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Urethral Cancer

Urethral cancer is a rare disease where the cells of the urethra become malignant. The urethra is the tube that empties urine from the bladder. In women, the urethra is approximately 4 cm long and opens to the outside of the body above the vagina. In men, the urethra is approximately 20 cm long, going through the prostate gland and then through the penis to the outside of the body.

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Urinary System Cancers

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    MeSH term: Urethral Neoplasms
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Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Bickell M, Beilan J, Wallen J, et al.
Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.
Urol Clin North Am. 2016; 43(4):545-559 [PubMed] Related Publications
This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

Zargar-Shoshtari K, Sexton WJ, Poch MA
Management of Urethral Recurrences: Urothelial and Nonurothelial.
Urol Clin North Am. 2016; 43(4):515-521 [PubMed] Related Publications
This article discusses the diagnostic and therapeutic options in the management of urethral cancer recurrence in patients treated with urethral sparing cystectomy as well as those who had urethral preservation following primary urethral carcinoma.

Zinman LN, Vanni AJ
Management of Proximal Primary Urethral Cancer: Should Multidisciplinary Therapy Be the Gold Standard?
Urol Clin North Am. 2016; 43(4):505-513 [PubMed] Related Publications
Primary urethral cancer (PUC) is a rare, but devastating genitourinary tumor that affects men and women. Although most PUC are localized, proximal PUC frequently presents with locally advanced disease, with 30% to 40% having lymph node metastasis. Single modality surgical or radiation therapy has dismal results. Multimodal therapy with cisplatin-based chemotherapy and consolidation surgery has greatly improved the local recurrence and overall survival rates for this aggressive disease. In locally advanced squamous cell carcinoma of the urethra, radiotherapy combined with radiosensitizing chemotherapy is an option for genital preservation. Prospective, multi-institutional studies are required to further define the optimal multidisciplinary treatment strategy for this destructive disease.

Traboulsi SL, Witjes JA, Kassouf W
Contemporary Management of Primary Distal Urethral Cancer.
Urol Clin North Am. 2016; 43(4):493-503 [PubMed] Related Publications
Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.

Regragui S, Slaoui A, Karmouni T, et al.
Urethral hemangioma: case report and review of the literature.
Pan Afr Med J. 2016; 23:96 [PubMed] Free Access to Full Article Related Publications
Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma.

Lucarelli G, Spilotros M, Vavallo A, et al.
A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review.
Medicine (Baltimore). 2016; 95(19):e3642 [PubMed] Free Access to Full Article Related Publications
Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the bulbomembranous urethra should be managed with radical surgery including the corporas up to the ischiatic tuberosity attachment, and membranous urethra in continuity with the prostate and bladder. Neo-adjuvant treatment may be advisable with the aim of improving the poor prognosis, even if the efficacy is not certain while it can delay the radical treatment of the disease.

Deberne M, Timsit MO, Verkarre V, et al.
Multimodal management of primary adenocarcinoma of the female urethra: About four cases.
Cancer Radiother. 2016; 20(3):169-75 [PubMed] Related Publications
PURPOSE: To retrospectively analyse female patients treated for urethral adenocarcinoma, modalities of treatment and long-term outcomes.
PATIENTS: Four cases of primary female urethral adenocarcinoma were treated in the departments of urology and radiation-oncology at Georges-Pompidou and Necker hospitals (France) over a 7-year period.
RESULTS: All of them underwent surgery, with three presenting stage pT3-pT4 and one a positive cytology on inguinal node. Three patients received adjuvant cisplatin-based chemoradiotherapy up to 60Gy, and one preoperative chemoradiotherapy at 45Gy. Two recurrences were observed: one local relapse occurred at 9months from the diagnosis and was treated by anterior pelvic exenteration followed by chemoradiotherapy, with no recurrence. One tumour relapsed both at the local level and on distant metastatic sites at 9months from the diagnosis, and died 21months after this progression. Median survival and progression-free survival are respectively 4.2years and 13months. Three patients are alive at 7, 4.5 and 3years from diagnosis.
CONCLUSION: Female urethral adenocarcinoma is a very rare entity and often present in locally advanced stages. Initial extensive surgery with pelvic exenteration should be considered, followed by chemoradiotherapy according to the surgical margins and lymph nodes involvement.

