Hematuria macroscópica como signo inicial del cáncer primario de uretra. Reporte de caso / Macroscopic hematuria as an initial sign of primary urethral cancer. Case report

Fundamento: El cáncer primario de uretra se define como el tumor cuya primera lesión se localiza en la uretra; es infrecuente, el mismo representa menos del 1 % de los tumores malignos y el 5 % de los tumores malignos del sistema urinario. La extensión de este proceso a la glándula prostática genera sintomatología urinaria obstructiva e irritativa y cuadros agudos como la hematuria macroscópica. Objetivo: Presentar el caso de un paciente con cáncer primario de uretra en su variedad urotelial con hematuria macroscópica como forma clínica de presentación. Presentación del caso: Caso clínico de un paciente masculino de 75 años de edad, con hematuria macroscópica como forma clínica de presentación de cáncer primario de uretra en su variedad urotelial, el cual se diagnosticó anatomopatológicamente durante el estudio de la hematuria. Conclusiones: El caso que se presenta permite alertar a la comunidad científica que en pacientes que presentan hematuria macroscópica, sin manifestaciones urológicas obstructivas ni irritativas, también debe tenerse en cuenta el diagnóstico de cáncer uretral primario, aunque sea un signo infrecuente como forma clínica de presentación de esa enfermedad.

Background: Primary urethral cancer is defined as a tumor whose first lesion is located in the urethra; is very uncommon, represents less than 1% of malignant tumors and 5% of malignant tumors of the urinary system. The extension of this process to the prostate gland creates obstructive and irritative urinary symptoms and acute conditions such as macroscopic hematuria. Objective: To present the case of a patient with primary urethral carcinoma in its urothelial variety with macroscopic hematuria as clinical presentation. Case presentation: Clinical case of a 75-year-old male patient, with macroscopic hematuria as a clinical presentation of primary cancer of the urethra in its urothelial variety, diagnosed anatomopathologically during the hematuria study. Conclusions: The case presented alerts the scientific community that the diagnosis of primary urethral cancer should be considered in patients with macroscopic hematuria in the absence of obstructive or irritative urologic manifestations, although it is a rare sign as clinical presentation of this disease.

Clinical features and optimal treatment of primary urethral carcinoma / 现代泌尿外科杂志

【Objective】 To explore the clinical features and treatment outcomes of female urethral carcinoma so as to improve the awareness and prognosis of this rare malignant disease. 【Methods】 Clinical data of 8 cases of female urethral carcinoma treated during Jan. 2012 to Dec.2022 at the Department of Urology of Peking University People’s Hospital were retrospectively analyzed. The patients underwent urodynamic tests, cystourethroscopy and pathological biopsy to confirm the diagnosis. Traditional radical surgery was performed in 5 cases, and radical surgery for lower urethral cancer with bladder preservation was performed in 3 cases. 【Results】 The patients aged 36 to 68 years, with a mean of 53.75 years. Urinary obstruction, lower urinary tract symptoms and urethral masses were common manifestations. Urodynamic tests indicated bladder outlet obstruction. After surgical treatment, radical surgery for lower urethral cancer with bladder preservation showed advantages over traditional radical surgery in terms of intraoperative bleeding, operation time and postoperative hospital stay. 【Conclusion】 Female primary urethral carcinoma is rare but invasive. Early diagnosis and radical surgery are crucial for improving the prognosis. Radical surgery for lower urethral cancer with bladder preservation has better treatment outcomes and postoperative quality of life compared to traditional radical surgery. For such patients, symptoms should be closely monitored and timely diagnosis and treatment should be performed.

Compartment Syndrome followed by Inflammatory Myositis in a Patient with Urethral Cancer / 대한내과학회지

Inflammatory myositis is a heterogeneous group of rare diseases characterized by inflammation of the skeletal muscle. The association between cancer and inflammatory myositis is well established, with most cancer-associated myopathies diagnosed within 2 years of initial diagnosis. However, despite this strong association, inflammatory myositis as a paraneoplastic syndrome of urethral cancer has not been reported in Korea. Furthermore, compartment syndrome in the context of inflammatory myositis is extremely rare. A 69 year-old woman presented with paresthesia and painful swelling of the right lower extremity 2 months after diagnosis with urethral cancer, which was treated by chemoradiotherapy. Painful numbness was particularly severe when extending the knee, leading to a preliminary diagnosis of myositis with compartment syndrome, which was confirmed by magnetic resonance imaging. After fascia resection, the patient was treated with high dose steroid and immunoglobulin therapy. Here, we report a case of compartment syndrome followed by inflammatory myositis in a patient with urethral cancer.

