Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany.
Department of Urology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, The Netherlands.
Eur Urol Oncol. 2020 Aug;3(4):424-432. doi: 10.1016/j.euo.2020.06.003. Epub 2020 Jun 27.
Primary urethral carcinoma (PUC) is a rare cancer accounting for <1% of all genitourinary malignancies.
To provide updated practical recommendations for the diagnosis and management of PUC.
A systematic search interrogating Ovid (Medline), EMBASE, and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed.
Urothelial carcinoma of the urethra is the predominant histological type of PUC (54-65%), followed by squamous cell carcinoma (16-22%) and adenocarcinoma (10-16%). Diagnosis of PUC depends on urethrocystoscopy with biopsy and urinary cytology. Pathological staging and grading are based on the tumour, node, metastasis (TNM) classification and the 2016 World Health Organization grading systems. Local tumour extent and regional lymph nodes are assessed by magnetic resonance imaging, and the presence of distant metastases is assessed by computed tomography of the thorax/abdomen and pelvis. For all patients with localised distal tumours (≤T2N0M0), partial urethrectomy or urethra-sparing surgery is a valid treatment option, provided that negative intraoperative surgical margins can be achieved. Prostatic Ta-Tis-T1 PUC can be treated with repeat transurethral resection of the prostate and bacillus Calmette-Guérin. In prostatic or proximal ≥ T2N0 disease, neoadjuvant cisplatin-based chemotherapy should be considered prior to radical surgery. All patients with locally advanced disease (≥T3N0-2M0) should be discussed within a multidisciplinary team. In men with locally advanced squamous cell carcinoma, curative radiotherapy combined with radiosensitising chemotherapy can be offered for definitive treatment and genital preservation. In patients with local urethral recurrence, salvage surgery or radiotherapy can be offered. For patients with distant metastatic disease, systemic therapy based on tumour characteristics can be evaluated.
These updated European Association of Urology guidelines provide up-to-date guidance for the contemporary diagnosis and management of patients with suspected PUC.
Primary urethral carcinoma (PUC) is a very rare, but aggressive disease. These updated European Association of Urology guidelines provide evidence-based guidance for clinicians treating patients with PUC.
原发性尿道癌（PUC）是一种罕见的癌症，占所有泌尿生殖系统恶性肿瘤的<1%。
为 PUC 的诊断和管理提供最新的实用建议。
通过 Ovid（Medline）、EMBASE 和 Cochrane 中央对照试验注册库和 Cochrane 系统评价数据库进行了系统检索。
尿道的尿路上皮癌是 PUC 的主要组织学类型（54-65%），其次是鳞状细胞癌（16-22%）和腺癌（10-16%）。PUC 的诊断取决于尿道膀胱镜检查和活检以及尿细胞学检查。病理分期和分级基于肿瘤、淋巴结、转移（TNM）分类和 2016 年世界卫生组织分级系统。局部肿瘤范围和区域淋巴结通过磁共振成像评估，远处转移的存在通过胸部/腹部和骨盆的计算机断层扫描评估。对于所有局部远端肿瘤（≤T2N0M0）的患者，部分尿道切除术或保留尿道手术是一种有效的治疗选择，前提是可以获得术中阴性的手术切缘。前列腺 Ta-Tis-T1 PUC 可以通过重复经尿道前列腺切除术和卡介苗治疗。在前列腺或近端≥T2N0 疾病中，应在根治性手术前考虑顺铂为基础的新辅助化疗。所有局部晚期疾病（≥T3N0-2M0）的患者都应在多学科团队中讨论。对于局部晚期鳞状细胞癌的男性，可提供根治性放疗联合放疗增敏化疗作为确定性治疗和生殖器官保存。对于局部尿道复发的患者，可以提供挽救性手术或放疗。对于远处转移性疾病的患者，可以评估基于肿瘤特征的全身治疗。
这些更新的欧洲泌尿外科学会指南为疑似 PUC 患者的当代诊断和管理提供了最新的指导。
原发性尿道癌（PUC）是一种非常罕见但侵袭性很强的疾病。这些更新的欧洲泌尿外科学会指南为治疗 PUC 患者的临床医生提供了循证指导。