Slaoui A, Lasri A, Karmouni T, et al.
Leiomyoma: a case report of a rare benign tumor of the female urethra.
Pan Afr Med J. 2015; 22:111 [PubMed] Free Access to Full Article Related Publications
Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. It often appears in females during their reproductive age (from menarche to menopause); the mean age of their appearance is approximately 41 years. Less than 100 cases were reported in the literature. We hereby report a case of a 52-year-old White woman who presented with complaints of dysuria and urinary tract infection. The mass was completely removed by transvaginal excision with a rim of normal tissue. Histopathological studies confirmed the urethral leiomyoma. The patient remained asymptomatic and there was no evidence of recurrence in the followup.

Chang CF, Hsu SN, Chien ST, et al.
Urethral Metastasis from Rectal Adenocarcinoma: A Case Report and Review of the Literature.
Low Urin Tract Symptoms. 2015; 7(3):162-5 [PubMed] Related Publications
CASE: A 73-year-old man with Dukes' C adenocarcinoma of the rectum, pT3N2bM0, stage IIIB, presented with voiding difficulties including poor stream and terminal dribbling for one month. The patient was under careful surveillance and had no postoperative recurrence. Physical examination revealed a palpable irregular nodular lesion (0.5 × 0.5 cm(2)) at the penile-scrotal junction. He underwent urethroscopy, which showed a cauliflower lesion in the pendulous urethra. Transurethral resection was performed and histopathologic and immunochemical staining demonstrated a metastatic moderately differentiated urethral adenocarcinoma from the colorectal primary.
OUTCOME: His voiding disorder improved significantly post-operation and he commenced second-line chemotherapy combined with regional radiotherapy. Follow-up urethrocystoscopy and abdominal computed tomography demonstrated no recurrence or metastatic disease. His tumor marker remained within the normal range for 12 months.
CONCLUSION: Urethral metastasis from primary colon cancer is extremely rare. This disease, with its various atypical presentations, presents a diagnostic challenge to the clinician. In patients with recurrent or persistent lower urinary tract symptoms, further urologic workup including thorough history taking, physical examination, and imaging surveys is warranted.

Fang D, Liu P, Li X, et al.
Characteristics and treatment outcomes of pan-urothelial cell carcinoma: a descriptive analysis of 45 patients.
Sci Rep. 2015; 5:18014 [PubMed] Free Access to Full Article Related Publications
The incidence of pan-urothelial cell carcinoma (panUCC), which refers to the presence of both bilateral (UTUC) and bladder tumor (BT), is relatively low. However, the profile of a panUCC cohort of patients remains to be elucidated. We reviewed the data of consecutive UTUC patients who received treatment at our center from 1999 to 2012. Overall, 45 patients were included in this study, with a median age of 64.5 years. Fourteen patients initially presented with unilateral UTUC, 11 initially with BT, and the remainder with multiple tumors. Patients with UTUC were more likely to manifest higher rates of muscle invasion and larger-sized tumors. Five patients were treated with complete urinary tract exenteration (CUTE), and most patients (73.3%) received combined management with conservative and radical surgery. After a median follow-up of 77 months, 18 patients (40%) died including 15 (33.3%) due to cancer. Higher tumor stage was the only risk factor predictive of worse survival. Nineteen patients experienced local recurrence after conservative surgery. This study indicated that PanUCC involves either synchronous or metachronous presentation of tumors with a high risk of tumor recurrence, progression, and dissemination after conservative surgery.

