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Case Reports
. 2022 Sep 21;15(9):e250200.
doi: 10.1136/bcr-2022-250200.

Primary resection of oligometastatic recurrent prostatic carcinoma in the urethra

Malia Alexandra Foo  1 , Ee Jean Lim  2 , Christopher Wai Sam Cheng  2   3 , Lay Guat Ng  2
Affiliations
Case Reports

Primary resection of oligometastatic recurrent prostatic carcinoma in the urethra

Malia Alexandra Foo et al. BMJ Case Rep. .

Abstract

A man in his 70s presented to the emergency department with acute urinary retention following a 2-day history of gross haematuria with blood clots. He had a significant medical history of intermediate-risk prostate adenocarcinoma (grade group 2, prostate-specific antigen (PSA) 14.9 ng/mL) for which he underwent a robotic-assisted laparoscopic radical prostatectomy (RARP) 13 years ago. PSA nadir was achieved (<0.03 ng/mL). Three years after RARP, he had biochemical recurrence with PSA rising to 0.06 ng/mL. Salvage radiotherapy was performed with good PSA response back to nadir. Workup for gross haematuria included a flexible cystoscopy which revealed a lobulated fleshy lesion occupying the mid-penile urethra. Staging imaging showed no local recurrence at prostatectomy site or lymphadenopathy. PSA was 4.2 ng/mL. Surgical resection with primary repair of the urethra was performed. Postoperative recovery was good with PSA achieving nadir. Histology revealed an upgraded metastatic prostate adenocarcinoma, grade group 5.

Keywords: hematuria; prostate cancer; urological surgery; urology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flexible cystoscopy showing a pedunculated lobulated fleshy lesion arising from the dorsal aspect of the urethra, 3 cm distal from the bulbar urethra.
Figure 2
Figure 2
MR image of the pelvis showing a T2-weighted hyperintense lobulated enhancing 4.1×1.7×1.7 cm lesion (arrow) in the mid-segment of the penile urethra extending into the corpus spongiosum, not involving the corpus cavernosa, PS; partial saturation.
Figure 3
Figure 3
Illustration of the male anatomy and potential pitfalls of surgery. The figure was created by Malia Alexandra Foo.
Figure 4
Figure 4
Intraoperative photo showing isolation of the penile urethra with the fleshy lesion bulging in situ.
Figure 5
Figure 5
Intraoperative photo showing ventral incision to expose lobulated lesion arising from the dorsal urethra.
Figure 6
Figure 6
Intraoperative photo showing a 20 mm×8 mm defect in the dorsal urethra after excision of the lesion in entirety.
Figure 7
Figure 7
Intraoperative photo showing the primary closure of the dorsal defect and the ventral aspect in the urethra with vicryl 4/0.
Figure 8
Figure 8
Postoperative retrograde urethrography showing no leakage.
See this image and copyright information in PMC

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