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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; 134:175-184. [PMID: 38587299 DOI: 10.1111/bju.16334] [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] [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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Paighan NM, Goel HK, Makkar A. A case report on locally advanced squamous cell carcinoma in permanent perineal urethrostomy: A surgical conundrum!! Indian J Urol 2024; 40:197-199. [PMID: 39100612 PMCID: PMC11296581 DOI: 10.4103/iju.iju_106_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 08/06/2024] Open
Abstract
Primary urethral cancer is a rare condition often manifesting in the sixth decade of life and is typically associated with urethral stricture disease. A 65-year-old male, a known case of stricture urethra, underwent perineal urethrostomy 10 years back. He presented with a growth at the urethrostomy site and the biopsy revealed squamous cell carcinoma. Magnetic resonance imaging of the pelvis revealed that the lesion extended into the penile and prostatic urethra with possible involvement of the corpus spongiosum, bulbospongiosus, and the bladder neck. Radical cystectomy, penectomy, scrotectomy, and bilateral orchiectomy with ileal conduit were performed. At 18-months of follow-up, the patient is recurrence-free.
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Affiliation(s)
- Nitin Madanrao Paighan
- Department of Urology and Renal Transplantation, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Hemant Kumar Goel
- Department of Urology and Renal Transplantation, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Arun Makkar
- Department of Urology and Renal Transplantation, ABVIMS and Dr. RML Hospital, New Delhi, India
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3
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Neuville P, Murez T, Savoie PH, Rocher L, Fléchon A, Ferretti L, Van Hove A, Branger N, Camparo P, Rouprêt M. Primary urethral carcinoma: Recommendations of the oncology committee of the French Urology Association. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102606. [PMID: 38437949 DOI: 10.1016/j.fjurol.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Primary urethral carcinoma (PUC) is defined as a tumor process arising within the urethra, with no history of other urinary tract localization or synchronous tumor of the urinary tract. The most common histological types are urothelial carcinoma (UC), squamous cell carcinoma (SCC) and adenocarcinoma (AC). In men, UC predominates, while AC is rare. In women, AC affects around one in two patients, while EC and UC are equally divided between the remaining cases. Diagnosis is often delayed, and requires endoscopic examination with biopsies. MRI is the gold standard for local staging. FDG-PET scan can help in cases of doubt about regional or distant extension. The prognosis remains unfavorable despite aggressive surgical treatment. Multimodal management combining surgery, radiotherapy and chemotherapy appears to improve prognosis in severe forms.
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Affiliation(s)
- Paul Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Thibaut Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Pierre Henri Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre d'urologie UROVAR, polyclinique les Fleurs, 332, avenue Frédéric-Mistral, 83190 Ollioules, France
| | - Laurence Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Aude Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Ludovic Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France; Service d'urologie, MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - Antoine Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - Nicolas Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France
| | - Philippe Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 11, allée de l'Échauguette, 80000 Amiens, France
| | - Morgan Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, 75013 Paris, France
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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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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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Adebayo SA, Chibuzo INC, Takure AO, Ifeh MO, Adeoye AO, Omenai SA, Shittu OB. Clear cell adenocarcinoma of the male urethra: a case report. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary urethral cancer in males is rare. Clear cell adenocarcinoma is more rare. We report a case in an African male suspected to have a urethral stricture.
Case presentation
A 66-year-old man presented in with preceding intermittent haematuria and acute urinary retention. Failed attempts at catheterisation necessitating a suprapubic catheter insertion raised the suspicion of a urethral stricture. Multiple irregular urethral filling defects were seen on a retrograde urethrogram. Urethroscopy revealed obstructing urethral masses. Histology reported clear cell adenocarcinoma.
Conclusion
Primary urethral cancer should be entertained as a differential diagnosis of a urethral stricture in a patient with haematuria, difficult urethral catheterisation and ambiguous urethrogram findings. Cystoscopy and biopsy are essential in the investigative work-up to make the distinction.
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7
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D'Amico MJ, Shumaker AD, Chung P. Urethral Cancer After Urethroplasty: A Case Report and Review of the Literature. Urology 2022; 169:218-225. [PMID: 35914585 DOI: 10.1016/j.urology.2022.07.032] [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: 05/09/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To review and report data on transformation to urethral carcinoma after urethroplasty for urethral stricture disease. Primary urethral carcinoma is a rare entity, and guidelines lack high quality data from which to cite. Urethroplasty is a highly effective treatment for urethral stricture disease, though in rare cases complications may include development of urethral carcinoma. METHODS A systematic PubMed search was performed to identify all articles describing patients with urethral carcinoma after urethroplasty. Data were collected on the following parameters: patient age and sex, indication for urethroplasty, presentation of cancer, imaging, pathology, presence of metastasis, intervention, and outcome. RESULTS The final cohort included fourteen patients, thirteen from previously published cases and one from our institution. The median patient age at presentation was 60, most had endoscopic management prior to urethroplasty, and the majority presented with decreased urinary stream. All patients developed squamous cell carcinoma of the urethra. Patients underwent radical resection, lymph node dissection, chemotherapy, or radiotherapy, often in combination. A majority of patients had died at the time of case report. CONCLUSIONS Development of urethral SCC, particularly after urethroplasty, is a rarely encountered process. Patients and urologists must have a high index of suspicion and investigate symptoms such as fistula or lower urinary tract symptoms, even if these occur many months or even years after BMG. By compiling previously reported cases and adding an additional case to the literature, we hope that familiarity with this entity will lead to earlier recognition and diagnosis of disease.
