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Descripción caso clínico: Femenino de 64 años, sin antecedentes de importancia, valorada por síntomas urinarios bajos y hematuria de 1 mes de evolución. En los estudios radiológicos se encuentra una imagen compatible con una tumoración uretral en la resonancia magnética. Se realiza uretrocistoscopía encontrando una tumoración dentro de un divertículo de uretra, se le realiza resección transuretral y posteriormente exenteración pélvica anterior. Histopatológicamente se reportó un adenocarcinoma de células claras dentro de un divertículo uretral proximal. No se realizó adyuvancia, permanece en seguimiento y vigilancia, actualmente libre de recidiva. Relevancia: Los carcinomas de uretra son neoplasias poco comunes y que estos se originen en un divertículo son raros. Estos tipos de tumores son de comportamiento agresivo y se requiere de un tratamiento agresivo para poder ofrecer la mayor probabilidad de curación. Implicaciones clínicas: No existe un tratamiento estandarizado, el tratamiento quirúrgico mediante una uretrectomía radical o una exenteración pélvica anterior con o sin adyuvancia sería la opción terapeútica más aceptada. Conclusiones: El adenocarcinoma de células claras que se origina de un divertículo de uretra es una enfermedad poco común, usualmente se presentan de forma localmente avanzada; para lo cual no se cuenta con un tratamiento o seguimiento estandarizado.

Introduction The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). Materials and methods We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). Results A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). Conclusion In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients’ history may allow for better clinical decision-making and patient counseling.

We present a rare case of a 69-year-old male patient with serendipitous urethral melanoma. He complained of dysuria and recurrent urinary retention and was initially diagnosed with benign prostatic hyperplasia. Accidentally, a dark-brown pigmented macula was found in the distal urethra at the end of transurethral prostatectomy when we exited the resectoscope, transurethral resection of the nidus and sent to pathological examination showed the characteristics of melanoma. No other lesions were found on further examination and the patient preferred a close follow-up cystoscopy rather than an immediate urethrectomy. Unsurprisingly, he relapsed in the urethra with the local disease three months later and we treated him with partial urethrectomy, followed by watchful waiting for 11 months. However, the patient was readmitted for hematuria, and 18F-FDG PET-CT showed a large number of pelvic and bone metastatic lesions. Therefore, eight cycles of single-agent dacarbazine chemotherapy were administered, and the disease was demonstrated prolonged stabilization. Follow-up was conducted every 3 months, during which time palliative transurethral resection of the melanoma in the bladder was performed to control urinary tract infections. Although the prognosis of the disease is extremely poor, this patient has gained more than 50 months of overall survival and is alive to date.

Background BK polyomavirus (BKPyV) infection after kidney transplantation is an important cause of graft failure among kidney transplant recipient and may cause malignant tumor, although the association between BKPyV infection and malignant tumor has been controversial yet. Case presentation We report a case of a 39-year-old-male kidney transplantation (KTx) recipient with urine BKPyV replication who developed a graft pelvic tumor with the positive Simian virus 40 large T antigen (SV40 TAg). The patients received a living-related KTx from his 65-year-old mother. A protocol biopsy at 14 months after KTx showed BKPyV-associated nephropathy. Therefore, the dose of immunosuppressants was reduced, resulting in improved BKPyV viremia, but viruria persisted. About 117 months after KTx, urine cytology showed atypical cells suspicious for malignancy. Cystoscopy revealed a tumor on the neck of the bladder. Transurethral resection of the bladder tumor (TUR-BT) was performed; however, the diagnosis of malignancy was not confirmed at that time. Six months after the TUR-BT, urine cytology showed atypical cells definite for malignancy. Computed tomography and retrograde pyelography showed no evidence of urinary tract tumor and metastasis. Subsequently, total nephroureterocystectomy and urethrectomy were performed. Histological examination of the graft ureter revealed a high-grade urothelial carcinoma, with glandular differentiation, pT1. Immunohistochemically, the tumor showed positivities for SV40 TAg and p53, along with increased Ki67 labeling cells were increased. By contrast, nonneoplastic cells were negative for SV40 TAg. At the time of writing the present manuscript, the patient is free from recurrence or residual tumor and being closely monitored without additional therapy, 32 months after the surgery. Conclusion The relationship between BKPyV infection after KTx and bladder carcinogenesis remains to be elucidated. However, when the KTx recipients who continue to have BKPyV infection for a long time are treated, the possibility of risk factors for renourinary carcinoma should always be carefully considered.

