Down the Not So Straight and Narrow: A Rare Case of Primary Urethral Squamous Cell Carcinomas in a Young Patient

Primary urethral squamous cell carcinomas (SCCs) are rare, with a variable clinical presentation, and occur infrequently in patients younger than 45 years of age [1,2,3]. The surgical management for advanced urethral SCCs remains challenging, given it occurs in less than 1 in 100 000 men [1,4]. We describe the diagnosis and management of urethral SCC in a 37-year-old male presenting with urinary retention.

The patient initially presented to our emergency department with fevers, perineal pain on voiding, and high post-void residuals. His history included recurrent bulbar urethral strictures, UTIs, smoking, and intra- venous drug use. His urethral stricture was previously endoscopically managed with dilatation, but the patient had been lost to follow-up.

An initial pelvic ultrasound revealed a complex peri- neal mass inferior to the prostate and contiguous with the urethra. Pelvic MRI subsequently revealed 2 lesions in the perineum (Figure 1). FDGPET-scan demon- strated avid lesions in the right inguinal and meso-rectal nodes with no distal metastatic disease. Urine cytology suggested malignant cells suspicious for SCC. On pelvic examination, 2 distinct masses were palpable in the bulbar urethra and rectum. Cystoscopy demonstrated an obliterated urethra that could not be cannulated with a wire, thus a suprapubic catheter was placed.

Because of the severity of local symptoms, the patient was discussed in a multi-disciplinary team meeting and transferred to a specialist centre for pelvic exenteration. Before adjuvant chemo-radiotherapy was begun, the patient was identified to have significant local disease recurrence and opted instead for palliative treatment.

Primary urethral SCCs are a rare cause for advanced cancer in young men. This case exhibits the need for considering neoplasms as a differential diagnosis for young patients presenting with urinary retention and perineal pain. It also highlights the need for close follow-up of recurrent urethral stricture patients to ensure there are no complications of their disease.