Clinical examination
Physical examination should comprise palpation of the external genitalia for suspicious indurations or masses and digital rectal examination. Inguinal lymph nodes palpation should be carried in all patients with suspected or confirmed urethral carcinoma.
Urinary cytology
Cytological assessment of urine specimens can help the diagnosis of urethral carcinoma. Three urine samples collected from the first micturition of the day of three consecutive days are required for the test. Detection rates depend on the underlying histological entity. In male patients, the sensitivity for urothelial carcinoma and squamous-cell carcinoma is around 80% and 50%, respectively, whereas in female patients, sensitivity is 77% and 50% for squamous-cell carcinoma and urothelial carcinoma, respectively.
Diagnostic urethrocystoscopy and biopsy
This procedure is carried in outpatient setting with local anesthesia. A 16Ch cystoscope is guided inside the urethra to enable visualization of the lesion. Careful cystoscopic examination is necessary to exclude the presence of concomitant bladder tumors. A biopsy of the lesion can be taken to allow its histologic characterization.
Diagnostic imaging
Radiological imaging of an urethral cancer aims to assess local tumor extent and detect lymphatic and distant metastatic spread. Computed tomography scan or Magnetic resonance imaging can be used to evaluate local tumor extension and presence of regional lymph node metastases. Computed tomography scan with or without PET/CT scan of the chest, abdomen, and pelvis should be used if an invasive disease is suspected.