Objective: To compare the clinical effects and safety of two methods of laparoscopic total cystectomy for female bladder cancer patients with retention and resection of the urethra. Methods: Female bladder cancer patients with bladder invasive urothelial carcinoma were selected in grade II~III from January 2008 to March 2018. Patients were divided into two groups based on the surgical method: group A laparoscopic radical cystectomy, and group B laparoscopic radical cystectomy + urethrectomy, to observe the clinical efficacy, operation duration, blood loss during surgery, hospitalization time, and complications. Results: The operation times in groups A and B were 262.54 ± 27.95 min and 310.28 ± 32.99 min, respectively. The volumes of intraoperative blood loss in groups A and B were 439.46 ± 44.52 mL and 456.74 ± 47.18 mL, respectively. There were no discernable differences in the probability of postoperative complications in the two groups. In group A, four patients experienced bladder cancer recurrence and metastasis, and 50% of these cases had a urethral recurrence. In group B, one patient experienced bladder cancer recurrence and metastasis; however, there was no urethral recurrence. Conclusion: Although laparoscopic radical cystectomy + urethrectomy extended the operation times; prophylactic urethrectomy can further shorten the bladder cancer recurrence and metastasis and improve patient prognosis without an increase in complications. However, its long-term clinical efficacy needs further study and supplement.

Purpose of review The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. Recent findings Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33-93 and 99-100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients' treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal. Summary Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.

We report two cases with recurrences of urachal adenocarcinoma (UrAC) in the urethra. Both patients had mucinous UrAC without metastasis, for which they were treated with en-bloc partial cystectomy and umbilectomy. The first patient developed recurrence of UrAC in the distal urethra after 1 yr. Distal urethrectomy revealed multiple additional recurrences in the penile and prostatic urethra. The patient underwent radical cystoprostatectomy with en-bloc urethrectomy. At 5 mo after surgery, liver metastases were found. A search in our institutional database revealed a second patient who developed a solitary recurrence of UrAC in the prostatic urethra 8 yr after partial cystectomy. Radical cystoprostatectomy was performed. The patient subsequently experienced recurring UrAC in the urethra, which were treated with multiple surgeries and radiation. Unfortunately, local tumor control could not be achieved and the patient developed distant metastases 7 yr after cystoprostatectomy. Our two cases and four comparable cases reported in the literature indicate that urothelial spread of UrAC is rare but possible. It remains to be determined if UrAC spreads along the urothelium similar to urothelial cancer or if these multifocal urethral recurrences were the first sign of local metastasis.

There is little research on the role of urethrectomy during cystectomy in patients with micropapillary bladder cancer (MPBC). We present two cases of MPBC cystectomy and suggest that urethrectomy be performed concurrently as a preventive measure. The first case involved a woman who had a mixed solid and papillary bladder tumour. An anterior pelvic exenteration was performed as well as a total urethrectomy. The T4a micropapillary variant tumour was confirmed by pathology. The second case involved a man with T1 MPBC who was treated with a BCG induction course. A recurrent muscle-invasive MPBC was discovered during follow-up. During the radical cystoprostatectomy, the urethra was spared. T2 MPBC was discovered through pathology. He had a urethrectomy 6 months later due to urethral bleeding, and the pathology revealed micropapillary cancer of the urethra.

INTRODUCTION AND OBJECTIVE:Female urethral stricture is a rare condition. Distal stricture have usually been managed using meatoplasty. Advancement urethroplasty might be an interesting surgical al...

Objective: To compare the diagnostic role of Florine-18 2-fluoro-2-deoxy-D-glucose-Positron emission tomography/computed tomography (FDG-PET/CT) in the restaging of bladder cancer with other radiological methods and to determine its effect on the treatment management of patients with bladder cancer. Material and methods: A total of 83 patients who showed suspicious lesions with radiologic methods and FDG-PET/CT images were enrolled in the study. Positive lesion sites were detected and compared in all imaging modalities. Positive lesions were confirmed by biopsy or serial radiological imaging. Furthermore, the rate of change of the management and treatment modalities of patients after FDG-PET/CT were noted. Results: The most frequent metastasis was observed in lymphatic localizations in all imaging methods. Lymph node metastases was detected with FDG-PET/CT in 37/83 patients, with computed tomography in 28/80 patients, and with magnetic resonance imaging in 6/19 patients. Lymph node metastasis was detected most commonly in the pelvic region with all modalities. Following lymphatic localization in FDG-PET/CT and CT, metastases were found most frequently in the lung and bone regions. FDG-PET/ CT also revealed 8 of the 12 local lesions that were detected by radiological methods and showed additional lesions in four patients that could not be demonstrated by radiological methods. FDG-PET/CT changed the treatment approaches in 34.9% (29/83) of patients. In 16 patients, it caused upstaging and commencement of advanced treatment methods. In 13 patients, malignancy was excluded in suspicious lesions and unnecessary advanced examination and treatment were avoided. FDG-PET/CT also caused three radical cystectomies, one partial cystectomy, and one urethrectomy in patients who had not undergone any operational procedure previously. Conclusion: Despite physiological urinary tract uptake, FDG-PET/CT is superior to other imaging modalities not only in distant localizations but also in evaluating pelvic lesions and lymph nodes. In addition, the use of FDG-PET/CT during the restaging process contributes to the management of maximum number of patients. © 2019 by Turkish Association of Urology.

