primary cancer of the male urethra cancer occurs rarely . it entails less than 1% of all cancers of the urogenital system in men . more rarely it develops in the distal part of the urethra . in about 80% of the patients , it is a squamous cell carcinoma ( scc ) and in 15% it is a transitional cell carcinoma ( tcc ) . the first symptom usually includes hematuria , which occurs at the beginning of voiding , or a blood leak from the urethra regardless of micturition , as well as a narrowed stream of urine . the purpose of this paper was to present a surgically treated patient , who was diagnosed with the primary tcc of the distal part of the urethra . a 76-year - old patient , reported to our urology outpatient department in october 2008 due to hematuria , which he observed at the beginning of micturition , a narrowed stream of urine , and a palpable small tumor in the distal part of the urethra . physical examination of the penis revealed the presence of an oval , painless , solid tumor measuring approximately 2 cm in diameter , located in the peripheral part of the urethra , just below the glans penis . an ultrasonographic evaluation of the upper urinary tracts and the urinary bladder did not reveal any pathological lesions . in the ultrasonographic evaluation of the penis we established a hypoechogenic area measuring 2.5 x 1.5 cm that was clearly separated from the surrounding area in the distal part of the penis at the site of the palpable tumor . micturition urethrocystography and urethrocystoscopy performed on november 16 , 2008 supported and confirmed the preliminary diagnosis of tumor of the anterior urethra . the procedure of turt was performed on november 18 , 2008 . immediately after the procedure the histopathological evaluation of the specimens of the urethral tumor revealed the following diagnosis : tcc g3 , high grade , and lack of normal tissue makes an evaluation of the depth of infiltration impossible  . on january 20 , 2009 , a follow - up urethrocystoscopy was performed and specimens were collected from the urethra . the histopathological evaluation revealed that a neoplastic structure was not established . after three months , in april of 2009 , follow - up cytological evaluation of the urine sediment was performed and the presence of neoplastic cells was not established . the next cytological evaluation of the urine sediment , performed in february 2010 revealed the presence of neoplastic cells in the urine sediment . the patient reported the appearance of blood in the urine at the beginning of voiding , and physical examination revealed a small palpable tumor in the distal part of the urethra again . the patient was qualified for urethrocystoscopy and the procedure was performed at the beginning of march 2010 . radical treatment including surgical removal of the distal part of the urethra with neoplastic lesion was proposed to the patient . the patient did not consent to this type of treatment so a second electroresection of the urethral tumor was performed on the 23 of march 2010 . the histological evaluation provided the following diagnosis : urothelial carcinoma g2 , high grade , pt1 . the next urethroscopy with specimen collection for histopathological evaluation was performed on the 11th of june 2010 . the evaluation result : invasive urothelial carcinoma , high grade , pt1 , g2 . due to the occurrence of another local relapse , the patient was qualified for an open surgery . this time the patient gave his consent , but the procedure date was postponed due to cardiac disease in the patient . it included sharp preparation of the distal segment of the urethra at the length of approximately 2.5 cm with a margin of 0.5 cm of healthy tissues and excision of this part of the urethra . then , the remaining unchanged segment of the urethra was longitudinally incised and sutured to the skin of the abdominal surface of the penis , after previous placement of foley catheter no . primary cancer of the male urethra is a cancer developing within the prostatic , membranous , and , more rarely , the spongy segment of the urethra without an accompanying neoplasm within the urinary bladder . it occurs rarely , as it composes nearly 1% of all malignancies of the urogenital system in men . in 80% of cases , it is a squamous cell carcinoma and in 15% it is a transitional cell carcinoma . the diagnosis is supported by a precise medical history , ultrasonographic evaluation , urethrocystography , and urethrocystoscopy . however , the final diagnosis is established based on histopathological evaluation of collected specimens . the urethral cancer spreads by continuity , via blood and lymphatic vessels . metastases of the cancer are usually located in the spongy - membranous part and most often occur in the internal and external iliac lymph nodes and the obturator lymph nodes . cancer metastases from the penile part mainly relate to the inguinal lymph nodes and the external iliac lymph nodes . they include : hematuria occurring at the beginning of voiding , a blood leak regardless of micturition , a narrowed stream of urine to the retention of urine , pain of the penis and the perineum , the tumor noticeable in palpation ( the penile part of the urethra ) [ 16 ] . presence of the tcc located in the distal part of the urethra was established in the described patient . cancer metastases to the lymph nodes were not established . due to location of the neoplastic lesions and the nature of histopathological structure , follow - up urethroscopy performed after two months revealed no neoplastic lesions within the urethra . the patient did not provide his consent for the surgical procedure of partial amputation of the penis . after the second electroresection and another relapse , the patient provided his consent for the open surgery . the procedure of choice for urethral cancer located in the distal segment of the urethra is partial amputation of the penis [ 2 , 4 ] . in this case , the distal part of the urethra was excised with part of the glans penis . the major part of the glans penis remained , and the urethra was implanted to the abdominal part of the penis . such management is connected with the necessity for regular follow - up visits . in each similar case , the patient should receive detailed information about the necessity for regular follow - up visits . within the diagnostics of hematuria occurring at the beginning of micturition , presence of the primary urethral cancer should be considered . in radical treatment of the male urethral cancer , if the neoplastic focus is located in the distal part of the urethra , it is possible to save part of the penis after partial excision of the urethra . ultrasound evaluation . the glans penis part of the penis is visible . within its area , there is hypoechogenic zone located in the distal segment of the urethra , within the palpable tumor location . a , b. partial excision of the anterior urethra and a part of the glans penis . circular incision of the urethral ostium located at the top of the glans penis without the prepuce . c. the urethra was sharply prepared at the length of approximately 2.5 cm with a margin of 0.5 cm of healthy tissues . d. excision of the distal part of the urethra with neoplastic lesions . excised distal segment of the urethra with the tumor and the margin of healthy tissue . b , c. incision of the urethra and suturing it to the skin of the abdominal surface of the penis , after previous placement of the foley catheter no . 16 into the urinary bladder . surgically created hypospadias resulted from excision of the distal part of the urethra together with the tumor .