










































Key Words Competing Interests Article Information

Urethra, carcinoma, squamous cell, urinary 
retention, urethral stricture, penile neoplasms

Conflict of Interest: None declared.

Patient Consent: Obtained.

Received on October 15, 2021 
Accepted on October 17, 2021

Soc Int Urol J.2022;3(2):109–110

DOI: 10.48083/BUJM3438

FIGURE 1.  
Pelvic MRI demonstrating 2 lesions in the perineum

 

Peri-urethral lesion with corpus spongiosum, left crus 
corpus cavernosum, and subcutaneous tissue involvement. 

Lesion posterior to the prostate with invasion of the left 
ano-rectal junction.

109SIUJ.ORG SIUJ  •  Volume 3, Number 2  •  March 2022

This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

CLINICAL PICTURE

Down the Not so Straight and Narrow:  
A Rare Case of Primary Urethral Squamous  
Cell Carcinomas in a Young Patient
Kevin Yinkit Zhuo,1,2 Aditya Sharma,1,2 Chloe Wilcox,1,2 Cameron Parkin,1,2 Nicola Jeffery,3  
Amanda Chung1,2

1 Department of Urology, Royal North Shore Hospital, Sydney, Australia 2 North Shore Urology Research Group, Sydney, Australia 
3 Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia

Primary urethral squamous cell carcinomas (SCCs) are 
rare, with a variable clinical presentation, and occur 
infrequently in patients younger than 45 years of age 
[1–3]. The surgical management for advanced urethral 
SCCs remains challenging, given it occurs in less than 
1 in 100 000 men[1,4]. We describe the diagnosis and 
management of urethral SCC in a 37-year-old male 
presenting with urinary retention.

The patient initially presented to our emergency 
department with fevers, perineal pain on voiding, and 

high post-void residuals. His history included recurrent 
bulbar urethral strictures, UTIs, smoking, and intra-
venous drug use. His urethral stricture was previously 
endoscopically managed with dilatation, but the patient 
had been lost to follow-up.

An initial pelvic ultrasound revealed a complex peri-
neal mass inferior to the prostate and contiguous with 
the urethra. Pelvic MRI subsequently revealed 2 lesions 
in the perineum (Figure 1). FDGPET-scan demon-
strated avid lesions in the right inguinal and meso-rectal 

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nodes with no distal metastatic disease. Urine cytology 
suggested malignant cells suspicious for SCC. On pelvic 
examination, 2 distinct masses were palpable in the 
bulbar urethra and rectum. Cystoscopy demonstrated 
an obliterated urethra that could not be cannulated with 
a wire, thus a suprapubic catheter was placed.

Because of the severity of local symptoms, the patient 
was discussed in a multi-disciplinary team meeting and 
transferred to a specialist centre for pelvic exenteration. 
Before adjuvant chemo-radiotherapy was begun, the 

patient was identified to have significant local disease 
recurrence and opted instead for palliative treatment.

Primary urethral SCCs are a rare cause for advanced 
cancer in young men. This case exhibits the need for 
considering neoplasms as a differential diagnosis for 
young patients presenting with urinary retention 
and perineal pain. It also highlights the need for close 
follow-up of recurrent urethral stricture patients to 
ensure there are no complications of their disease.

References

1. Hakenberg OW, Compérat E, Minhas S, Necchi A, Protzel C, Watkin 
N, et al. EAU guidelines on penile cancer.2019. Available at: http://
uroweb.org/guideline/penile-cancer/. Accessed January 11, 2022.

2. Ant werpen I, Gstrein L, Moskovszk y L, Gissler HM, Möltgen 
T, Kwiatkowski M, et al. Primar y urethral squamous cell 
carcinoma: a unique manifestation of a penile tumor. J Int Med 
Res.2019 Feb;47(2):999–1004. Published online 2018 Dec 5. doi: 
10.1177/0300060518813506

3. Castiglione F, Alnajjar HM, Christodoulidou M, Albersen M, Parnham 
A, Freeman A, et al. Primary squamous cell carcinoma of the male 
proximal urethra: outcomes from a single centre. Eur Urol Focus.2021 
Jan;7(1):163-169. doi: 10.1016/j.euf.2019.02.016. Epub 2019 Mar 7.

4. Janisch F, Abufaraj M, Fajkovic H, Kimura S, Iwata T, Nyirady P, et al. 
Current disease management of primary urethral carcinoma. Eur Urol 
Focus.2019 Sep;5(5):722–734. doi: 10.1016/j.euf.2019.07.001. Epub 
2019 Jul 13.

110 SIUJ  •  Volume 3, Number 2  •  March 2022 SIUJ.ORG

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