Obstructive Lower Urinary Tract Symptoms Research Articles

Robotic bladder diverticulectomy with concurrent management of bladder outlet obstruction: A choice to consider.

Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.

Defining the "Cutoff" on the Urethral Caliber in Diagnosing a Female Urethral Stricture.

Introduction The rarity in detecting female urethral stricture (FUS) backed by the inconsistency regarding the cutoff on the caliber to direct any treatment for its increase poses a challenge to its existence. Therefore, the present study was conducted to determine the caliber of the urethra that clearly identifies aFUS. Materials and method In this prospective observational study conducted between November 2015 and July 2017, women with obstructive lower urinary tract symptoms (LUTS) and a history of relief on at least a single urethral dilatation were included if the American Urological Association (AUA) score was more than seven and the maximum flow rate (Qmax) was less than 20 mL/sec. Of the 71 women recruited, 10 women had recognizable external causes: caruncle (five), mucosal prolapse (three), and meatal stenosis (two). The remaining 61 underwent voiding cystourethrogram (VCUG) and urodynamics followed by urethrocystoscopy, if the findings suggested a stricture. A definitive diagnosis was sought in those without stricture disease. We categorized all patients as either having a "true" stricture or an alternate etiology. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Results The mean dilatationranged between one and six; the mean AUA score, ~17.82 ± 3.59; mean Qmax, ~10.21 ± 3.39 mL/sec; and the mean post-void residue (PVR), 106.65 ± 51 mL. A total of 29 patients were diagnosed to have stricture (dense = 17; flimsy = 12). None of the patients in this group had a urethral caliber of more than 14 French (Fr). Other etiologies were dysfunctional voiding (17), underactive bladder (seven), cystocele (four), and primary bladder neck obstruction (PBNO) (four). Conclusion Women with voiding LUTS should be screened for FUS only if the urethral caliber is ≤14 Fr.

Simultaneous treatment of anterior urethral stricture and benign prostatic hyperplasia: primary experience overview

Introduction. Research on the treatment of patients with a combination of anterior urethral stricture and benign prostatic hyperplasia (BPH) is basically absent in the worldwide literature.Objective. To analyse the primary experience results with simultaneous treatment of anterior urethral stricture and BPH.Materials &amp; methods. The study included four patients with anterior urethral stricture and BPH, who underwent simultaneous surgical treatment including perineal / penile urethrostomy and thulium laser enucleation of the prostate. The success criterion for treatment was considered to be the absence of obstructive lower urinary tract symptoms requiring the use of endoscopic or open surgery, regardless of whether urethrostomy was considered as the first step or the final option for urinary diversion.Results. The age of the patients ranged from 54 to 69 years (mean 63.0 ± 6.5 years). In one (25%) patient the stricture was localised in the penile urethra and in three (75%) patients it was localised in the bulbous urethra. The stricture length ranged from 1.0 to 3.0 cm (mean 2.1 ± 0.9 cm). The prostate volume varied from 45 to 77 cc (mean 63.8 ± 13.5 cc). One patient had cystostomy drainage. The post-void residual volume among 3 patients with preserved urination ranged from 90 to 130 ml (mean 113.3 ± 20.8 ml). Postoperative follow-up periods ranged from 3 to 18 months (mean 11.3 ± 7.4 months). At these follow-up periods, treatment was successful in all four (100%) patients. No intra- or postoperative complications were observed.Conclusions. The proposed method can be successfully applied in patients with a combination of anterior urethral stricture and BPH. However, the final guidelines for the management of such patients can be developed after further research.

Assessment the Ability of Free/Total Ratio of Serum PSA in Diagnosing Prostate Cancer and Benign Prostatic Hyperplasia

