The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
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Traumatic urethra injury presenting as urethral cancer : A case study

외상성 요도 손상으로 오인된 요도암

  • Shin, Sang-Yol (Department of Emergency Medical Service, Howon University) ;
  • Hwang, Yong (Department of Emergency Medicine, Wonkwang University College of Medicine)
  • 신상열 (호원대학교 응급구조학과) ;
  • 황룡 (원광대학교 응급의학과)
  • Received : 2020.09.15
  • Accepted : 2020.12.18
  • Published : 2020.12.31
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Abstract

Purpose: The purpose of the study was to investigate traumatic urethral injury in a 63-year-old patient with hematuria. Methods: A hematuria patient was transferred by paramedics. At the time of the visit, the patient's blood pressure (151/91mmHg), pulse rate (86/min), body temperature (37.1℃), and other vital signs were stable. Their KTAS (Korean Triage and Acuity Scale) was Level 4. The patient had no damage to the injured area, but a large contrast defect was observed between the prostate urethra and the bladder in urethral angiography performed due to persistent hematuria and pain in the injured area. Results: Following radiological evaluation of a suspected liposarcoma or neuroma mass of the prostate urethra, the mass was removed through urethral tumor resection. The result of histologic evaluation provided a diagnosis of highly differentiated invasive urethral cell carcinoma that had invaded the muscle layer. The patient was given additional treatment for urethral cancer but was rejected and is currently being followed. Conclusion: The prognosis for urinary tract cancer has distinct differences for patients with lymph node metastasis and tumor characteristics. The presence or absence of urethral cancer should be confirmed through angiography, CT, MRI, and cystoscopy.

