Surgical Procedures: Surgery and Staging for Urethral Cancer

Cancerous cells in the urethra are called urethral cancer. The urethra is a tube attached to the bladder. In women, the job of the urethra is to move urine, from the bladder, out of the body. In men, the urethra moves urine from the bladder and semen from the prostate gland, out of the body. 

Urethral cancers most often start in the lining of the urethra within the penis in men, and in the portion of the urethra closest to the bladder in women. They are most often squamous cell cancers. Other types of urethral cancers include:

• Transitional cell carcinoma.
• Adenocarcinoma.
• Melanoma.
• Sarcoma.

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For urethral cancer, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues. This may also include a digital rectal exam and a pelvic exam for women. 

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include: 

• Chest X-ray.
• CAT Scan (CT Scan).
• Bone scan.
• Magnetic Resonance Imaging (MRI). 

Laboratory Testing: These include urine cytology, urinalysis, blood chemistry studies, and complete blood count.

Procedures: These may include:

• Ureteroscopy: The ureter and renal pelvis (part of the kidney) are looked at and biopsied (if needed) using a thin, lighted tube, called a ureteroscope. 
• Biopsy: A biopsy takes cells from the urethra, bladder, and/or prostate, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample in a laboratory. 

Urethral cancer spreads to other parts of the body through the tissue, lymph, and blood systems. When the cancer spreads, it is called metastatic cancer. Urethral cancer is described in one of two ways:

• Distal: This is cancer that has not deeply invaded the tissue. For women, the affected portion of the urethra is often the part that is nearest to the outside of the body. In men, the area of the urethra that lies within the penis is affected by cancer.
• Proximal: The cancer has typically deeply invaded the tissue and is in the non-distal portion of the urethra.

Surgical Procedures for Urethral Cancer

Surgery is often used to treat urethral cancer. The procedure used will depend on many factors, including the size and location of the cancer. Your surgeon will talk to you about your specific procedure. 

Surgical procedures used to treat urethral cancer include:

• Open excision: Surgical removal of the cancer.
• Mohs surgery: Removal of thin layers of tissue only.
• Transurethral resection (TUR): Removal of the cancerous area using small surgical tools that have been inserted into urethra.
• Electroresection with fulguration: The use of an electrical current to burn the cancerous area off.
• Laser surgery: The use of a laser beam to remove and kill the area affected by cancer.
• Lymph node dissection: Removal of pelvic and groin lymph nodes.
• Cystourethrectomy: Removal of the bladder and urethra.
• Cystoprostatectomy: Removal of the bladder and prostate gland.
• Anterior exenteration: Removal of the urethra, bladder, and vagina. In some cases, reconstructive vaginal surgery can be used to create a new vagina.
• Partial penectomy: Removal of part of the penis, which may require penile reconstructive surgery.
• Radical penectomy: Removal of the entire penis. Reconstructive penile surgery may be considered.
• Urinary diversion: Creation of a new route for urine to be moved out of the body after the urethra has been removed. 
• Urostomy (ostomy): This procedure involves creating a new way for urine to be stored and excreted, using a piece of the small intestine and an external urine collection bag; this is done when the bladder is removed.
• Continent reservoir: Use of the small intestine to make a storage pouch to replace the bladder, which is drained through an external opening. This procedure is done when the entire bladder is removed.

What are the risks associated with urethral cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Infection.
• Bleeding.
• Urethral scarring can make it hard to urinate.
• Changes in urination, including the need for a urostomy and catheterization or an external urine collection device.
• Changes in sexuality.

Before surgery, your surgeon will talk to you about any other risks based on your health and the specific surgery you are having. 

What is recovery like?

Recovery from urethral cancer surgery will depend on the extent of the procedure you have had. At times, a hospital stay is required.

You will be told how to care for your incisions, any drains or tubes and will be given any other instructions before leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about activity restrictions and nutritional needs you may have, depending on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.