Anterior Urethrectomy for Primary Carcinoma of the Female Urethra Mimicking a Urethral Caruncle
A 52-year-old woman with a 5-year history of a palpable urethral mass presented at Urology Department with intermittent urethral pain. The patient did not complain of any urinary symptoms or dyspareunia. Her medical history included an appendectomy 30 years previous but was otherwise unremarkable. Pelvic examination showed the presence of a urethral mass approximately 1.7 cm in diameter (). The mass appeared to be a simple urethral caruncle despite a small amount of ulceration; therefore, we did not perform urethroscopy or cystoscopy. Three hours after the carunclectomy, the Foley catheter was removed and the patient reported good voiding ability. She was then discharged, and a follow-up visit was scheduled for 7 days later.\nSix days after the operation, our department received the pathological results of the excised urethral mass, which indicated a squamous cell carcinoma in situ (). We promptly evaluated the case for cancer and consulted with the department of gynecology. Abdominal and pelvic computed tomography, intravenous pyelography, bone scanning, and chest radiography showed no evidence of disseminated disease. The final disease stage was classified as TisN0M0; therefore, partial urethrectomy was planned.\nGeneral anesthesia was used for the surgery. A 22-Fr cystoscope was inserted through the urethra without resistance. A cystoscopic examination revealed erythematous mass-like lesions on the trigone, bladder neck (3- and 7-o'clock positions), and right lateral wall. Frozen biopsy analysis showed the presence of atypical cells on the trigone and bladder neck (at two points), but no malignancy was identified on the right lateral wall. The urethral orifice was tagged with a 2-0 silk suture (12-, 3-, and 9-o'clock positions), and we were able to excise the anterior urethra. The final pathologic analysis indicated a negative surgical margin and a tumor depth of 0.3 cm.\nThe patient was followed up at 6-month intervals. Her medical records were assessed, and a clinical examination was performed. Imaging studies were performed when she reported new symptoms. She remained free of recurrence and reported normal voiding function 50 months after the tumor was diagnosed.