Specimen

— biopsy/urethrectomy or as part of cysto(prostato)urethrectomy.

— weight (g) and size/length (cm), number of fragments.

— urethral cancers can present with haematuria, urinary hesitancy or retention. Proximal lesions present at a late stage. Investigation is by urethroscopy and biopsy, often combined with cytoscopy, and CT/MRI scan to determine tumour stage. Treatment is by surgical excision, the extent of which depends on the location and stage of disease, e.g. local excision for cancer of the distal or meatal urethra. Radiotherapy can preserve the penis but results in troublesome stricturing. Advanced proximal tumours may require a combination of radical surgery and radiotherapy for palliative control. Brachytherapy and radiosensitiz-ing chemotherapy are other options. Secondary urethral cancers from the penis or bladder are excised as part of a penectomy (see Chapter 34) or cysto(prostato)urethrectomy, respectively. In women, urethrectomy is usually in continuity as part of a radical cystectomy. In men, preop-erative biopsies are carried out to determine the presence of urethral disease (either in-situ or invasive) and the procedure carried out in two stages, viz cystoprostatectomy down to the level of the urogenital diaphragm and then a perineal urethrectomy for the residual urethra.

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