. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815584129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary urethral cancer is a rare malignancy; the most common histological subtype is squamous cell carcinoma. The aetiology of this cancer is similar to penile cancer and the human papilloma virus (HPV) is thought to be an important factor in tumourigenesis. Surgery with or without chemoradiotherapy is the accepted treatment for primary urethral cancer. Current practice supports penile-sparing surgery, to maximise functional and psychological outcomes. We have reviewed the literature to summarise the pathogenesis and management of primary urethral cancer.
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Affiliation(s)
| | - Varun Sahdev
- Department of Urology, University College Hospital, London, UK
| | - Anita Mitra
- Department of Urology, University College Hospital, London, UK
| | - Raj Nigam
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Asif Muneer
- Department of Urology, University College Hospital, London, UK
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Smith Y, Hadway P, Ahmed S, Perry MJ, Corbishley CM, Watkin NA. Penile-preserving surgery for male distal urethral carcinoma. BJU Int 2007; 100:82-7. [PMID: 17488307 DOI: 10.1111/j.1464-410x.2007.06901.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate medium-term outcome data from patients with distal urethral cancers treated with penile-preserving surgery. PATIENTS AND METHODS We analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra-regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour-Node-Metastasis classification and the patients offered penile-preserving surgery when tumours were limited to the glanular or penile urethra. RESULTS All 18 patients were suitable for penile-preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow-up was 26 (20.5, 9-58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition. CONCLUSION Medium-term data show that penile-preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow-up is needed.
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Affiliation(s)
- Yuko Smith
- Department of Urology, St George's Hospital, Tooting, London, UK.
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Castillo OA, Pinto I, Portalier P, Díaz MA, Vitagliano G. Laparoscopic radical cystoprostatectomy and in block urethrectomy in urethral cancer: initial experience in 2 cases. Surg Laparosc Endosc Percutan Tech 2007; 17:38-41. [PMID: 17318053 DOI: 10.1097/01.sle.0000213754.69137.2b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We introduce laparoscopic radical cystoprostatectomy and in block urethrectomy as an option for the treatment of urethral cancer in men. Using a 5-port transperitoneal approach, a radical cystoprostatectomy is completed laparoscopically with bilateral iliac and pelvic lymphadenectomy. Urethrectomy and extraction of bladder and prostate is performed through a perineal incision. A segment of ileum is isolated and exteriorized to create an extracorporeal ileal conduit and restore ileo-ileal continuity by open standard technique. Bilateral stented uretero-ileal anastomosis is extracorporeally performed. Total operative time ranges from 4.5 to 4.8 hours. Laparoscopic radical cystoprostatectomy with perineal urethrectomy and an extracorporeally made ileal conduit is a feasible technique that can be reproduced. To our knowledge, this is the first report of laparoscopic radical surgery in the treatment of urethral cancer in men.
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Affiliation(s)
- Octavio A Castillo
- Section of Endourology and Laparoscopic Urology, Department of Urology, Clínica Santa Maria, Santiago de Chile, Chile.
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Urethra Reconstruction Following Resection of Penile Leiomyosarcoma: Part 2. Eur Urol 2006. [DOI: 10.1016/j.eururo.2006.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Christopher N, Arya M, Brown RSD, Payne HA, Woodhouse CRJ, Ralph DJ. Penile preservation in squamous cell carcinoma of the bulbomembranous urethra. BJU Int 2002; 89:464-5. [PMID: 11872045 DOI: 10.1046/j.1464-4096.2001.00135.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- N Christopher
- Institute of Urology, University College London, London, UK
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SUBCUTANEOUS PENECTOMY AND PHALLOPLASTY USING A TESTICLE FOR INVASIVE URETHRAL CARCINOMA. J Urol 2002. [DOI: 10.1097/00005392-200201000-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ISHII TATSU, HIRATSUKA YOSHIHARU, ABE HIRONORI, IKEDA MINORU, ARIYOSHI ASAMI. SUBCUTANEOUS PENECTOMY AND PHALLOPLASTY USING A TESTICLE FOR INVASIVE URETHRAL CARCINOMA. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65427-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- TATSU ISHII
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - YOSHIHARU HIRATSUKA
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - HIRONORI ABE
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - MINORU IKEDA
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
| | - ASAMI ARIYOSHI
- From the Department of Urology, Chikushi-Hospital, Fukuoka University, Chikushino, Fukuoka University School of Medicine, Fukuoka and Ikeda Clinic, Kumamoto, Japan
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