The management of urethral carcinoma is different whether it is primary or secondary to another cancer of the urinary tract and according to gender (male vs. female).
​
Primary urethral cancer
Treatment of localized primary urethral carcinoma in male (T≤2N0M0)
Distal or radical urethrectomy with penile preserving surgery is advised, if minimal safety margins can be guaranteed. Iliac/inguinal lymphadenectomy should be offered when clinical lymph node involvement is suspected. The surgery is performed under spinal or general anesthesia and requires a perineal incision. The urethra is dissected from the two corpora cavernosa circumferentially. The dissection is carried proximally up to the membranous-prostatic junction and distally up to the external urethral meatus. To disconnect the fossa navicularis, a circular incision is carried on the glans, around the external meatus, and deepened to meet the proximal dissection.
Treatment of localized primary urethral carcinoma in females (T≤2N0M0)
Radical urethrectomy with removal of all the peri-urethral tissue, with a cylinder of all adjacent soft tissue up to the pubic symphysis and bladder neck, is advised. Urethral-sparing surgery with local radiotherapy can be recommended, but it is associated with higher risk of local recurrences.
Treatment of locally advanced urethral carcinoma in both genders (T3-4N0-2M0)
These patients should be managed with a multimodal approach which includes the cooperation of urologists, oncologists, and radiotherapists. Surgery alone is unlikely to offer long term results. Thus, chemotherapy should be administered before surgery. In squamous-cell carcinoma, radiotherapy with radiosensitising chemotherapy represents the best solution with the highest survival outcomes. Surgery should be considered in case of local recurrence.
Treatment of urethral carcinoma of the prostate (Ta, Tis, T1)
Surgery plus periodic instillationof bacillus-Calmette Guérin (BCG) represents the best treatment option. Patient is referred for transurethral resection (TUR) to remove all visible tumor areas. After, a prolonged treatment with BCG instillation (2 years usually) is advised to reduce the risk of recurrence. In patients not responding to BCG, or in patients with extensive ductal or stromal involvement, cystoprostatectomy with extended pelvic lymphadenectomy may represent a treatment option.
Secondary urethral cancer
The treatment of secondary urethral cancer is largely related to the treatment of the primary tumor. Generally, when a patient is diagnosed with an isolated urethral recurrence after radical cystoprostatectomy, radical urethrectomy with or without chemotherapy is advised.