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Affiliation(s)
- Maria J D'Amico
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Maria.D'
| | - Andrew D Shumaker
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Paul Chung
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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8
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Calderón Cortez JF, Territo A, Fontana M, Gaya JM, Sanguedolce F, Palou J, Huguet J, Breda A. Primary urethral carcinoma: Results from a single center experience. Actas Urol Esp 2022; 46:70-77. [PMID: 35120853 DOI: 10.1016/j.acuroe.2020.10.017] [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: 05/16/2020] [Accepted: 10/26/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND AIM OF THE STUDY Primary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. MATERIALS AND METHODS Medical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN+ with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (<T2) and/or more distal tumors underwent urethrectomy or partial penectomy. Kaplan-Meier curves were evaluated for analysis of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). RESULTS A total of 13 male patients with anterior PUC were studied retrospectively. Total penectomy was performed in 7 cases, while partial urethrectomy was performed in 5 cases, and partial penectomy in 1 case. Of the 7 patients who underwent total penectomy, 5 underwent radical cystectomy with bilateral inguinal lymphadenectomy. Three patients were treated with neoadjuvant systemic chemotherapy, of which 2 were cT3N+ and 1 was cT3N0. The predominant histologic subtype was squamous cell carcinoma (SCC), found in 7 patients (53.8%), while urothelial carcinoma (UC) was present in 5 patients (38.5%) and a malignant fibro-histiocytoma in 1 case. Most patients were diagnosed at advanced stages of the disease, with T2 tumors in 15.4% and T3 tumors in 46.2% of the cases. Median follow-up was 24 months (range 1-294). After surgical treatment, 8 patients (61.5%) presented disease recurrence after a median of 6.3 months, with a 5-year RFS of 58% ± 14%. The 5-year OS rate was 50% ± 14% while the 5-year CSS rate was 66% ± 13%. CONCLUSION Given its rarity, urethral carcinoma should be treated in a referral center. Treatment options include a radical approach or penile-preserving surgery (urethrectomy or partial penectomy) in cases of localized disease. Due to the high recurrence rate, strict follow-up is mandatory.
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Affiliation(s)
- J F Calderón Cortez
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Territo
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - M Fontana
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Gaya
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - F Sanguedolce
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Palou
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Huguet
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Breda
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
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Maek M, Kröpfl D. Perineale Urethrektomie beim Mann. Aktuelle Urol 2022; 53:82-96. [PMID: 35078261 DOI: 10.1055/a-1544-9841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Assadiq K, Rimawi A, Jebreen K. Urothelial carcinoma of the fossa navicularis successfully treated with laser ablation and distal urethrectomy: A case report. Qatar Med J 2021; 2021:60. [PMID: 34745913 PMCID: PMC8555675 DOI: 10.5339/qmj.2021.60] [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: 12/27/2020] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Primary urothelial carcinomas very rarely arise from the fossa navicularis of the penis. They are rarely reported in the literature, with only 13 cases reported thus far. Herein, we present the case of a 34-year-old man with bloody urethral discharge due to a mass detected by cystourethroscopy in the fossa navicularis. Biopsy confirmed the diagnosis of noninvasive urothelial carcinoma. The patient was managed successfully with two sessions of holmium laser ablation, followed by distal urethrectomy. After the treatment, the patient's erectile function and continence were preserved, and no tumor recurrence was observed after 1 year of follow-up.
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Affiliation(s)
- Khalid Assadiq
- Consultant Urologist: The Specialty Hospital, Amman, Jordan E-mail:
| | - Ahmad Rimawi
- Medical Student: University of Jordan, Faculty of Medicine, Amman 11942, Jordan
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11
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[70/m presenting with macrohematuria, palpable penile mass, and obstructive voiding symptoms : Preparation for the medical specialist examination: part 21]. Urologe A 2021; 61:68-71. [PMID: 34605926 DOI: 10.1007/s00120-021-01656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
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12
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Alghafees MA, Seyam RM, Altaweel WM, Alghamdi OS, Al-Hussain T, Alotaibi T, Alturki A, Alessa L. A Primary Urothelial Carcinoma Presenting as a Mid-Bulbar Urethral Stricture in a 30-Year-Old Male. Cureus 2021; 13:e16774. [PMID: 34476142 PMCID: PMC8404477 DOI: 10.7759/cureus.16774] [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] [Accepted: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
The bulbar urethra is the most common site of anterior urethral strictures. In this case report, we present a 30-year-old male who was referred to us as a case of mid-bulbar urethral stricture. Urethroplasty was booked and a papillary lesion was found on routine diagnostic cystoscopy. An open biopsy was taken which showed invasive high-grade papillary urothelial carcinoma with squamous differentiation. This case is rare in terms of a young age of incidence, a lack of risk factors, an absence of suspicious symptoms, and a short duration of signs and symptoms. Urologists should consider workup for malignancy even in young patients who present with an idiopathic urethral stricture and a short duration of symptoms.
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Affiliation(s)
| | - Raouf M Seyam
- Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Waleed M Altaweel
- Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Turki Al-Hussain
- Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Tariq Alotaibi
- Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Laila Alessa
- Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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13
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Calderón Cortez JF, Territo A, Fontana M, Gaya JM, Sanguedolce F, Palou J, Huguet J, Breda A. Primary urethral carcinoma: Results from a single center experience. Actas Urol Esp 2021; 46:S0210-4806(21)00096-6. [PMID: 34332811 DOI: 10.1016/j.acuro.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIM OF THE STUDY Primary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. MATERIALS AND METHODS Medical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN + with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease ( RESULTS A total of 13 male patients with anterior PUC were studied retrospectively. Total penectomy was performed in 7 cases, while partial urethrectomy was performed in 5 cases, and partial penectomy in 1 case. Of the 7 patients who underwent total penectomy, 5 underwent radical cystectomy with bilateral inguinal lymphadenectomy. Three patients were treated with neoadjuvant systemic chemotherapy, of which 2 were cT3N + and 1 was cT3N0. The predominant histologic subtype was squamous cell carcinoma (SCC), found in 7 patients (53.8%), while urothelial carcinoma (UC) was present in 5 patients (38.5%) and a malignant fibro-histiocytoma in 1 case. Most patients were diagnosed at advanced stages of the disease, with T2 tumors in 15.4% and T3 tumors in 46.2% of the cases. Median follow-up was 24 months (range 1-294). After surgical treatment, 8 patients (61.5%) presented disease recurrence after a median of 6.3 months, with a 5-year RFS of 58%±14%. The 5-year OS rate was 50%±14% while the 5-year CSS rate was 66%±13%. CONCLUSIóN: Given its rarity, urethral carcinoma should be treated in a referral center. Treatment options include a radical approach or penile-preserving surgery (urethrectomy or partial penectomy) in cases of localized disease. Due to the high recurrence rate, strict follow-up is mandatory.
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Affiliation(s)
- J F Calderón Cortez
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Territo
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Fontana
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
| | - J M Gaya
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - F Sanguedolce
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Palou
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Huguet
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Breda
- Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
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Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation. BMC Cancer 2021; 21:857. [PMID: 34315433 PMCID: PMC8314574 DOI: 10.1186/s12885-021-08603-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC. Methods A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS). Results The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit. Conclusion Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08603-z.
