Urrutia Alonso J, Machuca Santacruz J, Tallada Buñuel M, Moreno Jiménez J, Vicente Prados J, Cozar Olmo J M, Cámara Ortega M
Servicios de Urología, Ciudad Sanitaria Virgen de las Nieves, Motril, Granada, España.
Arch Esp Urol. 1995 May;48(4):355-63.
Epidermoid carcinoma of the male urethra is a rare tumor that accounts for 70% of primary neoplasms of the urethra. The present study reviews our experience of 5 years in the diagnosis and treatment of this tumor type.
From 1991 to 1994, we diagnosed and treated 5 male patients with epidermoid carcinoma of the urethra; mean age 58 years (range 43 to 76 years). The tumor was localized in the bulbomembranous urethra in 3 cases (60%) and in the penile urethra in the remaining 2 cases (40%). All patients presented with urethral stricture and complications following treatment (internal urethrotomy and dilatation). The tumors of the posterior urethra were Levine stage C and D at the time of diagnosis, while those of the anterior urethra were Levine stage B and C.
Two patients with tumor in the posterior urethra underwent radical cystoprostatourethrectomy and bilateral inguinal lymphadenectomy, whereas the remaining patients underwent emasculation or urethrectomy. Patient survival has ranged from 1 to 2.5 years at the present time. One patient with tumor in the bulbous urethra has died despite postoperative radio and chemotherapy, the outcome has been poor in another patient with tumor in the posterior urethra and no progression has been observed in the remaining patients at present.
a) Urethral stricture with a torpid course and localized complications (fistula, periurethral abscess, etc.) following standard therapy have been the only widely accepted etiologic factors that we have observed in our patients; b) This tumor type must be suspected since treatment by radical surgery will have some likelihood of success if the carcinoma is diagnosed early, while it is still localized; c) To date, radio and chemotherapy have achieved poor results, the former being effective in tumors of the penile urethra only when given at a high dose; d) Patients generally die from localized complications, tumor recurrence, or lymph node metastasis (sepsis, hemorrhage, etc.).
男性尿道表皮样癌是一种罕见肿瘤，占尿道原发性肿瘤的70%。本研究回顾了我们5年来对该肿瘤类型的诊断和治疗经验。
1991年至1994年，我们诊断并治疗了5例男性尿道表皮样癌患者；平均年龄58岁（范围43至76岁）。3例（60%）肿瘤位于球膜部尿道，其余2例（40%）位于阴茎尿道。所有患者均表现为尿道狭窄及治疗（尿道内切开术和扩张术）后的并发症。后尿道肿瘤在诊断时为Levine C期和D期，而前尿道肿瘤为Levine B期和C期。
2例后尿道肿瘤患者接受了根治性膀胱前列腺尿道切除术和双侧腹股沟淋巴结清扫术，其余患者接受了去势术或尿道切除术。目前患者存活时间为1至2.5年。1例球部尿道肿瘤患者尽管术后接受了放疗和化疗仍死亡，另1例后尿道肿瘤患者预后较差，目前其余患者未观察到病情进展。
a）我们在患者中观察到的唯一广泛认可的病因是尿道狭窄病程迂缓和标准治疗后出现局部并发症（瘘管、尿道周围脓肿等）；b）必须怀疑这种肿瘤类型，因为如果癌症早期诊断且仍局限时，根治性手术治疗有一定成功的可能性；c）迄今为止，放疗和化疗效果不佳，前者仅在高剂量时对阴茎尿道肿瘤有效；d）患者通常死于局部并发症、肿瘤复发或淋巴结转移（败血症、出血等）。
