Urethral tumour: rare images of unaware entity.

To cite: Prakash J, Kumar M, Sankhwar S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-010493 DESCRIPTION A 55-year man with a history of thin stream of urine and dysuria for the last 7 years presented with mild haematuria followed by acute urinary retention for 2 days. Clinical examination showed indurated mass with urethrocutaneous fistula in perineum (figure 1A). Per-urethral catheter could not be negotiated and so urine was drained by suprapubic catheterisation. Retrograde urethrogram and voiding cystourethrogram were suggestive of filling defect in bulbar urethra (figure 1B,C). Urethroscopy (figure 2A) revealed a broad base lesion arising from dorsal and left lateral wall of distal bulbar urethra occluding the lumen of urethra. MRI showed a low signal intensity heterogeneous mass of bulbo-membranous urethra that invaded into spongiosa and penile skin with bilateral inguinal node involvement (figure 2B). Biopsy was suggestive of transitional cell carcinoma (figure 3). The patient was counselled for cystoprostectomy with total penectomy but he refused. He received 60 Gy of radiotherapy in 30 fractions followed by six cycles of methotrexate, vinblastine, doxorubicin and cisplatin. Follow-up at 3 months showed good local response and absence of progression in regional nodes. Urethral carcinoma is very rare and is less common in men than in women. Symptoms are non-specific 3 and unaware to patients and so presentation is usually delayed. Because of difficulty in achieving local control, proximal urethral cancer carries a worse prognosis than distal. 5 However, cases of a curative