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15
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Farrell MR, Xu JT, Vanni AJ. Current Perspectives on the Diagnosis and Management of Primary Urethral Cancer: A Systematic Review. Res Rep Urol 2021; 13:325-334. [PMID: 34104638 PMCID: PMC8180270 DOI: 10.2147/rru.s264720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Primary urethral cancer (PUC) is a rare but highly aggressive malignancy that causes malignant urethral obstruction. We conducted a literature review using PubMed to identify original research studies that assessed the diagnosis and management of primary urethral cancer. PUC affects men more than women, is more common in African Americans than Caucasians, and is associated with history of chronic inflammation and irritation of the urinary tract. Patients suspected of PUC should undergo a complete work-up including cystoscopy, magnetic resonance imaging, and biopsy. In men and women, surgical monotherapy ranging from organ-sparing to more radical reconstructive procedures has adequate survival rates for early stage PUC and has been shown to be similarly as effective as radiation monotherapy, while multimodal therapy has become the standard of treatment for advanced stage PUC. Salvage surgery or radiation therapy has been linked with increased survival rates. Nodal involvement at the time of diagnosis is a negative prognosticator and should be treated with multimodal therapy. Further prospective studies with greater sample sizes and standardized clinical trials would allow for greater consistency in evaluating the different treatment modalities for PUC.
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Affiliation(s)
- M Ryan Farrell
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jonathan T Xu
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Alex J Vanni
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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16
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Patschan O, Spiess PE, Thalmann GN, Redorta JP, Gakis G. Systematic Review of the Role of BCG in the Treatment of Urothelial Carcinoma of the Prostatic Urethra. Bladder Cancer 2021; 7:213-220. [PMID: 38994530 PMCID: PMC11181694 DOI: 10.3233/blc-201516] [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: 11/16/2020] [Accepted: 02/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with non-invasive urothelial carcinoma of the prostatic urethra (PUC), treatment with Bacillus Calmette-Guérin (BCG) could be beneficial. OBJECTIVE To assess the response rates to BCG in the different tumor stages, to describe the clinical impact of transurethral resection of the prostate (TURP) before BCG treatment, and to review the side effects of BCG treatment for PUC. METHODS A systematic search was conducted using the PubMed database to identify original studies between 1977 and 2019 reporting on PUC and BCG. RESULTS Of a total of 865 studies, ten were considered for evidence synthesis. An indication for BCG treatment was found in non-stromal invasive stages (Tis pu, Tis pd) and in stromal infiltrating cases (T1) of primary and secondary PUC when transitional cell carcinoma was the histology of origin. Studies including patients treated with TURP before BCG showed a better local response in the prostatic urethra with a higher disease free survival (DFS) (80-100% vs. 63-89%) and progression free survival (PFS) (90-100% vs. 75-94%) than patients in studies in which no TURP was performed. However, this difference in recurrence and progression in the prostate neither affected the total PFS (57-75% vs. 58-93%), nor the disease specific survival (70-100% vs. 66-100%). CONCLUSIONS The use of resection loop biopsies of the prostatic urethra in appropriate cases during the primary work-up for suspected PUC, as well as the use of the current TNM classification for PUC, need to be improved. BCG therapy for non-stromal invasive stages of PUC show a good local response. Local response is further improved by a TURP before BCG therapy, although the overall prognosis does not seem to be affected. Further evidence for BCG treatment in the rare cases of stromal invasive PUC is needed. Specific side effects of BCG treatment for PUC are not reported.
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Affiliation(s)
- Oliver Patschan
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Philippe E Spiess
- Department of GU Oncology and Department of Tumor Biology, Moffitt Cancer Center, Tampa, FL, USA
| | - George N Thalmann
- Department of Urology, University Hospital Inselspital, Bern, Switzerland
| | - Joan Palou Redorta
- Department of Urology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Fundatió Puigvert, Barcelona, Spain
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany
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17
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Urethral cancer managed with phallus preserving surgery: a case report. J Med Case Rep 2021; 15:91. [PMID: 33608031 PMCID: PMC7896403 DOI: 10.1186/s13256-020-02553-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background Primary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible. Case presentation Here, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved. Conclusions Urethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.
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18
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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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19
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Wang N, Min J, Wei Q, Tan W, Dang Q. Primary Urothelium Carcinoma of the Distal Urethra in a Male: Case Report and Literature Review. Onco Targets Ther 2020; 13:6011-6015. [PMID: 32612366 PMCID: PMC7322166 DOI: 10.2147/ott.s252822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
Male primary urethral urothelium carcinoma is a rare clinical case. Here, we detail a case of a 58-year-old man with primary urothelium carcinoma of the distal urethra treated in our hospital. The patient with a neoplasm inside the external urethral orifice for 2 years, which was previously diagnosed as condyloma acuminata, had received photodynamic therapy for 3 times, with initial symptoms of urinary stream bifurcation and dysuria. The exfoliative urine cytology showed negative. Cystoscopy showed a tumor growing around the distal urethra. Biopsy and immunohistochemistry revealed high-grade papillary urothelium carcinoma. The patient received partial urethrectomy, followed by urinary bladder irrigation chemotherapy with epirubicin postoperatively. The corpus spongiosum was invaded while the corpus cavernosa were not. Postoperative pathological examination showed high-grade invasive urothelium carcinoma. There is no evidence of tumor recurrence, metastasis or surgical complications during a 61-month follow-up period. Male primary urethral urothelium carcinoma is a rare clinical case with particular clinical and pathological characteristics. There are still no established treatment guidelines and should be studied further.