Context: Primary urethral cancer (PUC) is a rare cancer entity. Owing to the low incidence of this malignancy, the main body of literature consists mainly of case reports, making evidence-based management recommendations difficult. Objective: To review reported disease management strategies of PUC and their impact on oncological outcomes. Evidence acquisition: A systematic research was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement using Medline, Scopus, and Web of Science, to find studies of the past 10yr including ≥20 patients, and investigating treatment strategies and their impact on outcomes of the three most frequent histologies: urothelial carcinoma, adenocarcinoma, and squamous cell carcinoma. Evidence synthesis: In localized PUC, penis-sparing surgery can be performed in males, while in females, complete urethrectomy with surrounding tissue is advised to minimize recurrence due to positive margins. Radiotherapy (RT) has worse survival and recurrence rates, as well as more adverse effects, than surgery, limiting its use in genital-preserving therapy. Locally advanced PUC should be treated with multimodal therapy, as monotherapies result in inferior recurrence and survival rates. Extent of surgery is still undecided, favoring radical cyst(oprostat)ectomy with total urethrectomy (RCU). Lymph node involvement is a predictor of survival, highlighting the role of lymph node dissection for disease control and staging. RT can improve survival in combination with surgery and/or chemotherapy (CHT). Neoadjuvant platinum-based CHT can improve overall and recurrence-free survival. At recurrence, salvage therapy with surgery and/or CHT can improve survival. Superficial urothelial carcinoma of the prostatic urethra can be treated with transurethral resection. Stromal invasion often features concomitant bladder cancer with a poor prognosis and requires RCU with or without systemic preoperative CHT. Conclusions: PUC is a rare malignancy with an often poor natural course, requiring a stage- and gender-specific risk-based treatment strategy. The role of systematic perioperative CHT and the extent of surgery are becoming more important. Patient summary: In this review, we looked at the treatment options for primary urethral cancer. We found that while an organ-confined disease can be managed with local resection, growth beyond the organ border makes a combination of different treatment modalities, such as surgery and systematic chemotherapy, necessary to improve outcomes.

The International Collaboration on Cancer Reporting (ICCR) is a not-for-profit organisation sponsored by the Royal Colleges of Pathologists of Australasia and the United Kingdom, the College of American Pathologists, the Canadian Association of Pathologists in association with the Canadian Partnership Against Cancer, the European Society of Pathology, the American Society of Clinical Pathology and the Faculty of Pathology, Royal College of Physicians of Ireland. Its goal is to produce standardised, internationally agreed-upon, evidence-based datasets for cancer pathology reporting throughout the world. This paper describes the development of a cancer dataset by the multidisciplinary ICCR expert panel for the reporting of carcinoma of the urethra in urethrectomy specimens. The dataset is composed of 'required' (mandatory) and 'recommended' (non-mandatory) elements, which are based on a review of the most recent evidence and supported by explanatory commentary. Fourteen required elements and eight recommended elements were agreed by the international dataset authoring committee to represent the essential/required (core) and recommended (non-core) information for the reporting of carcinoma of the urethra in urethrectomy specimens. Use of an internationally agreed, structured pathology dataset for reporting carcinoma of the urethra (in urethrectomy specimens) will provide the necessary information for optimal patient management, will facilitate consistent data collection and will provide valuable data for research and international benchmarking. The dataset will be valuable for those countries and institutions that are not in a position to develop their own datasets.

Background Pagetoid urothelial intraepithelial neoplasia is a form of secondary extramammary Paget disease. It is a rare malignant condition seen on the female genitalia synchronous or metachronous with bladder cancer.Case presentation A 66-year-old female presented with pagetoid urothelial intraepithelial neoplasia at the labia minora two years after an open anterior pelvic exenteration with ileal conduit urinary diversion for carcinoma in situ of the bladder. Pagetoid urothelial intraepithelial neoplasia of the vulva and vagina was confirmed by a punch biopsy and the patient underwent a radical vaginectomy with urethrectomy and inguinal sentinel node procedure. Immunohistochemically extramammary Paget disease was identified by the expression tumor protein 63, cytokeratin 7 and cytokeratin 20.Conclusion Pagetoid urothelial intraepithelial neoplasia is a rare but distinct clinical entity as a form of secondary EMPD which can be differentiated from primary EMPD based on medical history, histology and immunohistochemistry.