Skowron MA, Niegisch G, Fritz G, et al.
Phenotype plasticity rather than repopulation from CD90/CK14+ cancer stem cells leads to cisplatin resistance of urothelial carcinoma cell lines.
J Exp Clin Cancer Res. 2015; 34:144 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Tumour heterogeneity and resistance to systemic treatment in urothelial carcinoma (UC) may arise from cancer stem cells (CSC). A recent model describes cellular differentiation states within UC based on corresponding expression of surface markers (CD) and cytokeratins (CK) with CD90 and CK14 positive cells representing the least differentiated and most tumourigenic population. Based on the fact that this population is postulated to constitute CSCs and the origin of cisplatin resistance, we enriched urothelial carcinoma cell lines (UCCs) for CD90 and studied the tumour-initiating potential of these separated cells in vitro.
METHODS: Magnetic- and fluorescence-activated- cell sorting were used for separation of CD90(+) and CD90(-) UCCs. Distribution of cell surface markers CD90, CD44, and CD49f and cytokeratins CK14, CK5, and CK20 as well as the effects of short- and long-term treatment with cisplatin were assessed in vitro and measured by qRT-PCR, immunocytochemistry, reporter assay and flow cytometry in 11 UCCs.
RESULTS: We observed cell populations with surface markers according to those reported in tumour xenografts. However, expression of cytokeratins did not concord regularly with that of the surface markers. In particular, expression of CD90 and CK14 diverged during enrichment of CD90(+) cells by immunomagnetic sorting or following cisplatin treatment. Enriched CD90(+) cells did not exhibit CSC-like characteristics like enhanced clonogenicity and cisplatin resistance. Moreover, selection of cisplatin-resistant sublines by long-term drug treatment did not result in enrichment of CD90(+) cells. Rather, these sublines displayed significant phenotypic plasticity expressing EMT markers, an altered pattern of CKs, and WNT-pathway target genes.
CONCLUSIONS: Our findings indicate that the correspondence between CD surface markers and cytokeratins reported in xenografts is not maintained in commonly used UCCs and that CD90 may not be a stable marker of CSC in UC. Moreover, UCCs cells are capable of substantial phenotypic plasticity that may significantly contribute to the emergence of cisplatin resistance.

Bakarev MA, Neimark AI, Lushnikova EL, et al.
Pathomorphological Analysis and Evaluation of Microcirculation in Polyps of the External Urethral Meatus in Women.
Bull Exp Biol Med. 2015; 160(1):103-8 [PubMed] Related Publications
Combinations of various factors of polypogenesis determine the formation of a mixed structural phenotype of urethral polyps consisting of heterogeneous changes of the epithelium (hyperplasia, metaplasia, and erosions), inflammatory cell infiltration of the stroma, and dilatation of the venous plexus vessels. Urogenital infections are associated with the predominance of symptoms of inflammation, high serum levels of IL-1β and TNF-α, more extensive areas of inflammatory infiltration and subepithelial microvascular bed, predominance of hyperemic form of microcirculatory disorders. The combination of hyperplastic reactions of the epithelial layer with neoangiogenesis and myofibroblast proliferation in the subepithelial zone confirms the key role of dysregeneratory hyperplasia in the mechanisms of polypogenesis.

Chan Y, Fisher P, Tilki D, Evans CP
Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.
BJU Int. 2016; 117(4):563-9 [PubMed] Related Publications
To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy.

Harari SE, Cheng L, Osunkoya AO
Primary mucinous adenocarcinoma of the female urethra: a contemporary clinicopathologic analysis.
Hum Pathol. 2016; 47(1):132-7 [PubMed] Related Publications
Primary mucinous adenocarcinoma of the female urethra is very rare and may lead to both diagnostic and therapeutic challenges. Although primary mucinous adenocarcinoma of the prostate and prostatic urethra has been well characterized in men, this is the largest clinicopathologic study to date of primary mucinous adenocarcinoma of the female urethra. A search was made through the files of 2 major academic institutions for cases of confirmed primary mucinous adenocarcinoma arising from the female urethra. Tumors arising from adjacent organs were excluded both clinically and pathologically in all cases. Five cases were identified. The mean patient age was 67 years (range, 54-74 years). All patients presented with a polypoid/papillary mass arising from the urethra. Pathologic stages were as follows: pT4 3 (60%) of 5 cases; pT3 1 (20%) of 5 cases, and pT2 1 (20%) of 5 cases. Immunohistochemical stains for GATA3, p63, CK7, CK20, CDX2, ER, PAX8, and β-catenin were performed on all cases. Immunohistochemical stains were positive in the tumor cells for CDX2 in 4/5 (80%) cases; focally positive for CK20 in 4/5 (80%) cases; focally positive for CK7 in 4/5 cases (80%); and negative for p63, GATA3, ER, PAX8 and β-catenin in all cases. In the 4 patients with available follow-up data, mean follow-up was 25 months (range, 4-54 months). It is critical for pathologists to be aware of this entity in light of potential diagnostic pitfalls and therapeutic implications.