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Affiliation(s)
- Ning Wang
- Department of Radiotherapy, Nan Fang Hospital, Southern Medical University, Guangzhou City, Guangdong Province 510515, People's Republic of China.,Department of Oncology, Kanghua Hospital, Dongguan City, Guangdong Province 523000, People's Republic of China
| | - Jingxian Min
- Department of Health Management, Nan Fang Hospital, Southern Medical University, Guangzhou City, Guangdong Province 510515, People's Republic of China
| | - Qiang Wei
- Department of Urology, Nan Fang Hospital, Southern Medical University, Guangzhou City, Guangdong Province 510515, People's Republic of China
| | - Wanlong Tan
- Department of Urology, Nan Fang Hospital, Southern Medical University, Guangzhou City, Guangdong Province 510515, People's Republic of China
| | - Qiang Dang
- Department of Urology, Nan Fang Hospital, Southern Medical University, Guangzhou City, Guangdong Province 510515, People's Republic of China
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20
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Mano R, Vertosick EA, Sarcona J, Sjoberg DD, Benfante NE, Donahue TF, Herr HW, Donat SM, Bochner BH, Dalbagni G, Goh AC. Primary urethral cancer: treatment patterns and associated outcomes. BJU Int 2020; 126:359-366. [PMID: 32336001 DOI: 10.1111/bju.15095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate treatment patterns and associated outcomes of patients with urethral cancer. PATIENTS AND METHODS After obtaining institutional review board approval we identified 165 patients treated for primary urethral cancer between 1956 and 2017. Treatment included monotherapy (surgery or radiation), dual therapy (surgery+radiation, surgery+chemotherapy, or chemotherapy+radiation) or triple therapy (surgery+radiation+chemotherapy). Rates of different treatments were described by treatment year. The association between treatment type and outcomes was evaluated with multivariable Cox regression models, adjusting for disease characteristics. RESULTS The study cohort included 74 men and 91 women, with a median age of 61 years. Common histologies were squamous cell (36%), urothelial (27%) and adenocarcinoma (25%). At presentation, 72% of patients had invasive disease, 24% had nodal involvement, and 5% had metastases. Treatment included monotherapy (57%), dual therapy (21%), and triple therapy (10%). The use of monotherapy decreased over time, while rates of dual therapy remained consistent, and rates of triple therapy increased. The median follow-up was 4.7 years. Estimated 5-year local recurrence-free, disease-specific and overall survival were 51%, 48% and 41%, respectively. Monotherapy was associated with decreased local recurrence-free survival after adjusting for stage, histology, sex and year of treatment (P = 0.017). There was no evidence that treatment type was associated with distant recurrence, cancer-specific or overall survival. CONCLUSIONS We found preliminary evidence that multimodal therapy, more commonly used in recent years, was of benefit in patients with primary urethral cancer. This finding should be confirmed in further studies involving multiple centres because of the low incidence of the disease.
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Affiliation(s)
- Roy Mano
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.,Department of Urology, Tel-Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Joseph Sarcona
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.,Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Nicole E Benfante
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Timothy F Donahue
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Harry W Herr
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - S Machele Donat
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Bernard H Bochner
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Guido Dalbagni
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Alvin C Goh
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
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Strouthos I, Tselis N, Ferentinos K, Karagiannis E, Milickovic N, Chatzikonstantinou G, Feder O, Zamboglou N. Intraluminal High-Dose-Rate Brachytherapy—An Alternative Organ-Preserving Approach for Primary Male Urothelial Carcinoma With Panurethral Involvement. Pract Radiat Oncol 2020; 10:e53-e56. [DOI: 10.1016/j.prro.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
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22
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Current Disease Management of Primary Urethral Carcinoma. Eur Urol Focus 2019; 5:722-734. [DOI: 10.1016/j.euf.2019.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/06/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022]
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23
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Shanks JH, Srigley JR, Brimo F, Comperat E, Delahunt B, Koch M, Lopez‐Beltran A, Reuter VE, Samaratunga H, Tsuzuki T, Kwast T, Varma M, Grignon D. Dataset for reporting of carcinoma of the urethra (in urethrectomy specimens): recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2019; 75:453-467. [DOI: 10.1111/his.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan H Shanks
- Department of Histopathology The Christie NHS Foundation Trust Manchester UK
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto ON Canada
| | - Fadi Brimo
- McGill University Health Center Montréal QC Canada
| | - Eva Comperat
- Department of Pathology Hospital Tenon, HUEP, Sorbonne University Paris France
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences University of Otago Wellington New Zealand
| | - Michael Koch
- Department of Urology Indiana University School of Medicine Indianapolis IN USA
| | | | - Victor E Reuter
- Department of Pathology Memorial Sloan Kettering Cancer Center New York NY USA
| | - Hemamali Samaratunga
- Aquesta Specialized Uropathology Brisbane Qld, Australia
- Centre for Clinical Research The University of Queensland Brisbane Qld, Australia
- Princess Alexandra Hospital Brisbane Qld Australia
| | | | - Theo Kwast
- Laboratory Medicine Program University Health Network, University of Toronto Toronto ON Canada
| | - Murali Varma
- Department of Cellular Pathology University Hospital of Wales Cardiff UK
| | - David Grignon
- IUH Pathology Laboratory, Department of Pathology and Laboratory Medicine Indiana University School of Medicine Indianapolis IN USA
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24
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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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25
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Singh T, Li QK, Song DY. Pathologic Complete Response After Chemoradiation of a Massive Primary Urethral Carcinoma. Adv Radiat Oncol 2019; 4:487-491. [PMID: 31360804 PMCID: PMC6639762 DOI: 10.1016/j.adro.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tanmay Singh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Qing Kay Li
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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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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Primary transitional cell carcinoma of penis - A rare presentation. Urol Case Rep 2018; 23:25-26. [PMID: 30505693 PMCID: PMC6263087 DOI: 10.1016/j.eucr.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022] Open
Abstract
Primary transitional cell carcinoma arising from the anterior portion of the male urethra is rare, with no recent cases reported in the literature. We present a case of penile TCC with positive urine cytology and a delayed definitive diagnosis.
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28
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Abudurexiti M, Wang J, Shao N, Wan FN, Zhu Y, Dai B, Ye DW. Prognosis of rare pathological primary urethral carcinoma. Cancer Manag Res 2018; 10:6815-6822. [PMID: 30584373 PMCID: PMC6289122 DOI: 10.2147/cmar.s184197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Urethral carcinoma (UC), as a rare tumor, is not widely studied. There have been no systematic studies of rare pathological types of UC. We conducted this study to further investigate rare pathological types of primary urethral carcinoma (PUC). Materials and methods We used the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate prognostic factors in rare pathological types of PUC. From 1978 to 2015, 2,651 and 257 cases were identified in the SEER database as common and rare pathological types of PUC, respectively. Overall and cancer-specific survival (CSS) times were computed using the Kaplan–Meier method, and the Cox proportional hazards analysis was used to evaluate patient age at diagnosis, gender, race, and TNM stage. Results The median overall survival (OS) rates were 36 and 59 months for rare and common pathological groups, respectively, and their respective 10-year OS rates were 31.9% and 42.4%, respectively. The median CSS rate was 61 months for the rare pathological group. Through multivariate analysis, it was found that age, race, T stage, and M stage were independent prognostic risk factors for rare pathological type of urethral cancer. In the age group, the HR ratio of patients aged older than 60 years and younger or equal to 60 years was 2.778 (P<0.001). The HR ratio of other races to Whites was 1.444 (P=0.040). In TNM staging, the HR ratio between T3–T4 and Ta–T2 was 2.386 (P=0.046), and the HR value of M1 and M0 was 5.847 (P<0.001). Conclusion Age, race, T stage, and M stage were predictive of OS and CSS in rare pathological PUC.
