Carcinoma of the male urethra

Abstract

FROM THE SURGII.'AL UXIT, ST. THUMBS'S HOSPITAL, LONDOX.THE case of carcinoma of the male urethra reported here is worthy of record not only because of the rarity of thc condition, but also because thc growth was situated in the fossa navicularis: an uncommon position. In addition, the extreinely early diagnosis and treatment of the patient are of interest. Up to 1929 Huggins and Curtis were able to collect only 110 cases from the records in which there was but little doubt of the diagnosis. Since then a few more have been put on record, mostly in the foreign literature.The first example of carcinoma of the urethra to be published was described by Thiaudihre in 1S34, hut subsequently Kaufman has thrown some doubt on the diagnosis. Hobb notes the interesting fact that up to 19% there was no specimen of this condition in the museums of either the Royal College of Surgeons of London or Edinburgh. No doubt this is due in part to the fact that early cases are rarely seen, but it is largely because the majority of urethral carcinomata originate in the membranous and bulbous urethra, where invasion of surrounding tissues prevents removal in the form of a specimen.The following are the notes of a case admitted to St. Thomas's Hospital under the care of the late Sir Percy Sargent, t o whom I am indebted for permission to publish these details. HrsToRr.-Mak, age 60. In his youth he had suffered from both gonorrhea and syphilis, but did not develop a urethral stricture. For years he had suffered from epileptic fits, which were controlled by luminal. Three months before admission he noticed a slight bloody discharge from the external urinary meatus, and this drew his attention to a small nodule on the under surface of his penis.Or; EXAMINATIOX.-A hard nodule about the size of a split pea was felt 011 the under surface of the glans penis in the line of the urethra and about one inch from the external meatus. The tumour was subcutaneous, and when squeezed a drop of bloody discharge exuded from the urinary meatus. In the right inguinal region two rubbery and movable glands were felt.The general condition of the patient was poor. A provisional diagnosis of carcinoma was made and it was dec+ided to explore the urethra in order to verify this.OPERATIOX (Feh. 17, 1932).-An operation was carried out under general anzsthesia. The floor of the urethra was split open from the external meatus to the site of' the tumour, which consistcd of a small ulcer with an indurated base and edge.In view of the uncertainty of the results of treatment by radium, it was decided that a cbonservative This was considered to be malignant.