Adenocarcinoma of the Female Urethra

Abstract

Royal Infirmary, AberdeenCARCINOMA of the female urethra is uncommon, but none the less it is more common than carcinoma of the male urethra. Wasserman in 1895 reported the first large series of 24 cases of urethral carcinoma in females. It occurs primarily in parous post-menopausal women and may be associated with urethral caruncle (Adno, 1957) or urethral diverticulum (Hamilton and Leach, 1951). Usually carcinoma of the female urethra is of transitional cell type but 12 per cent. are adenocarcinomata (Walker and Huffman, 1947 ;McCrae, 1952). Adenocarcinomata are presumed to arise in the peri-urethral glands.It is the purpose of this paper to present an unusual case of adenocarcinoma of the female urethra.Case Report.-Mrs J. M., aged 65 years, a multipara, was admitted to hospital as an emergency because of acute on chronic retention of urine. She gave a history of increasing frequency of micturition over a period of six months culminating in overflow incontinence and eventually complete retention. There was no history of dysuria or haematuria. There was no vaginal bleeding or discharge. Previous medical history was not relevant. Physical examination showed an enormously distended bladder and palpable nodes in the right inguinal region. The significance of the nodes was not clear at this stage. In the first instance she was catheterised and 5 litres of urine obtained. Subsequent vaginal examination under anathesia revealed an indurated area in t h e anterior vaginal wall overlying the urethra, but not involving the vaginal mucosa. The uterus and adnexa were normal.Cystoscopy was performed without difficulty and revealed a carcinoma of the urethra invading the bladder neck.A biopsy was taken.The lesion was treated by cystourethrectomy combined with anterior vaginectomy with total hysterectomy and bilateral salpingo-oophorectomy. Urinary diversion was via an ileal loop. At operation there was no evidence of any intra-abdominal spread and subsequent examination of the excised specimen suggested that excision had been complete. The post-operative course was uneventful.At follow-up three months later it became obvious that the right inguinal lymph nodes were the site of neoplastic involvement and there was a local recurrence in the vagina. A block dissection of the right inguinal region was done and radium was applied to the vaginal recurrence.Histologically the lesion was an adenocarcinoma.The patient remains well and there has been no further evidence of recurrence.Comment.-Reviews of adenocarcinoma of the female urethra have been made by Walker and Huffman (1947) and McCrae (1952). They describe 48 cases altogether. Marshall et al.(1960) describe a further three cases. The patients usually present with a painful tumour. dysuria and/or hzmaturia. Frequency of micturition is common, but retention of urine was noted on only five occasions. Of these five patients, three had hamaturia, the fourth patient had an obvious mass and the fifth patient had severe dysuria. Our patient is unusual in that she complained only of ...