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

Abstract

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 transperinealincision 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.

A Primary Urothelial Carcinoma Presenting as a Mid-Bulbar Urethral Stricture in a 30-Year-Old Male

“…The presence of risk factors or symptoms suggesting cancer like hematuria, or a rapid course of symptoms may suggest a more sinister pathology. The delayed presentation may include physical signs such as a urethral mass or evidence of metastasis [ 12 ]. The clinical picture of our patient did not raise the suspicion of the correct diagnosis because of the absence of suggestive symptoms or signs, the young age, and the multiple urethral stricture treatments he received elsewhere in a short period.…”

Primary Urethra Non-Hodgkin Lymphoma in a 46-Year-Old Man on FDG PET/CT

“…No common symptoms of urinary retention described in the literature were found, probably because this patient had only mucosal thickening and no polypoid masses were found 5 . This case demonstrates that in addition to primary urethral cancer, 6 metastases, 7,8 tumor recurrence, 9 and melanoma, 10 primary lymphoma should also be considered when PET/CT imaging shows lesions along the urethra in a man with elevated FDG uptake. PET/CT imaging may also help in staging and evaluating the efficacy of primary lymphoma in the male urethra.…”