Keywords

References

  1. Janisch F, Abufaraj M, Fajkovic H, Kimura S, Iwata T, Nyirady P et al. Current disease management of primary urethral carcinoma. Eur Urol Focus 2019;5(5):722-34. https://doi.org/10.1016/j.euf.2019.07.001
  2. Zhang M, Adeniran AJ, Vikram R, Tambol P, Pettaway C, Bondaruk J et al. Carcinoma of urethra. Hum Pathol 2018;72:35-44. https://doi.org/10.1016/j.humpath.2017.08.006
  3. Mano R, Vertosick EA, Sarcona J, Sjoberg DD, Benfante NE, Donahue TF et al. Primary urethral cancer: treatment patterns and associated outcomes. BJU Int 2020;126 (3):359-66. https://doi.org/10.1111/bju.15095
  4. Sui W, RoyChoudhury A, Wenske S, Decastro GJ, Mckiernan JM, Anderson CB. Outcomes and prognostic factors of primary urethral cancer. Urology 2017;100:180-6. https://doi.org/10.1016/j.urology.2016.09.042
  5. Chung DE, Purohit RS, Girshman J, Blaivas JG. Urethral diverticula in women: discrepancies between magnetic resonance imaging and surgical findings. J Urol 2010;183(6): 2265-9. https://doi.org/10.1016/j.juro.2010.02.016
  6. Khalil MI, Alliston JT, Bauer-Erickson JJ, Davis R, Bissada NK, Kamel MH. Organ-sparing procedures in GU cancer: part 3-organ-sparing procedures in urothelial cancer of upper tract, bladder and urethra. Int J Urol Nephrol 2019;51:1903-11. https://doi.org/10.1007/s11255-019-02232-z
  7. Mizusawa H, Hara H, Mimura Y, Kato H. Primary male urethral squamous cell carcinoma presenting with a genital abscess. Int J Urol 2019;2(4):225-8. https://doi.org/10.1002/iju5.12090
  8. Singh T, Li QK, Song DY. Pathologic complete response after chemoradiation of a massive primary urethral carcinoma. Adv Radiat Oncol 2019;4(3):487-91. https://doi.org/10.1016/j.adro.2019.02.005
  9. Lee YT. Urethral Injury. Korean J Urol 2006;47(3):221-31. https://doi.org/10.4111/kju.2006.47.3.221
  10. Kwon H, Jeon CH, Kim CW. Intervention for urologic trauma. J Korean Soc Radiol 2019;80(4):667-83. https://doi.org/10.3348/jksr.2019.80.4.667
  11. Morris R, Bernard J, Morley C. Spontaneous urethral laceration in a patient experiencing acute ulcerative colitis flare. Case Rep Urol 2020;9285071. https://doi.org/10.1155/2020/9285071
  12. Gakis G, Witjes JA, Comperat E, Cowan NC, Santis MD, Lebret T et al. EAU guidelines on primary urethral carcinoma. Eur Urol 2013;64(5):823-30. https://doi.org/10.1016/j.eururo.2013.03.044
  13. Gakis G, Morgan TM, Efstathiou JA, Keegan KA, Mischinger J, Todenhoefer T et al. Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma. World J Urol 2016;34(1):97-103. https://doi.org/10.1007/s00345-015-1583-7
  14. Berjeaut RH, Persaud MD, Sopko N, Burnett AL. Urethral carcinoma in situ: recognition and management. Int Urol Nephrol 2017;49 (4):637-41. https://doi.org/10.1007/s11255-017-1512-3
  15. National Cancer Information Center. Statistical analysis of Urethral cancer in 2019. https://www.ncc.re.kr/ (accessed as of December 19, 2020)
  16. Wang N, Min J, Wei Q, Tan W, Dang Q. Primary urothelium carcinoma of the distal urethra in a male: case report and literature review. Onco Targets Ther 2020;13 6011-5. https://doi.org/10.2147/OTT.S252822
  17. Liedberg F, Gudjonsson S, Hakansson U, Johansson ME. Clear cell adenocarcinoma of the female urethra: four case presentations of a clinical and pathological entity requiring radical surgery. Uro Int 2017;99:487-90. https://doi.org/10.1159/000443020
  18. Taylor JH, Davis J, Schellhammer P. Long-term follow-up of intravesical bacillus Calmette-Guerin treatment for superficial transitional-cell carcinoma of the bladder involving the prostatic urethra. Clin Genitourin Cancer 2007;5(6):386-9. https://doi.org/10.3816/CGC.2007.n.021
  19. Zinman LN, Vanni AJ. Management of proximal primary urethral cancer: should multidisciplinary therapy be the gold standard? Urol Clin North Am 2016;43(4):505-13. https://doi.org/10.1016/j.ucl.2016.06.011
  20. Kent M, Zinman L, Girshovich L, Sands J, Vanni A. Combined chemoradiation as primary treatment for invasive male urethral cancer. J Urol 2015;193(2):532-7. https://doi.org/10.1016/j.juro.2014.07.105
  21. Chen H, Zou LL, Dong CJ, Li T, Dong ZQ. Advanced primary urethral cancer: a case report. J Med Case Rep 2019;13:365. https://doi.org/10.1186/s13256-019-2253-y
  22. Kitamura Y, Horiguchi A, Ojima K, Kawamura K, Shinchi M, Asano T et al. Penile‐preserving surgery for male distal urethral carcinoma followed by buccal mucosa urethroplasty. Int J Urol 2019;2(4):198-201. https://doi.org/ 10.1002/iju5.12076
  23. Stewart SB, Leder RA, Inman BA. Imaging tumors of the penis and urethra. Urol Clin North Am 2010;37(3):353-67. https://doi.org/10.1016/j.ucl.2010.04.014
  24. Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Kubler H, Stenzl A et al. Urethral recurrence after radical cystectomy for urothelial carcinoma: A systematic review and meta-analysis. Urologic Oncology: Seminars and Original Investigations 2018;36(2):54-9. https://doi.org/10.1016/j.urolonc.2017.11.007
  25. Burnett AL. Penile preserving and reconstructive surgery in the management of penile cancer. Nature Reviews Urology 2016;13:249-57. https://doi.org/10.1038/nrurol.2016.54