Editing Urethral Tumours (section)

==== '''Diagnosis and Evaluation''' ====

* '''UrologySchool.com Summary'''
** '''H+P'''
** '''Imaging'''
*** '''Primary: MRI'''
*** '''Metastases:'''
**** '''Regional: CT abdomen/pelvis'''
**** '''Distant: CT chest'''
** '''Other'''
*** '''Cystoscopy with biopsy'''
* '''History and Physical Exam'''
** '''History'''
*** '''Usually delayed presentation; 96% are symptomatic at presentation'''
*** '''Most common presenting symptoms: urethral bleeding, palpable urethral mass, and voiding LUTS'''
** '''Physical Exam'''
*** '''Bimanual palpation of the external genitalia examination under anesthesia, urethra, rectum, and perineum, aids in evaluating the extent of local involvement by tumor'''
**** If rectal involvement is suspected on bimanual examination or by the patient’s symptoms, an evaluation of the lower colon by barium enema study and flexible sigmoidoscopy is recommended to assist with surgical planning
*** '''Palpable inguinal lymph nodes occur in ≈20-30% of cases and almost always represent metastatic disease, in contrast to penile cancer, in which a large percentage of palpable nodes may be inflammatory'''
* '''Laboratory'''
** '''Voided urine cytology is not reliable for diagnosis of primary urethral carcinoma'''
* '''Imaging'''
** '''CT scan of the chest, abdomen, and pelvis (or in some cases by MRI) to evaluate local soft tissue involvement, lymph node involvement, bone extension, and the presence of distant metastatic disease'''
*** '''MRI is the most sensitive staging modality for the assessment of local tumor extent;''' may be particularly helpful for detecting invasion of the corpora cavernosa
* '''Other'''
** '''Cystoscopy and transurethral or needle biopsy of the lesion is performed'''