Christodoulidou M, Sahdev V, Muneer A, Nigam R
A rare case of metachronous penile and urethral metastases from a rectal mucinous adenocarcinoma.
BMJ Case Rep. 2015; 2015 [PubMed] Related Publications
Metastatic lesions in the penis are uncommon in patients with prostate or bladder cancer but penile metastatic lesions from rectal tumours are rare with only 65 cases reported in the literature. We describe the case of a 70-year-old man who developed metastatic lesions within his corpus cavernosum 2 years after being diagnosed and treated for a mucinous adenocarcinoma of the rectum and a year after a wedge resection of an isolated lung metastasis. He proceeded with total penectomy and intraoperatively two skip lesions were also found within the wall of his urethra; histological analysis proved that these were also metastatic lesions. A perineal urethrostomy was formed with the remaining macroscopically healthy urethra. He made a good recovery from his operation and continued his treatment under the oncology team.

Fujii T, Shimada K, Tatsumi Y, et al.
microRNA-145 promotes differentiation in human urothelial carcinoma through down-regulation of syndecan-1.
BMC Cancer. 2015; 15:818 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: A new molecular marker of carcinoma in the urinary bladder is needed as a diagnostic tool or as a therapeutic target. Potential markers include microRNAs (miRNAs), which are short, low molecular weight RNAs 19-24 nt long that regulate genes associated with cell proliferation, differentiation, and development in various cancers. In this study, we investigated the molecular mechanisms by which miR-145 promotes survival of urothelial carcinoma cells and differentiation into multiple lineages. We found miR-145 to regulate expression of syndecan-1, a heparin sulfate proteoglycan.
METHODS: Cell proliferation in the human urothelial carcinoma cell lines T24 and KU7 was assessed by MTS assay. Cellular senescence and apoptosis were measured by senescence-associated β-galactosidase (SA-β-gal) and TUNEL assay, respectively. Quantitative RT-PCR was used to measure mRNA expression of various genes, including syndecan-1, stem cell factors, and markers of differentiation into squamous, glandular, or neuroendocrine cells.
RESULTS: Overexpression of miR-145 induced cell senescence, and thus significantly inhibited cell proliferation in T24 and KU7 cells. Syndecan-1 expression diminished, whereas stem cell markers such as SOX2, NANOG, OCT4, and E2F3 increased. miR-145 also up-regulated markers of differentiation into squamous (p63, TP63, and CK5), glandular (MUC-1, MUC-2, and MUC-5 AC), and neuroendocrine cells (NSE and UCHL-1). Finally, expression of miR-145 was down-regulated in high-grade urothelial carcinomas, but not in low-grade tumors.
CONCLUSIONS: Results indicate that miR-145 suppresses syndecan-1 and, by this mechanism, up-regulates stem cell factors and induces cell senescence and differentiation. We propose that miR-145 may confer stem cell-like properties on urothelial carcinoma cells and thus facilitate differentiation into multiple cell types.

Raspollini MR, Carini M, Montironi R, et al.
Mucinous Adenocarcinoma of the Male Urethra: A Report of Two Cases.
Anal Quant Cytopathol Histpathol. 2015; 37(4):267-72 [PubMed] Related Publications
BACKGROUND: Primary malignancies arising in the urethra are rare and, contrary to the other genitourinary malignancies, are more common in female patients. The pathologic diagnosis of primary adenocarcinoma can be challenging due to its rarity and overlapping features with other primary and secondary malignancies. There is no specific immunoprofile to define these adenocarcinomas, but available markers may allow comparison with common secondary tumors. About 30 primary cases have been recorded to date.
CASES: We report 2 cases of primary mucinous adenocarcinoma of the male urethra, one with possible origin from Littrè glands and the other from the prostatic urethra.
CONCLUSION: The available data suggest that this is a heterogeneous group of aggressive tumors and that the optimal management remains to be established.

Nogueira MA, Santos GC, Lopes RI, et al.
Male urethral sarcoma: a case report and literature review.
Einstein (Sao Paulo). 2016 Jan-Mar; 14(1):64-6 [PubMed] Free Access to Full Article Related Publications
Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature.

Chouikh T, Ghorbel S, Charieg A, et al.
Uncommun etiology of pediatric Hematuria: urethral lymphangioma.
Tunis Med. 2015; 93(2):107-8 [PubMed] Related Publications
We report a case of urethral cystic lymphangioma. Hematuria is the revealing symptom. Im our knowledge, is the third case described in literature.

