Fall 2012 - 08.pdf 711Vol. 9 | No. 4 | Fall 2012 |U R O LO G Y J O U R N A L Preservation of Erectile Function and Uri- nary Continence in Squamous Cell Carci- noma of the Bulbomembranous Urethra Mohammad Samzadeh, Abbas Basiri Keywords: urethra, squamous cell carcinoma, urethral neoplasms INTRODUCTION C arcinoma of the male urethra is an uncommon neoplasm accounting for less than 1% of all malignancies,(1) and generally occurs in the 5th decade of life. It is a very serious disease, often with a late diagnosis and lymph node involvement, which usually manifests as ure- (2-4) Dysuria is the most common symptom, sometimes associated with pain during urination, later with hematuria.(5) The epithelial neoplasms in the male urethra are usually squamous cell carcinoma (SCC), transitional cell carcinoma (TCC), and adeno- carcinoma in order of prevalence.(2,3,6,7) Management of the urethral carcinoma is still controversial. The surgical approach to the urethral are of less importance. Radical cystoprostatectomy, pelvic lymphadenectomy, and total penectomy of treatment. CASE REPORT - tive urinary symptoms in September 2006. Traumatic postoperative catheterization 2 years earlier was considered the possible cause of urethral stenosis, which was diagnosed by rigid cystoscopy. Corresponding Author: Abbas Basiri, MD Urology and Nephrology Research Center, No.103, 9th Boustan St, Pasdaran Ave, Tehran, Iran Tel: +98 21 2256 7222 Fax: +98 21 2256 7282 E-mail: basiri@unrc.ir Received December 2011 Accepted May 2012 Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sci- ences, Tehran, Iran POINT OF TECHNIQUE 712 | - ineal swelling and urinary retention in March 2009, a per- ineal drainage was performed and suprapubic catheter was continuous purulent discharge. urinary stone disease, fever, bone pain, bowel habit changes, or rectorrhagia, but losing appetite, 8 kg weight loss, and re- current urinary tract infections. - - charge without any regional and systemic lymphadenopathy. no obvious collection, with normal corpora cavernosa and urethrography showed irregular bulbomembranous urethra - giosum and possibly left the corpus cavernosum without - puted tomography (CT) scan, and bone scintigraphy revealed no evidence of distant metastasis or regional organ involve- ment. Up and down cystourethroscopy revealed multiple irregular bulbomembranous mucosal lesions protruded to the prostatic urethra covering with necrotic debris, normal penile and pro- static urethra, and a normal tumor-free bladder with normal - - lar follow-up plan was considered. TECHNIQUE The patient was diagnosed with urethral cancer (cT2 or - cal surgery was performed with total corpus spongioureth- rectomy, radical nerve-sparing prostatectomy, pelvic lym- phadenectomy, and appendicovesicostomy (Mitrofanoff procedure) as a continent urinary diversion (Figure 2). SCC of the urethra with corpus spongiosum and left crus of corpora cavernosa invasion and no vascular, perineural, and prostatic invasion was made (Figure 3). All the resected pel- Point Of Technique Figure 1. Magnetic resonance imaging shows the bulbomembra- nous involvement. Figure 2. Removed enbloc specimen (1. Mea; 2. Penile urethra + Corpus spongiosum; 3. Cutaneous fistula; 4. Bulbomembranous tumor; 5. Left corpus cavernosum crura; 6. Membranous urethra; 7. Prostate; and 8. Seminal vesicles). Figure 3. Squamous cell carcinoma of the urethra. Cellular poly- morphism and atypia (×200 Hematoxylin and Eosin stain). 713Vol. 9 | No. 4 | Fall 2012 |U R O LO G Y J O U R N A L Erectile Function in Bulbomembranous Carcinoma | Samzadeh and Basiri vic lymph nodes were negative for malignancy and it was suggested as having T3N0M0 disease. The patient subse- quently received 40 GY/ 20 fractions pelvic radiotherapy and 6 cycles of cisplatin-based chemotherapy. RESULTS - month perineal pain post operation, which was controlled by medication, all the metastatic lab tests and paraclinic studies, including whole body bone scan and thoracoabdominopelvic invasion, or lymphadenopathy at his regular follow-ups (at 6, 12, 24, and 36 months post operation). DISCUSSION Treatment of urethral carcinoma is controversial due to rarity of the disease and the lack of uniformity and detailed com- parative studies in the literature. Surgery plays a basic role in the management of urethral cancers, and various approaches have been employed. The standard primary mode of treat- the tumor within the urethra together with the clinical stage In summary, stage, grade, and site of the disease are predic- tors of survival. It may be possible that with proper selection, the bladder, prostate, and penile-preserving surgery could be considered in the management of male urethral cancers. CONFLICT OF INTEREST None declared. REFERENCES 1. Sharp DS, Angermeier KW. Surgery of Penile and Urethral Carcinoma. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 9 ed. Philadel- phia: Saunders; 2007:993-1022. 2. Dalbagni G, Zhang ZF, Lacombe L, Herr HW. Male ure- thral carcinoma: analysis of treatment outcome. 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