The treatment of primary urethral carcinoma - the dilemmas of a rare condition: Experience with partial urethrectomy and adjuvant chemotherapy

Background: Primary urethral carcinoma is a very rare condition, and no lar ge-scale experience with such cases has been published. Treatment will ther efore have to follow rules established for the treatment of similar conditi ons. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) w ho had been treated at our institution between 1995 and 1999 were retrospec tively analyzed. In 3 male cases, a primary urothelial carcinoma of the dis tal urethra was treated by distal urethrectomy on ly. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment wa s followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preserva tion of the penis resulted in cure, with a follow-up of 12-71 months. In th e cases with advanced disease, adjuvant chemotherapy after surgery has resu lted in complete remissions in all 3 cases, with a followup of 4-47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of peni le amputation justified. In advanced cases, after local excision and lympha denectomy adjuvant chemotherapy which by necessity must follow the guidelin es established for the treatment of other urothelial or squamous cell malig nancies seems to be beneficial.