Mehta S, Sheth K, Khatri G, et al.
Management of Female Anterior Urethral Masses.
Female Pelvic Med Reconstr Surg. 2015 Sep-Oct; 21(5):e46-8 [PubMed] Related Publications
OBJECTIVES: Little is known about anterior female urethral masses and their management. Owing to their location, these masses are often missed on physical examination and are diagnosed at an advanced stage.
METHODS: We report on 2 anterior urethral masses, with 1 mass arising from an anterior diverticulum.
RESULTS: Both masses were difficult to identify on examination but were clearly delineated by magnetic resonance imaging. In both cases, a biopsy was essential for histologic characterization of the mass, predicting prognosis and dictating management options. One patient had high-grade clear-cell adenocarcinoma, necessitating an anterior exenteration. The other patient had a low-grade leiomyoma amenable to conservative management.
CONCLUSIONS: Tailored intervention for anterior female urethral masses can provide both symptomatic relief and mortality benefit.

Kang M, Jeong CW, Kwak C, et al.
Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients.
J Korean Med Sci. 2015; 30(8):1143-9 [PubMed] Free Access to Full Article Related Publications
The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (≥T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.

Migliari R, Buffardi A, Mosso L
Female paraurethral leiomyoma: treatment and long-term follow-up.
Int Urogynecol J. 2015; 26(12):1821-5 [PubMed] Related Publications
INTRODUCTION: We describe our experience with evaluating the ideal management of female paraurethral leiomyomas from imaging to surgery and follow-up.
METHODS: Between January 2009 and January 2012, we treated six women (age range 32-49 years) affected by paraurethral leiomyoma of different sizes.
RESULTS: All the six patients underwent transvaginal excision of the mass. They are free of recurrence at follow-up (range 32-72 months). Two patients developed stress urinary incontinence after the excision: in both cases, incontinence was corrected by a tension-free vaginal tape-obturator (TVT-O) placement. In one patient, a fascial sling was necessary to repair a urethral lesion that developed during surgical excision of the mass.
CONCLUSION: A well-defined protocol for diagnosing and managing a paraurethral mass had not been established as yet due the rarity of the mass. We suggest performing pelvic magnetic resonance imaging (MRI) as a primary examination, followed by lesion biopsy. Complete surgical resection performed transvaginally should be the treatment of choice. As paraurethral leiomyomas does not originate from intraurethral smooth-muscle component, urethral lesion is rare. Excision of female urethral leiomyoma transvaginally is safe, and postoperative urinary incontinence, if any, can be easily corrected with minimally invasive tecniques.

Itani M, Kielar A, Menias CO, et al.
MRI of female urethra and periurethral pathologies.
Int Urogynecol J. 2016; 27(2):195-204 [PubMed] Related Publications
INTRODUCTION AND HYPOTHESIS: Accurate diagnosis of a wide spectrum of urethral/periurethral pathologies in women remains challenging due to its anatomical location and nonspecific clinical presentations. Magnetic resonance imaging (MRI) has emerged as the modality of choice for diagnosing female urethral and periurethral pathologies due to its multiplanar scanning capability, superior soft tissue differentiation, noninvasive nature, and overall excellent contrast resolution.
METHODS: In this narrative review, we describe the use of MRI to visualize the female urethra and periurethral pathologies.
RESULTS: MRI can confidently characterize lesions into cystic or solid, provide a more succinct differential diagnosis, and in some cases provide a specific and accurate diagnosis, enabling surgeons to prepare a roadmap before operative procedure. Moreover, functional MRI can be useful to assess dynamic disorders such as urethral hypermobility.
CONCLUSIONS: We provide a comprehensive review of normal MR anatomy of the female urethra, as well as the MR features of practically important urethral and periurethral lesions.

Han H, Zhou XG, Fan DD, et al.
An Unusual Etiology for Hematospermia and Treatments That Were Successful.
Urology. 2015; 86(4):740-3 [PubMed] Related Publications
OBJECTIVE: To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma.
METHODS: The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration.
RESULTS: The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available.
CONCLUSION: The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

Bethell GS, Johal NS, Cuckow PM
A Case of Embryonal Rhabdomyosarcoma Presenting as a Lobulated Protrusion From the Urethral Meatus at Birth.
Urology. 2015; 86(4):805-7 [PubMed] Related Publications
This is the first reported case of rhabdomyosarcoma presenting as a mass protruding from the urethral meatus present at birth. A male neonate was transferred to a tertiary pediatric urology center on day 4 of life where the mass was surgically excised. Histology confirmed an embryonal rhabdomyosarcoma and chemotherapy commenced. The patient completed chemotherapy at the age of 8 months. The child is now 3.5 years old and well with no recurrence of disease.