Background: The Prostate gland is the male secondary sexual organ most commonly affected by benign or malignant neoplasm. Prostate cancer (Ca-P) is one of the most commonly diagnosed cancers in men and is now the third commonest cause of cancer death in western countries.The aim of the study was to evaluate the use of serum prostate-specific antigen levels in differentiating prostate cancer from benign prostatic hyperplasia. Methods:The present study is a cross-sectional observational study.The study was conducted at the outpatient department and indoor patients at the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City during the period from July 2019 to June 2020.The study population included male patients above 50 years of age, who attended in the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically prostate cancer or benign prostatic hyperplasia (BPHStatistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution of the prostatic carcinoma and BPH patients. Prostatic carcinoma was observed to be significantly higher from 80 years onwards, while BPH was common between 60 - 80 years (p = 0.00001). Table 10shows the validity or accuracy of the free/total ratio of serum PSA as a diagnostic test in differentiating prostatic carcinoma from BPH in patientswith total PSA levels between 4-10ng/ml. The percentage of false positives was significantly higher when total PSA ratio was used to diagnose the disease compared to when free to total PSA was used as a diagnostic tool (p&lt;0.000001). The overall accuracy of total PSA was also significantly lower (61.45%) than that of free/total PSA (91.67%) (p&lt; 0.011526). Conclusion: Free and total prostate specific antigen (PSA) is increased significantly in carcinoma prostate than benign prostatic hyperplasia but free/total ratio of serum prostate- specific antigen level significantly decreases in prostatic carcinoma than benign prostatic hyperplasia. TAJ 2023; 36: No-2: 215-230

Evaluation of a noninvasive uroflowmetry parameter (Delta Q value) in detrusor underactivity and bladder outlet obstruction

Purpose To determine the significance of the Delta Q value in discrimination between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in adult male patients. Methods A total of 238 patients in this cohort study underwent pressure-flow study. Patients were divided into two groups based on UDS outcomes: DU (n = 121) and BOO (n = 117). From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), postvoid residual urine (PVR), and the difference between (Qmax) and (Qave) known as (Delta Q) were obtained. Diagnostic prediction of these variables was evaluated with DU and BOO. Results Delta Q was less in the DU group compared with the BOO group 2.9 ml/s and 6.2 ml/s, respectively. Delta Q showed a promising diagnostic value in the discrimination between DU and BOO. A cut-off value of 6.1 ml/s was found to be discriminatory between the two groups with a sensitivity of 96.58% and specificity of 92.79%. Conclusion Delta Q value has proven to be a useful noninvasive screening and diagnostic tool in differentiating between DU and BOO in men with obstructive lower urinary tract symptoms.

Efficacy and safety of Water Vapor Thermal Therapy in the treatment of benign prostate hyperplasia: a systematic review and single-arm Meta-analysis

BackgroundBenign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH.MethodsThe protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I2 > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger’s test was used to assess publication bias.ResultsA total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%).ConclusionsWVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.

UroLift implants as surrogate fiducial markers for cone-beam CT-based prostate image-guided radiotherapy

Abstract Introduction: UroLift implants are a novel treatment for the obstructive lower urinary tract symptoms arising from benign prostatic hyperplasia. This case study aimed to assess their effectiveness as fiducial marker (FM) surrogates in prostate image-guided radiotherapy (IGRT). Method: Cone-beam CT images from a patient receiving prostate radiation therapy underwent manual alignment using UroLift implants and also prostate soft-tissue matching by five experienced therapeutic radiographers. The match values of both methods were compared using Bland–Altman analysis. All five observers were also asked to score the ease of matching using both approaches. Results: The 95% mean level of agreement for the UroLift matches were within a 2-mm threshold in all dimensions. Comparison of UroLift and prostate matches had 95% limit of agreement values of −0·98 to 1·78, −0·58 to 0·49 and −1·83 to 1·04 mm in the vertical, longitudinal and lateral planes, respectively. All of the UroLift matches were rated as ‘very easy’ or ‘possible with little difficulty’ by the five observers. Conclusion: A small difference between the CBCT UroLift and CBCT prostate match was found. It has been shown that IGRT to the prostate with the aid of the UroLift system implants and CBCT is feasible and can eliminate the need for FM implants. Wider evaluation in a large cohort is recommended.

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial.

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

Holmium laser enucleation of the prostate in patients with preexisting inflatable penile prostheses

This retrospective study evaluated the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with an inflatable penile prosthesis (IPP). Five men with a preexisting IPP underwent HoLEP for obstructive lower urinary tract symptoms at Baylor Scott and White Medical Center between January 2016 and September 2020. None of the patients had preexisting prostate malignancy or urethral strictures. Minimal blood loss was seen during HoLEP, with an average length of hospital stay of 1.4 days and an average time of catheterization of 1.4 days. None of the patients had any known postoperative complications, including need for transfusions, return to the operating room for postoperative bleeding, or clot evacuation. In conclusion, there was no increased risk of perioperative or postoperative complications for HoLEP in this group compared with the general population. HoLEP appears to be a safe and efficacious method for the treatment of lower urinary tract symptoms in patients with a preexisting IPP.

