Primary carcinoma of anterior urethra presenting as a benign urethral stricture disease - Case report
Primary cancers of the male urethra are rare and only few cases have been reported. Primary urethral cancer, the only urological malignancy that is more common in females; accounts for less than 1% of all urological malignancies. The rarity of this disease thus present with challenges in diagnosis. It is on this background that this case of primary male urethral cancer initially diagnosed as urethral stricture disease is reported for its rarity.
The case note of the patient was retrieved and the management reviewed. Relevant literature search was also done.
A 43 year old man presented with a four month history of progressive diminution of urine stream associated with obstructive lower urinary tract symptoms and acute urinary retention. There was no history of trauma, but he had a past history of urethritis 15 years earlier which was treated with antibiotics. Evaluation showed a 1.0cm x l.0 cm indurated mass with urethrocutaneous fistula at mid-shaft of penis. Supra-pubic cystostomy was done after failed catheterization. A clinical diagnosis of post inflammatory urethral stricture was made. Rectrograde and micturating cysto-urethrogram showed a long segment, 3.5 cm peno-bulbar anterior urethral stricture with urethrocutaneous fistula at mid-shaft of penis. He was then planned for a substitution urethroplasty. Intra-operatively, the strictured segment appeared abnormal with a mass invading the corpora carvenosa. Biopsy showed primary squamous cell carcinoma of the urethra. He was counseled for penectomy with perineal urethrostomy for optimal oncological control. He refused surgery. The tumor rapidly progressed and spread further proximally along the shaft of the penis. Three weeks later, he gave consent for total penectomy with perineal urethrostomy which was done.
Urethral cancers are rare. Early presentation by the patient and a heightened index of index of suspicion will reduce the need for radical surgeries which is often not desirable
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