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Affiliation(s)
- Mierxiati Abudurexiti
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Jun Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ning Shao
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Fang-Ning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
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29
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Werntz RP, Riedinger CB, Fantus RJ, Smith ZL, Packiam VT, Adamsky MA, Smith N, Steinberg GD. The role of inguinal lymph node dissection in men with urethral squamous cell carcinoma. Urol Oncol 2018; 36:526.e1-526.e6. [PMID: 30446445 DOI: 10.1016/j.urolonc.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/07/2018] [Accepted: 09/21/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Urethral squamous cell cancer is a rare disease with limited clinical recommendations regarding management of the inguinal lymph nodes. Despite the similarities to penile cancer in terms of squamous cell carcinoma (SCC) histology and lymphatic drainage, there is not enough evidence to recommend for or against a prophylactic inguinal lymph node dissection (ILND) in patients with clinically negative groins and a primary tumor stage of T1b or higher. The objective of the study was to identify the rate of prophylactic inguinal lymph node dissection, node positive rate, and overall survival in patients with clinical T1 to T4 stage. The patients were separated into clinical N stage and the rates of node positivity were compared. We hypothesize that the node positivity rate would be similar to that observed in penile cancer of similar clinical T and N stage and provide evidence for prophylactic inguinal lymph node dissection in urethral squamous cancer. We also sought to determine the value of ILND in clinically node positive (cN+) and clinically node negative (cN-) patients. METHODS The National Cancer Database was queried for all cases of primary urethral cancer in men from 2004 to 2014. Patients with other cancer diagnoses, metastasis, nonsquamous histology, female patients, and patients with a history of radiation therapy were excluded. Male patients with urethral squamous cell cancer of the anterior urethra with T1 or higher T stage were included in this study. All-cause mortality was compared using multivariable Cox regression controlling for covariates. RESULTS The study included 725 men with urethral SCC with T1 or higher clinical T stage. The median age was 63 years (33-83 interquartile range). Of the 725 men, 536 men did not receive an ILND and 189 (26%) underwent ILND. Patients who received LND had significantly higher clinical T and clinical N stage. There was no difference in age, sex, or histology between those with ILND versus no ILND. In patients with T1 to T4 and clinical N0, the ILND rate was 21.8% (89/396). The lymph node positive rate in patients with N0 and T1 to T4 primary tumor was 9%. In patients with clinically node positive disease (N1/N2), the overall ILND rate was 76%. The lymph node positive rate for patients with clinical nodal disease was 84%. On multivariable analysis cox regression, lymph node positivity was associated with worse overall survival when controlling for T stage, clinical N stage, and age (HR 1.56, 95% 1.3-1.9, P = 0.000). On multivariable analysis after controlling for T stage, sex, and age, having an ILND was associated with improved OS in patients with clinical N1 or N2 disease (HR 0.46, 95% 0.28-0.78 P = 0.002). CONCLUSION The node positivity rate in patients with T1 to T4 and N0 is 9%, much lower than reported in penile cancer with a high-risk primary tumor but clinically negative groins. This argues against routine prophylactic inguinal ILND in patients with urethral SCC who are clinically N0, perhaps suggesting different biological behavior of urethral SCC compared to penile SCC. Performing a lymph node dissection in patients with clinically N1 or N2 disease is associated with improved OS.
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Affiliation(s)
- Ryan P Werntz
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL.
| | | | - Richard J Fantus
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
| | - Zachary L Smith
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
| | - Vignesh T Packiam
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
| | - Melanie A Adamsky
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
| | - Norm Smith
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
| | - Gary D Steinberg
- Department of Surgery, Section of Urology, The University of Chicago, Chicago, IL
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Garg G, Mehdi S, Bansal N, Sankhwar S. Squamous cell carcinoma of male urethra presenting as urethrocutaneous fistula. BMJ Case Rep 2018; 2018:bcr-2018-227447. [PMID: 30391928 DOI: 10.1136/bcr-2018-227447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saqib Mehdi
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nupur Bansal
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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31
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Son CH, Liauw SL, Hasan Y, Solanki AA. Optimizing the Role of Surgery and Radiation Therapy in Urethral Cancer Based on Histology and Disease Extent. Int J Radiat Oncol Biol Phys 2018; 102:304-313. [DOI: 10.1016/j.ijrobp.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
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32
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Guo H, Peng X, Jin C, Wang L, Chen F, Sa Y. Lichen Sclerosus Accompanied by Urethral Squamous Cell Carcinoma: A Retrospective Study From a Urethral Referral Center. Am J Mens Health 2018; 12:1692-1699. [PMID: 29926751 PMCID: PMC6142166 DOI: 10.1177/1557988318782095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To evaluate the characteristics of lichen sclerosus (LS) accompanied by urethral squamous cell carcinoma (USCC) and to raise urologists' awareness about the early management of LS, a retrospective analysis was performed on the clinical features, diagnosis, treatment, and prognosis of 18 male genital LS accompanied by USCC patients who were referred to Shanghai Sixth People's Hospital between June 2000 and August 2014. All of the patients had a long-term history of LS, urethral strictures, and urethral dilatation. Seven patients are with distal (glanular or penile) USCC, 10 patients with proximal USCC, and one with entire USCC. The most common presentation, except for LS and urethral strictures, was periurethral abscess, followed by extraurethral mass, pelvic pain, urethrocutaneous fistula, hematuria, and bloody urethral discharge. All had primary surgical excision that was adapted to tumor location and extension. All of the USCC were positive for P53 and Ki-67. P16 was positive in four cases of human papillomavirus (HPV)-associated USCC and negative in 14 cases of HPV-independent USCC. Patients with distal USCC had a significant longer survival time than proximal USCC ( p < .05). LS should be treated early to prevent the disease progression. LS probably has some associations with USCC. Distal USCC has a relatively better prognosis than proximal USCC.
