BAUS 2015

Introduction: Squamous carcinoma involving the male urethra (SCC-MU) is a rare condition requiring specialist multi-disciplinary management. Tumours present as primary urethral carcinoma or intra-urethral extension of penile carcinoma. Using techniques developed for benign stricture disease, we have extended the role of two stage buccal graft substitution urethroplasty to manage this disease.

Patients and Methods: Patients with primary urethral carcinoma, intra-urethral extension of penile carcinoma or intraepithelial neoplasia were prospectively recruited following discussion at a supra-regional multi-disciplinary meeting. Patients were offered staged substitution urethroplasty with buccal mucosal graft. Primary outcome measure was recurrence free survival. Secondary outcome measures included recurrent stricture rate, complication rate and patient-reported satisfaction using a validated questionnaire specific to urethral surgery.

Results: 51 patients were suitable for distal urethroplasty and 47 have completed surgery. Median patient age was 62. Median follow up is 2 years 3 months (range from 1 to 121 months). 39% had over 3 years follow up. Postoperative histology confirmed 24 primary urethral cancers, 12 penile cancers involving the urethra and 15 cases of intraepithelial neoplasia. 8 patients were node positive. Recurrence free survival was 96%. One patient developed a more proximal second urethral cancer and one patient a new penile cancer. Recurrent stricture rate was 5.9%. No cancer related deaths were observed.

Conclusion: We report the first series prospectively analysing urethral-preserving surgery for male distal urethral neoplasia. Our results show that this technique is feasible and oncologically effective, offering patients good functional outcomes.