Tumores de la uretra en el adulto / Urethra tumors in adult

Los tumores de uretra, benignos y malignos, en adultos de ambos sexos, son una entidad poco frecuente. La sintomatología, el exámen físico y los estudios complementarios nos permitirán realizar una orientación diagnóstica inicial, pero será la biopsia la que nos dé el diagnóstico definitivo que nos permitirá diferenciar entre un tumor benigno y el cáncer de uretra, cuyo concepto es primordial para la decisión terapéutica ulterior. En general, los tumores uretrales suelen tener una sintomatología común. Los benignos son candidatos para resección quirúrgica, siendo importante considerar aquellas entidades cuyo comportamiento es potencialmente neoplásico ya que deberán tener un seguimiento más estrecho. En cuanto al cáncer uretral hay que considerar que el pronóstico está determinado fundamentalmente por la ubicación anatómica, el tamaño y la profundidad invasora de la neoplasia siendo la histología de menor importancia en la respuesta terapéutica y en la sobrevida. El primer paso terapéutico es el control locorregional quirúrgico de la enfermedad con un margen libre de tumor de 2 cm, debiendo plantearse tratamiento adyuvante con quimioterapia y / o radioterapia en aquellos casos en los que no se pueda conseguir este margen. En casos seleccionados la radioterapia puede ser indicada en monoterapia con intención curativa.

Benign and malignant urethral tumors, in adults of both sexes, are a rare entity. Their symptoms, physical examination, and additional studies will allow us to perform an initial diagnostic approach, but it is the biopsy what will differentiate a benign tumor form cancer. In general, urethral tumors often have common symptoms. Benign tumors can usually be managed with surgical resection, but it is important to consider those entities whose behaviour is potentially neoplastic requiring a closer follow up. The prognosis of urethral cancer is determined mainly by the anatomical location, the size and depth of invasion of the tumor. Histology is of second importance in terms of therapeutic response and survival. The first step in treatment is surgical locoregional control of the disease with a tumor-free margin of 2 cm. Adjuvant chemotherapy and / or radiotherapy should be considered in those cases where this margin cannot be obtained. In selected cases, radiation therapy may be given as monotheraphy with curative intent.

Squamous Cell Carcinoma Occurred Concomitantly in the Female Urethra and Vulva / 대한비뇨기과학회지

Urethral carcinomas represent a rare and challenging subset of genitourinary malignancies. Treatments are variable from a radical operation to only radiotherapy, depending upon the size, extent and location of the lesion. Despite of the various treatments, the prognosis for urethral carcinoma is poor. We report a case of a 41-year-old woman with squamous cell carcinoma which occurred concomitantly in the urethra and vulva.

Remote After Loading HDR Brachytherapy for female Urethral Cancer / 대한치료방사선과학회지

In our institution, a 76-year-old woman with primary urethral carcinoma was treated with remote afterloading high dose rate (HDR) interstitial brachytherapy using micro selectron Ir-192. In this paper, authors described the technical aspect of remote afterloading HDR interstitial brachytherapy for female urethal cancer.

Clinical Investigation of the Female Urethral Cancer / 대한비뇨기과학회지

Primary cancer of the female urethra is a relatively rare disease. During the past 10 years, we could collect 11 cases of the female urethral cancer which were confirmed by pathological examinations. The results of clinical investigation were as followed: 1. The age distribution was from 28 years old to 72 years old and the average was 57 years old. The most common age group was 50 to 69 years (73%). 2. The intervals from onset of symptoms to admission were distributed as follows: the most common group was within 1 year (64%), the second common group was within 3 year (27%) and the third was within 3 months (9%). 3. The common symptoms were as follows: urinary frequency in 9 cases (82%), dysuria in 7 cases (64%), urethral mass in 6 cases (55%), urinary retention in 5 cases (46%), urethral bleeding in 4 cases (36%), hematuria in 2 cases (18%) and urethral pain in 2 cases (18%). 4. Histopathological findings showed squamous cell carcinoma in 5 cases (45%), adenocarcinoma in 4 cases (36%) and transitional cell carcinoma in 2 cases (18%) in order of their frequency. All of the 5 cases of squamous cell carcinoma were vulvourethral types. Among the 4 cases of adenocarcinoma, 3 cases were urethral types and 1 case was vulvourethral type. The 2 cases of transitional cell carcinomas were urethral type and vulvourethral type. 5. Clinical stages were distributed as follows: 2 cases were stage A, 3 cases. stage B, 2 cases, stage C and 4 cases, stage D. In the 7 cases of vulvourethral type, 5 cases were stage A or stage B and 2 cases were stage C or stage D, but the 4 cases of urethral type were stage C or stage D. 6. Treatment of female urethral cancers consisted of surgery and irradiation in general. 1) Local excision was performed on the 2 cases of stage A, but tumor recurrence occurred in 1 case after 1 month postoperatively. 2) In stage B, local excision and interstitial irradiation were made on 1 case, external and interstitial irradiation on 1 case and external irradiation only on 1 case. In the 1st case, tumor recurred after 1 month postoperatively and urinary retention developed after 6 months postoperatively. so suprapubic cystostomy was performed. In the second case, we couldn`t follow up, and in the last case the treatment showed no beneficial effect. 3) In stage C, anterior pelvic exenteration and Bricker`s operation were made on 1 cases. And only suprapubic cystostomy was performed on 1 case but the patient died after 14 months postoperatively. 4) It stage D, suprapubic cystostomy was performed on 3 cases. Among which 1 case died after 6 months postoperatively and 2 cases couldn`t be followed up. The other 1 case was operated with cystourethrectomy and Bricker`s operation but the metastasis to retroperitoneal lymph nodes was found in operative field. This case also couldn`t be followed up.