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Affiliation(s)
- Hailin Guo
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xufeng Peng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Chongrui Jin
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
| | - Lin Wang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.,3 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinglong Sa
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
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Naser-Tavakolian A, Tran C, Timoteo M, Chiu R, Ballas L. Novel Treatment Setup for Urethral Cancer: Use of the Prone Technique for Radiotherapy of the Penis. Case Rep Oncol 2018; 11:268-275. [PMID: 29867434 PMCID: PMC5981624 DOI: 10.1159/000488935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
Urethral cancer (UC) is a rare malignancy with a poor prognosis. Since local recurrence is common and associated with morbidity, case series have reported on the use of adjuvant radiotherapy. Radiotherapy treatment setup for malignancies of the penis can be challenging because of variability in anatomic positioning. This variability can lead to lack of reproducibility. We propose a novel external beam radiotherapy technique for the treatment of UC: prone positioning. This technique has been used to treat breast cancers successfully and can be used to treat any variety of penile malignancies. We present 2 patients who were treated using this positioning.
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Affiliation(s)
- Aurash Naser-Tavakolian
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Cindy Tran
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Marissa Timoteo
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Raymond Chiu
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
- *Leslie Ballas, MD, Department of Radiation Oncology, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033 (USA), E-Mail
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34
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Aleksic I, Rais-Bahrami S, Daugherty M, Agarwal PK, Vourganti S, Bratslavsky G. Primary urethral carcinoma: A Surveillance, Epidemiology, and End Results data analysis identifying predictors of cancer-specific survival. Urol Ann 2018; 10:170-174. [PMID: 29719329 PMCID: PMC5907326 DOI: 10.4103/ua.ua_136_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives Primary urethral carcinoma (PUC) is rare, accounting for <1% of genitourinary malignancies. Current knowledge regarding is founded upon tertiary care centers reporting their experiences. We aim to identify factors predictive of outcomes using a nationwide registry database. Materials and Methods The Surveillance, Epidemiology, and End Results-18 registries database was queried for cases of PUC ranging between 2004 and 2010. To identify PUC cases, ICD-O site code C68.0 was used as a filter, hence identifying PUC with histologic subtypes including urothelial carcinoma (UC), squamous cell carcinoma (SCC), and adenocarcinoma (AC). Tumor characteristics were compared using log-rank analysis, and survival outcomes were compared using Cox proportional hazards models. Results A total of 419 PUC cases were identified, 250 (59.7%) male and 169 (40.3%) female patients. The most common histology in men was UC (134, 53.6%), followed by SCC (87, 34.8%) and AC (29, 11.6%). The most common histology in women was AC (79, 46.7%), followed by SCC (43, 25.4%) and UC (42, 24.9%). Log-rank analysis illustrated significant difference in cancer-specific survival (CSS) for T-stage, N-stage, M-stage, and stage of PUC with all histological variants combined (P < 0.001). Multivariate Cox proportional hazards model demonstrated that stage and age were significant for survival, with a risk ratio of 1.033 (95% confidence interval [CI], 1.020-1.046)/year of increased age (P < 0.001) and 3.71 (95% CI, 2.72-5.05) for patients with regional or distant spread. Conclusions Knowledge of patient and tumor characteristics that influences survival is paramount in dictating management. The present study illustrates that age and stage are factors significantly associated with CSS in PUC.
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Affiliation(s)
- Ilija Aleksic
- Division of Urology, Albany Medical Center, Albany, NY, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama At Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Michael Daugherty
- Department of Urology, Upstate Medical University, Syracuse, NY, USA
| | - Piyush K Agarwal
- Center For Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Mendiratta P, Rini BI, Tendulkar RD. Organ Preservation for Recurrent Urethral Adenocarcinoma With Concurrent Chemotherapy and Radiation. Urology 2017; 113:e1-e2. [PMID: 29203190 DOI: 10.1016/j.urology.2017.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 12/01/2022]
Abstract
Urethral adenocarcinoma of males is a rare disease with limited prospective data to define optimal treatment. Surgical excision remains the primary treatment for early-stage disease. Multimodality therapy with a combination of chemotherapy, radiation, or surgery has been explored in patients with locally advanced disease. We present the case of a 45-year-old-man with a locally recurrent urethral adenocarcinoma after initial surgical resection managed successfully with combined weekly cisplatinum and radiation therapy.
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Affiliation(s)
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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36
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Peng X, Guo H, Jin C, Wang L, Sa Y. Squamous Cell Carcinoma of the Bulbar Urethra Accompanied by Lichen Sclerosus: A Case Report. Am J Mens Health 2017; 12:493-497. [PMID: 29182032 PMCID: PMC5818129 DOI: 10.1177/1557988317743386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the bulbar urethra accompanied by lichen sclerosus (LS) is rarely reported. This study reports the case of a 56-year-old man with urethral squamous cell carcinoma (USCC) accompanied by a long history of genital LS. The man presented with a painful perineal mass and had a long-term history of urethral strictures and urethral dilatation. The patient developed a periurethral abscess that expanded to the perineum and formed an urethrocutaneousperineal fistula. An organ-sparing perineal resection and fistulectomy was performed according to the patient's wishes. During the operation, residue-like pus mixed with necrotic tissues drained out. A section of the prepuce and the necrotic tissues were sent for histological analysis. Hematoxylin and eosin (HE) staining of the excised prepuce revealed classical LS. HE and immunohistochemical (IHC) staining of the necrotic tissues showed well-differentiated USCC. IHC staining showed the USCC to be positive for P53 and Ki-67 and negative for P16, suggesting the USCC was probably associated with LS. The patient received high-dose chemotherapy and radiation therapy and died 10 months after surgery.
