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 http://SIUJ.org mailto:k.zhuo2%40gmail.com?subject=SIUJ 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 CLINICAL PICTURE http://SIUJ.org