Clinicopathological features of carcinoma of the distal penile urethra

Distal urethral carcinoma: Contemporary management with phallus preserving techniques

INTRODUCTION

Primary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma.

METHODS

Seven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020.

RESULTS

The mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date.

CONCLUSION

Penile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.

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

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.

Carcinoma of the urethra

Primary carcinomas of the urethra are rare and poorly understood lesions; hence, their clinical and pathologic spectrum is not completely defined. We analyzed a series of 130 primary urethral tumors and classified 106 of them as primary urethral carcinomas. The age at diagnosis of patients with primary urethral carcinomas ranged from 42 to 97 years (mean, 69.4 years; median, 70 years). There were 73 male and 33 female patients with a ratio of 2.2:1. In male patients, the tumors most frequently developed in the bulbous-membranous segment of the urethra. In female patients, the entire length of the urethra was typically involved. Microscopically, they were poorly differentiated carcinomas with hybrid squamous and urothelial features and developed from precursor intraepithelial conditions such as dysplasia and carcinoma in situ, which were frequently present in the adjacent urethral mucosa. High-risk human papilloma virus infection could be documented in 31.6% of these tumors. Follow-up information was available for 95 patients. Twenty-three patients died of the disease with a mean and median survival of 39 and 21 months, respectively. Urethral carcinomas are aggressive tumors with a high propensity for regional and distant metastases with mean and median survival of 39 and 21 months, respectively. Our observations have important implications for the management of patients with primary carcinoma of the urethra by defining them as a unique entity linked to human papilloma virus infection.