Urethral adenocarcinoma (UA) is a rare type of urethral cancer with a poor prognosis. We present a case of UA of intestinal subtype in a 57-year-old patient who initially had lower urinary tract symptoms and was subsequently found to have a urethral lesion in a urethral diverticulum on pelvic MRI which was confirmed on biopsy. She had neoadjuvant chemotherapy followed by open anterior pelvic exenteration, complete urethrectomy and ileal conduit urinary diversion. She required adjuvant chemotherapy for local invasion and a metastasis in the uterus but developed progressive metastatic disease and succumbed to the disease 13-months after surgery., Highlights • Urethral adenocarcinoma is rare. • Diagnosis is challenging. • Prognosis is poor. • Surgery with or without chemotherapy and/or radiotherapy for advanced disease.

Primary urethral carcinoma (PUC) is a rare malignancy, covering less than 1% of all genitourinary cancers. Different tumor location, classified as tumor in distal or proximal urethra, represents different characteristics and often leads to different treatment modality. However, data on the surgical approach for PUC involving both distal and proximal urethra remains rare. In this case, we presented a 75-year-old man with untypical symptoms of perineal mass and unspecific frequent and painful urination. Results of multiparametric magnetic resonance imaging (mp-MRI), positron emission tomography/computed tomography (PET/CT) scan, and percutaneous biopsy revealed a cT2N1M0 PUC involving both distal and proximal urethra. Given the request of patients for a normal penile appearance after surgery, a transperineal-incision urethrectomy combined with laparoscopic prostatectomy and iliac lymphadenectomy was performed with optimal outcomes. The results of histopathological analysis revealed a moderately-high differentiated PUC with no positive lymph node. Post-operative recovery was uneventful. On first visit 1-month after surgery, physical examination revealed a satisfactory wound healing and appearance of penis and no recurrent lesions were found on mp-MRI. This is a rare case with untypical symptoms indicating that patients with PUC involving both distal and proximal urethra may present with no symptoms of urethral stricture but only non-specific lower urinary symptoms. The surgical approach we proposed in this case proves to be a safe and feasible one to completely resect the tumor and preserve a normal appearance of penis, thus worth to be applied in the specific patient population.

Urethrectomy is a surgical technique most commonly utilized for urethral involvement with tumor, pathology demonstrating prostatic stromal invasion, urethral tumor recurrence following radical cystoprostatectomy, and positive distal urethral margin on cystoprostatectomy specimen. It involves a meticulous dissection of both the distal and proximal urethra, the technique of which is described in this chapter.

We report a very rare case report of female diagnosed with primary ma lignant melanoma. A 65 years old diabetic elderly postmenopausal female presented with a history of intermittent blood spots on undergarments for few days. Genital examination revealed a single, tan colored, soft chest nut size and polypoidal non ulcerated mass lesion protruding through the urethral meatus. Mass biopsy revealed poorly differentiated epithelial ma lignancy and immuno-histological analysis revealed positive with HMB 45 and protein S-100 suggestive of melanoma. Metastatic work up for the malignancy was negative. Complete urethrectomy with Mitrofanoff pro cedure with inguinal lymph node dissection was performed. Histopatho logical examination was suggestive of malignant melanoma of urethra. Here we discuss the clinicopathological features and management option possible in this scenario.

Objective: To describe the feasibility and time effectiveness of simultaneous perineal urethrectomy and robotic cystectomy with total intracorporeal ileal conduit. Methods: After approval by the in...

Introduction Although the tumors are often easily detected, a considerable number of patients with female urethral carcinoma are diagnosed in an advance stage. Thus, no evidence-based therapeutic approach has been established. We herein report our experience in the treatment of three female patients with urethral carcinoma. We also examined the expression of PD-L1 and CTLA-4. Case presentation Three female patients pathologically diagnosed with urethral carcinoma, including urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma, between 2013 and 2017 were analyzed in this study. Two patients underwent urethrectomy with cystostomy. Immunohistochemistry was performed to assess the levels of PD-L1 and CTLA-4 expression in patients with urethral carcinoma. Eleven control cases of urethral carcinoma tissue were also stained. Conclusion This study revealed the expression of PD-L1 and CTLA-4 in female urethral carcinomas.