This protocol applies to male patients with primary carcinoma arising in the distal urethra — the penile urethra and fossa navicularis — at localised stages (Ta through T2) with no regional lymph node involvement and no distant metastases.
Clinical scenario: Male, primary urethral carcinoma confined to the distal urethra, stage Ta–T2, N0M0. Distal tumours carry a significantly more favourable prognosis than proximal urethral cancers. Historically, management in males followed the surgical framework for penile cancer, with wide-margin excision of the primary lesion; current evidence supports organ-preserving approaches at this stage.
Previously, treatment of male distal (penile urethra and fossa navicularis) urethral carcinoma followed the procedure for penile cancer, with surgical excision of the primary lesion with a wide safety margin.
Distal urethral tumours exhibit significantly improved survival rates compared with proximal tumours.
Offer distal urethrectomy as an alternative to penile amputation in localised distal urethral tumours if negative surgical margins can be achieved intra-operatively.
Ensure complete circumferential assessment of the proximal urethral margin if penile-preserving surgery is intended.
A retrospective series found no evidence of local recurrence in males with pT1-3N0-2 distal urethral carcinoma that were treated with well-defined, penile-preserving surgery and additional iliac/inguinal lymphadenectomy (LND) for clinically suspected LN disease, even with < 5mm resection margins.
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