Urethral carcinoma: critical view on contemporary consecutive series

Abstract

Urethral carcinoma is a rare cancer of the urinary tract. Although most cases are of squamous cell carcinomas, there are several reports in the literature about transitional cell carcinoma and adenocarcinomas whose origin remains controversial. While the diagnosis of this condition is essentially clinical, magnetic resonance imaging (MRI) is the examination of choice for its staging, and a pathological confirmation is still necessary. There is no consensus on the treatment of these tumors because of its low incidence. The following therapeutic options are currently available: surgical resection (often for small and distal urethral tumors); radiotherapy and chemotherapy, for larger tumors, seeking a functional preservation of the penis, bladder and/or vagina; or a combination of these therapies thereof in case of more extensive tumors. The classic treatment involves surgery aiming loco-regional disease control, and continent urinary derivation provides satisfactory functional results in cases of radical urethrectomy. Much still needs to be learned about urethral cancer, and molecular diagnostics tools and therapeutic targets are promissory. The key to better understanding urethral cancer is the pooling of data from a wide range of sources including international consortia.

A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma

“…The same procedure has been adopted in other recent series for the treatment of squamous invasive carcinoma of the bulbomembranous urethra, obtaining similar results in terms of quality of life and oncological outcomes after a follow-up of 42 months. 27 In the case described we could not choose a sparing approach; we performed a wide dissection including removal of the bladder beyond the urethra and penile shaft due to massive local spread of the tumor associated with nodal involvement. For the same reason we combined umbilicus-pubic and perineal incision: a scrotal fistula was clinically evident and later shown at CT scan to be neoplastic, originating in the right corpus cavernosum.…”