Hirpo Alemu Bedeado, Akasa Sena Sefara, Ahmed Mensur Mohammed, Dino Masresha Solomon, Molla Wondweson Alemu, Kidane Mintesnot Yitagesu
Urology Division, Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Urology Division, Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2025 Feb;127:110983. doi: 10.1016/j.ijscr.2025.110983. Epub 2025 Jan 29.
Primary urethral carcinoma (PUC) is a rare cancer, comprising less than 1 % of all genitourinary malignancies, with a male predominance (3:1 ratio), and typically affects those over 75 years of age. PUC shows varied histological subtypes based on their location and sex. The prognosis depends on age, tumor grade, TNM stage, histology, and site. Organ-preserving surgery is for distal disease becoming a preferred option.
We report the surgical management of a male patient presenting with a history of urethral meatal ulcer, bloody urethral discharge, dysuria, and urine spraying, initially misdiagnosed as a persistent herpes ulcer. Examination revealed a 1 × 2 cm erythematous plaque over the urethral meatus. Pelvic magnetic resonance imaging (MRI) showed a 1.7 × 1.7 cm lesion in the distal penile urethra invading the corpus spongiosum, and a biopsy confirmed squamous carcinoma in situ. The patient underwent partial glansectomy and anterior urethrectomy, but pathology showed well-differentiated squamous cell carcinoma with positive margins. The patient was successfully treated with a total anterior urethrectomy, partial glansectomy, and augmented perineal urethrostomy.
PUC (primary urethral carcinoma) presents nonspecifically, requiring high suspicion for diagnosis. Historically, treatment included total penectomy with cystoprostatectomy for proximal tumors and partial or radical penectomy for distal tumors. Distal tumors often have better outcomes, and organ preservation surgery is possible for selected patients, with no local recurrence in those treated with additional surgery or adjuvant radiation for positive margins.
PUC is a rare urological malignancy that is challenging to diagnose and treat. Clinical stage and tumor location are critical prognostic factors for urethral carcinoma in men. Organ-preserving surgery is the preferred treatment for distal disease, with a 5-year overall survival rate of approximately 50 %.
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比例不到1%，男性居多（男女比例为3:1），且通常影响75岁以上人群。PUC根据其位置和性别表现出多种组织学亚型。预后取决于年龄、肿瘤分级、TNM分期、组织学类型和部位。保留器官手术适用于远端疾病，正成为一种首选方案。
我们报告了一名男性患者的手术治疗情况，该患者有尿道肉阜溃疡、尿道血性分泌物、排尿困难和尿流喷洒的病史，最初被误诊为持续性疱疹溃疡。检查发现尿道口有一个1×2厘米的红斑性斑块。盆腔磁共振成像（MRI）显示阴茎远端尿道有一个1.7×1.7厘米的病变，侵犯海绵体，活检证实为原位鳞状癌。患者接受了部分龟头切除术和前尿道切除术，但病理显示为高分化鳞状细胞癌，切缘阳性。患者成功接受了全前尿道切除术、部分龟头切除术和扩大的会阴尿道造口术。
原发性尿道癌（PUC）表现不具特异性，诊断时需要高度怀疑。历史上，近端肿瘤的治疗包括全阴茎切除术加膀胱前列腺切除术，远端肿瘤的治疗包括部分或根治性阴茎切除术。远端肿瘤往往预后较好，对于选定的患者可以进行保留器官手术，切缘阳性的患者接受额外手术或辅助放疗后无局部复发。
原发性尿道癌（PUC）是一种罕见的泌尿系统恶性肿瘤，诊断和治疗具有挑战性。临床分期和肿瘤位置是男性尿道癌的关键预后因素。保留器官手术是远端疾病的首选治疗方法，5年总生存率约为50%。