Yagihashi Y, Arakaki Y
Recurrence of sigmoid colon carcinoma in the retained urethra after cystectomy: A case report and review of the literature.
Arch Ital Urol Androl. 2015; 87(2):167-8 [PubMed] Related Publications
Urethral recurrence arising from a primary colorectal adenocarcinoma is rare. Here, we report a case of urethral recurrence of sigmoid colon cancer, which developed after cysto-prostato-sigmoidectomy for sigmoid colon cancer invading the bladder. The patient underwent urethrectomy successfully and is currently tumor-free. Surgeons who follow patients with colorectal cancer invading the bladder should be aware of this case. The early detection of recurrence improves the chances for disease-free survival.

Tang J, He L, Long Z, Wei J
Phyllodes tumor of the verumontanum: a case report.
Diagn Pathol. 2015; 10:69 [PubMed] Free Access to Full Article Related Publications
The current report presents the case of a 42-year-old male with extraordinarily salient urination difficulty that had lasted 6 months. Transrectal ultrasonography and pelvic magnetic resonance imaging demonstrated prostatic hyperplasia and cyst. PSA level was 20.65 (>4) μg/L in the patient. Transrectal prostatic biopsy revealed benign prostatic hyperplasia. He agreed to receive plasmakinetic resection of the prostate. During operation a lobulated lump was unexpectedly found on the verumontanum, with the prostate macroscopically normal. Complete tumor excision was performed and pathological assessment indicated phyllodes tumor of the verumontanum. The patient had an uneventful post-operative course and recovered well. The diagnosis, histological classification, treatment, and prognosis of this case are presented. It is necessary to perform cystoscopy to exclude verumontanum tumor even when all imaging examinations indicate prostate hyperplasia, especially in young males. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1868931661161758.

Gakis G, Morgan TM, Efstathiou JA, et al.
Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma.
World J Urol. 2016; 34(1):97-103 [PubMed] Related Publications
PURPOSE: To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC).
METHODS: A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death.
RESULTS: Median age at definitive treatment was 66 years (IQR 58-76). Histology was urothelial carcinoma in 72 (47 %), squamous cell carcinoma in 46 (30 %), adenocarcinoma in 17 (11 %), and mixed and other histology in 11 (7 %) and nine (6 %), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p < 0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4 %, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p < 0.001), tumor location (p < 0.001), and age (p = 0.001), whereas clinical nodal stage was the only independent predictor for OS (p = 0.026).
CONCLUSIONS: These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.

Gakis G, Morgan TM, Daneshmand S, et al.
Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma.
Ann Oncol. 2015; 26(8):1754-9 [PubMed] Related Publications
BACKGROUND: To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC).
PATIENTS AND METHODS: A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48).
RESULTS: Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005).
CONCLUSION: In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.

Chiba M, Toki A, Sugiyama A, et al.
Urethral caruncle in a 9-year-old girl: a case report and review of the literature.
J Med Case Rep. 2015; 9:71 [PubMed] Free Access to Full Article Related Publications
INTRODUCTION: Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in post-menopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present an unusual case of a pediatric patient with a urethral caruncle, along with a review of the literature.
CASE PRESENTATION: A 9-year-old Mongolian girl was referred to our hospital with a 2-week history of frequent adherence of a small amount of blood to her underwear. We found a sessile smooth margin, a clear boundary and an elastic, soft red tumor over the entire circumference of the urethral meatus. At the beginning, because of the child's age, urethral prolapse was suspected. There was no response after 3 weeks of conservative treatment with steroid ointment. With the patient under general anesthesia, a partial tumor resection was performed for the purpose of histological examination. The tumor excision was limited to about 1/2 laps of the urethral meatus to prevent the development of urethral stricture. On the basis of clinical and histopathological examinations, a diagnosis of a urethral caruncle was made. Post-operatively, steroid ointment application to residual masses was continued, and these disappeared about 6 months later. Our patient was free of recurrence and had had no complications after 3 years of follow-up.
CONCLUSIONS: Urethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. It should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of the caruncle in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because caruncles take a long time to heal. The case that we describe in this report will serve as an example for similar cases in the future.

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