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Affiliation(s)
- Xufeng Peng
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Hailin Guo
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Chongrui Jin
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Lin Wang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
| | - Yinglong Sa
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Shanghai Eastern Urological Reconstruction and Repair institute, Shanghai, China
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Agrawal S, Lacy JM, Bagga H, Angermeier KW, Ciezki J, Tendulkar RD, Reddy CA, Wood HM. Secondary Urethral Malignancies Following Prostate Brachytherapy. Urology 2017; 110:172-176. [PMID: 28882777 DOI: 10.1016/j.urology.2017.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand urethral secondary malignancies among patients treated with brachytherapy (BRT) for primary prostate cancer. PATIENTS AND METHODS Institutional retrospective review identified 13 patients evaluated from 2003 to 2014 with urethral cancer and history of BRT monotherapy for prostate cancer. All patients were biochemically free of their primary disease and radiation-associated secondary malignancies (RASMs) were confirmed pathologically to be histologically distinct from primary tumor. BRT characteristics, patient age, presentation, staging workup, and clinical course were evaluated. RESULTS The mean time from BRT to presenting symptoms of hematuria, urinary retention, and/or renal failure was 71 months. Symptom onset to RASM diagnosis interval was 24 months. Mean time from BRT to RASM diagnosis was 95 months. Eighty-five percent of patients had an undetectable prostate-specific antigen level (<0.2 ng/mL) at last follow-up. Types of RASM included sarcomatoid carcinoma (6), small cell carcinoma (2), urothelial carcinoma with squamous differentiation (2), squamous cell carcinoma (1), rhabdomyosarcoma (1), and urothelial carcinoma (1). A majority of patients were diagnosed with advanced disease with either distant metastases (54%) or local progression (23%). Ten patients died during this study period with median time to death after RASM diagnosis of 6 months. CONCLUSION RASMs localized to the posterior urethra displayed advanced disease and high mortality rates. Refractory lower urinary tract symptoms, hematuria, and history of prostate BRT should raise suspicion for urethral RASMs. Further studies are warranted to determine patient and disease characteristics that correlate with disease-specific mortality of secondary urethral malignancies.
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Affiliation(s)
- Shree Agrawal
- Case Western Reserve University School of Medicine, Cleveland, OH.
| | - John M Lacy
- University of Tennessee Graduate School of Medicine, Knoxville, TN
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Gupta R, Gupta S, Basu S, Dey P, Khan IA. Primary Adenocarcinoma of the Bulbomembranous Urethra in a 33-Year-Old Male Patient. J Clin Diagn Res 2017; 11:PD07-PD08. [PMID: 29207776 PMCID: PMC5713798 DOI: 10.7860/jcdr/2017/28918.10581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/07/2017] [Indexed: 11/24/2022]
Abstract
Primary Urethral Carcinoma (PUC) is considered as a rare tumour, accounts for less than 1% of all malignancies and an incidence rate of four cases per million patients. Incidence increases with the patient's age and most commonly present in seventh decades. Urothelial carcinoma is the most common type (76%) of the PUC, adenocarcinoma accounts for less than 5% of the PUC. No definitive protocol for tumour management for urethral adenocarcinoma has been described in the literature due to lack of prospective study and scarcity of the cases. Treatment usually depends on the site and stage of the tumour. We hereby report a case of 33-year-old male patient with urethral adenocarcinoma of bulbomembranous urethra spread to the prostatic urethra and left side inguinal lymph node. He was treated through multimodal therapy with surgery plus adjuvant chemotherapy.
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Affiliation(s)
- Rupesh Gupta
- Senior Resident, Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sweta Gupta
- Junior Resident, Department of Obstetrics and Gynaecology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriya Basu
- Professor, Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Priyatosh Dey
- Senior Resident, Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Imran Ahmad Khan
- Senior Resident, Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
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Abstract
BACKGROUND Urethral cancer is a rare malignancy, representing <1% of all malignancies. Optimal management, due to its rarity, presents as a treatment dilemma for physicians. There is a lack of consensus regarding treatment as large randomized trials cannot be performed; thus, optimal management decisions rely on study of retrospective cases. This is a review of our institutional experience with urethral cancer treated with various treatment modalities. METHODS A retrospective chart review was performed on 31 patients treated for primary cancer of the urethra from 1958 to 2008. The patients were stratified by sex, histologic type, stage, date of diagnosis, type of treatment, and last follow-up. Early stage cases were designated as Tis-T2N0M0 and advanced cases were designated as T3-4, N+ or M+. Analysis was performed based on clinical stage, treatment modalities and outcomes. RESULTS Fourteen early stage cases and 17 advanced stage cases of urethral cancer were analyzed. The majority of early stage cases occurred in men (M:F=8:6) and the majority of advanced stage cases occurred in women (M:F=5:12). The most common histology was squamous cell carcinoma for both early and advanced stage cases. Surgery was the preferred modality of treatment for early stage cases (surgery used in 13 cases vs. chemo/radiotherapy used in 1 case) while for advanced cases, radiation ±chemotherapy was commonly used. Overall survival for this series was 45% at mean follow-up of 7 years. Eight of the 14 cases of early stage cancer remained disease free at last follow-up. Comparatively, only 5 of 17 with advanced cancers had no apparent disease at last follow-up. All but one of those patients were treated with combined modality therapy. CONCLUSIONS Patients with early stage urethral cancers do well with single modality therapy, whereas patients who present with advanced cancers may benefit from combined modality therapy. More extensive study is required to recommend a particular treatment protocol. However, in this rare malignancy, institutional experiences provide the best evidence currently due to the lack of multi-institutional trials.
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Abstract
Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.
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Berjeaut RH, Persaud MDI, Sopko N, Burnett AL. Urethral carcinoma in situ: recognition and management. Int Urol Nephrol 2017; 49:637-641. [PMID: 28101735 DOI: 10.1007/s11255-017-1512-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease. METHODS A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded. RESULTS Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2 years later. CONCLUSION This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.
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Affiliation(s)
- Ricardo H Berjeaut
- Division of Urology, Hospital das Clinicas, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Maliza D I Persaud
- Department of Urology, San Fernando General Hospital, University of the West Indies (UWI) School of Medicine, San Fernando, Trinidad and Tobago
| | - Nikolai Sopko
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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43
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Zargar-Shoshtari K, Sexton WJ, Poch MA. Management of Urethral Recurrences: Urothelial and Nonurothelial. Urol Clin North Am 2016; 43:515-521. [PMID: 27717437 DOI: 10.1016/j.ucl.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article discusses the diagnostic and therapeutic options in the management of urethral cancer recurrence in patients treated with urethral sparing cystectomy as well as those who had urethral preservation following primary urethral carcinoma.
