Urinary retention caused by adenocarcinoma arising in recurrent urethral diverticulum

Ghoniem, Gamal M.; Khater, Usama; Hairston, John; Ramsey, A. D.; Woodhouse, Sherry

doi:10.1007/s00192-004-1179-z

Cited by 4 publications

(3 citation statements)

References 9 publications

(9 reference statements)

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“…Urethral carcinomas are uncommon, and make up less than 0.02% of all female carcinomas [1]. Although squamous cell carcinomas are usually identified in female urethral carcinomas, more than half of carcinomas in the urethral diverticulum are adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Radical Cystourethrectomy in a Patient with Adenocarcinoma of the Female Urethral Diverticulum

Lee

et al. 2010

Korean J Urol

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Adenocarcinomas arising in the female urethra have been rarely reported. Here we report a case of laparoscopic radical cystourethrectomy with incontinent urinary diversion in a patient with adenocarcinoma in the urethra and bladder. A 60-year-old female presenting with a history of recurrent cystitis and painless hematuria was referred to our facility with voiding difficulty and a urethral mass. Radiologic evaluation showed an enhanced mass in the urethra and bladder neck. Cystoscopic biopsy of the mass in the bladder neck revealed an adenocarcinoma. Laparoscopic radical cystourethrectomy with anterior vaginal wall excision followed by extracorporeal incontinent urinary diversion was performed. Primary carcinomas arising in a urethral diverticulum have rarely been reported and account for only 5% of all urethral malignancies [1]. Most of these tumors arise from squamous or transitional cells, and only 20% are adenocarcinomas of unknown origin.Because of the rarity of such tumors, a treatment strategy has not been established, but radical cystourethrectomy with pelvic lymph node dissection and urinary diversion appears to be the most beneficial modality for nonmetastatic disease. Many authors have reported on an open approach; however, we performed laparoscopic radical cystourethrectomy with bilateral pelvic lymph node dissection and anterior vaginal wall excision followed by ileal urinary diversion with a minimal abdominal incision. CASE REPORTA 60-year-old female with a history of recurrent cystitis and painless gross hematuria for 3 years was referred to our institution complaining of intermittent urinary retention. The patient had undergone a radical hysterectomy with bilateral salpingo-oophorectomy due to squamous cell type cervical cancer 20 years ago. Physical examination revealed a firm mass on the anterior vaginal wall. Urine cytology was nonspecific. Serum CEA and CA 19-9 were within normal limits. During cystourethroscopy, a papillary growing tumor was found at the bladder neck (Fig. 1). We found no definite mass lesion during urethrography; however, a urethral narrowing was revealed. Magnetic resonance imaging (MRI) showed a urethral mass invading the base of the bladder and the anterior vaginal wall with no pelvic lymph node enlargement. The mass showed homogeneous, low signal intensity on T1-weighted images and inhomogeneous contrast enhancement after gadolinium administration. On T2-weighted images, the mass showed high signal intensity surrounded by a low signal intense rim (Fig. 2).A fan-shaped four-port laparoscopic transperitoneal approach was performed (one 10 mm port placed at 10 mm above the umbilicus [camera], one 12 mm right pararectal trocar, one 12 mm trocar placed laterally in the right lower quadrant [assistant port], and one 5 mm trocar placed between the left anterior iliac spine and the umbilicus).Mild adhesion was observed around the ureter. After ureteral dissection, we clamped the ureter close to the ureterovesical junction by using a Hem-o-Lok clip and performed a frozen biopsy....

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Section: Discussionmentioning

confidence: 99%

“…Primary carcinomas arising in a urethral diverticulum have rarely been reported and account for only 5% of all urethral malignancies [1]. Most of these tumors arise from squamous or transitional cells, and only 20% are adenocarcinomas of unknown origin.…”

mentioning

confidence: 99%

Laparoscopic Radical Cystourethrectomy in a Patient with Adenocarcinoma of the Female Urethral Diverticulum

Lee

et al. 2010

Korean J Urol

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“…The major etiologies for acute urinary retention may be subdivided into obstructive, infectious, pharmacologic, and neurogenic types. Obstructive causes of urinary retention in non-pregnant women, exclusive of post-operative cases, have included a leiomyomatous uterus [2], urethral leiomyoma [3], carcinoma [4,5], and calculus [6] as well as pelvic organ prolapse [7].…”

Section: Introductionmentioning

confidence: 99%