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Affiliation(s)
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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Sui W, RoyChoudhury A, Wenske S, Decastro GJ, McKiernan JM, Anderson CB. Outcomes and Prognostic Factors of Primary Urethral Cancer. Urology 2016; 100:180-186. [PMID: 27720774 DOI: 10.1016/j.urology.2016.09.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify prognostic and treatment factors for primary urethral cancer using a nationwide database. MATERIALS AND METHODS The National Cancer Database was queried for all cases of primary urethral cancer from 2004 to 2013. Patients with other cancer diagnoses, metastasis, or diagnosis on autopsy were excluded. Proportional hazards regression was used to identify independent predictors of overall survival in patients with primary urethral cancer. Because we hypothesized that predictors may covary by sex, we also performed regression analysis stratified by sex. RESULTS We identified 1268 men and 869 women with primary urethral cancer. Women tended to have more advanced tumors and adenocarcinoma histology. Median survival for the entire cohort was 49 months (43-55), with 5- and 10-year survival rates of 46% and 31%, respectively. On multivariate analysis, age, race, stage, grade, and Charlson comorbidity index were independent predictors of overall survival. Histology was not a predictor of overall survival in the combined model; however, adenocarcinoma in women increased hazards of death, whereas it decreased hazards of death in men when compared with squamous cell carcinoma. CONCLUSION Men and women with primary urethral cancer had significant differences in histology, grade, and nodal status. In addition to several expected disease-related factors, black race was associated with increased mortality for patients with primary urethral cancer.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, New York, NY
| | | | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
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Moore SJ, Rashidipour O, Moore RB. Primary Metastatic Squamous Cell Carcinoma of the Male Urethra Presenting with Scrotal Abscess and Subsequent Development of Fournier's Gangrene. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:83-86. [PMID: 27721660 PMCID: PMC5045045 DOI: 10.4137/ccrep.s40420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/05/2022]
Abstract
This male patient presented with a scrotal abscess and urinary obstruction. The patient's history included a perineal abscess and the development of urethrocutaneous fistulae (watering-can perineum). He underwent multiple debridement procedures without resolution. During the fifth debridement for Fournier's gangrene, a biopsy revealed invasive squamous cell carcinoma. The patient was bedridden because of the large mass, a wide en bloc resection with lymphadenectomy and reconstruction was performed revealing a large (22 cm) squamous cell carcinoma originating from the urethra. He also received palliative chemoradiotherapy and hip hemiarthroplasty. Unfortunately, he succumbed to the disease. Given the recognized relationship between inflammation and the development of cancer, it is important to entertain a differential diagnosis of cancer, especially with erosive infections. This case report highlights the all too common late presentation of urethral cancer. Interestingly, despite correction of the bedridden state with palliative surgery, the patient did not perceive an improvement in quality of life based on the FACT-G questionnaire.
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Affiliation(s)
- Sarah J Moore
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Omid Rashidipour
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ronald B Moore
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Lucarelli G, Spilotros M, Vavallo A, Palazzo S, Miacola C, Forte S, Matera M, Campagna M, Colamonico O, Schiralli F, Sebastiani F, Di Cosmo F, Bettocchi C, Di Lorenzo G, Buonerba C, Vincenti L, Ludovico G, Ditonno P, Battaglia M. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review. Medicine (Baltimore) 2016; 95:e3642. [PMID: 27175683 PMCID: PMC4902525 DOI: 10.1097/md.0000000000003642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the bulbomembranous urethra should be managed with radical surgery including the corporas up to the ischiatic tuberosity attachment, and membranous urethra in continuity with the prostate and bladder. Neo-adjuvant treatment may be advisable with the aim of improving the poor prognosis, even if the efficacy is not certain while it can delay the radical treatment of the disease.
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Affiliation(s)
- Giuseppe Lucarelli
- From the Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari (GLucarelli, MS, AV, SP, CM, MM, SF, MC, OC, FSchiralli, FSebastiani, FD, CBettocchi, PD, MB); Division of General Surgery, Polyclinic Hospital (LV), Bari; Department of Clinical Medicine, Medical Oncology Unit, Federico II University, Naples (GD, CBuonerba); and Department of Urology, Minimally Invasive and Robotic Surgery Center "F. Miulli", Acquaviva della Fonti (GLudovico), Italy
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Basiri A, Narouie B, Moghadasi MH, Ghasemi-Rad M, Valipour R. Primary Adenocarcinoma of the Urethra: A Case Report and Review of the Literature. J Endourol Case Rep 2015; 1:75-7. [PMID: 27579397 PMCID: PMC4996557 DOI: 10.1089/cren.2015.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary adenocarcinoma of the urethra is rarely reported. We report a case of a 47-year-old male with symptoms of urinary obstruction started 2 years before diagnosis. Video-assisted urethrocystoscopy revealed a papillary mass almost obstructing the entire lumen with bleeding. Pathology report was consistent with primary adenocarcinoma of the urethra.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Department of Urology and Renal Transplantation, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Behzad Narouie
- Urology and Nephrology Research Center, Department of Urology and Renal Transplantation, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mohammad Hossein Moghadasi
- Department of Medical Laboratory, Shahid Labbafinejad Medical Center, Iranian Social Security Organization Tehran , Iran
| | - Mohammad Ghasemi-Rad
- Division of Interventional Radiology, Harvard Medical School , Massachusetts General Hospital, Boston, Massachusetts
| | - Reza Valipour
- Urology and Nephrology Research Center, Department of Urology and Renal Transplantation, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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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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Serrano N, Chang M, Leland Rogers C, Orton M, Mannino R, Grob M, Agarwal R, Moghanaki D. Patient autonomy and shared decision making in the management of urethral cancer. Pract Radiat Oncol 2015; 6:66-70. [PMID: 26577009 DOI: 10.1016/j.prro.2015.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/28/2015] [Accepted: 09/09/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas Serrano
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - Michael Chang
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - C Leland Rogers
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Matthew Orton
- Department of Radiation Oncology, Indiana University, IU Health Arnett Cancer Center, Lafayette, Indiana
| | - Rosemarie Mannino
- Hematology Oncology Section, Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - Mayer Grob
- Department of Urology, Virginia Commonwealth University, Richmond, Virginia; Department of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Rakesh Agarwal
- Department of Radiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Drew Moghanaki
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
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High-dose-rate brachytherapy - a novel treatment approach for primary clear cell adenocarcinoma of male urethra. J Contemp Brachytherapy 2015. [PMID: 26207115 PMCID: PMC4499518 DOI: 10.5114/jcb.2015.52316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of male urethral cancer is rare with age preponderance of 50 to 60 years. The standard management approach is surgery. Here, we present a novel treatment approach for male urethral cancer. Thirty-six year old male, case of primary clear cell adenocarcinoma of urethra who refused surgery, underwent cystoscopic assisted intraluminal HDR brachytherapy. Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions. At 11 months post treatment, disease is well controlled with no post treatment toxicity so far. Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer.
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