PREDICTORS FOR FAILURE OF DIRECT VISION INTERNAL URETHROTOMY (DVIU) FOR SINGLE AND SHORT BULBAR URETHRAL STRICTURES? A FACT OR FALLACY

Aims &amp; Objectives: To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (&lt;2 cm) bulbar urethral strictures. Materials &amp; methods: We retrospectively analysed 1260 adult patients who underwent DVIU between September 2007 to January 2021 in the Department of Urology,Institute of Nephrourology(INU),Bangalore. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, dened as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. For association between categorical variables, the chi-square test was used, while the Student's t-test was used for comparing means between groups. Logistic regression analysis was used to determine independent predictors of failure after DVIU. All statistical analysis was performed using SPSS statistical software, with a P&lt; 0.05 considered to indicate statistical signicance. Results &amp; Observations:In all,1260 adult patients with a mean (SD) age of 48.3 years were included. The main causes of stricture were idiopathic followed by iatrogenic in 48.3% and 29.4 % of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (64.5%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 38.3%. The median (range) follow-up duration was 24 (8-127) months. In 60.1% patients did not require any further instrumentation, while RSD was maintained in 28.3%,patients. On multivariate analysis, older age at presentation [odds ratio (OR) 1.014; P = 0.02], obesity (OR 1.624; P = 0.013), and idiopathic strictures (OR 3.102; P = 0.035) were independent predictors of failure after DVIU. Conclusions:The failure rate after DVIU accounted for 39.9 % of our present study with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.

Clinical Profile and Outcome Analysis among Patients with Urosepsis at a Tertiary Care Centre: A Retrospective Cohort Study

Introduction: Urosepsis is a systemic reaction of the body to a bacterial infection of the urogenital organs with the risk of lifethreatening complications including septic shock. Aim: To assess the profile of patients with urosepsis and to analyse outcomes in patient management at a tertiary care centre. Materials and Methods: A retrospective, single-centre study was conducted between January 2015 and December 2019 including patients of either sex, aged ≥20 to &lt;80 years, with a confirmed diagnosis of urosepsis. Clinical report forms were reviewed to obtain patient characteristics (including age, sex, co-morbid conditions and clinical data). Blood, pus, urine culture data were evaluated to identify the source of infection. Details of upper and lower urinary tract symptoms and their imaging and urological intervention done were also recorded. Results: A total of 582 patients with urosepsis were included in this study. The majority of patients belonged to the age group of 41 to 60 years (n=315). The most frequent radiological diagnosis was infected hydronephrosis with calculus disease (n=237). The associated co-morbid conditions contributing to the perpetuation of urosepsis were Type II Diabetes Mellitus (T2DM), systemic hypertension, chronic kidney disease, decompensated liver disease, neurological disease, and coronary artery disease. Escherichia coli was the most commonly observed uropathogen (57.90%) in this study. Bilateral Double-J (DJ) stenting was usually preferred in patients with infected hydronephrosis and acute pyelonephritis (n=85, 76.58%). The insertion of a suprapubic catheter was more frequent among patients with obstructive lower urinary tract symptoms. Multivariate analysis showed that urosepsis with emphysematous pyelonephritis, uncontrolled diabetes, and persistent hypotension inspite of inotropic agents had a prolonged intensive care unit and higher mortality rate. Conclusion: Renal salvage is achievable in majority of cases with early surgical intervention, either DJ stenting or percutaneous nephrostomy. Suprapubic catheterisation is indicated in urosepsis patients with predominant lower urinary tract symptoms. An early diagnosis and an appropriate treatment can reduce the costs of hospitalisation, morbidity, mortality and better outcome.

Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Prostatic Abscess: A Review and Update

Prostatic Abscess: A Review and Update

International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain.

This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.

Prostatic basal cell carcinoma treated by chemoradiation with weekly cisplatine: case report and literature review

BackgroundBasal cell carcinoma of the prostate is a relatively rare entity. Their evolution is characterized by the frequency of local and/or distant relapses. Due to their rarity, the treatment is not consensual in the literature. We report here a case of Basal cell carcinoma of the prostate in a 40-year-old patient.Case presentationOur patient initially presented an obstructive lower urinary tract symptoms with a normal initial level of prostate specific antigen (PSA) test (3.5 ng/m). The transurethral resection of the prostate (TURP) was in favor of a prostatic basal cell carcinoma with its specific anatomopathological and immunohistochemical characteristics. The prostatic MRI and thoraco-abdominal CT realized after the TURP revealed a tumoral lesion of the prostatic peripheral zone with extra-capsular extension combined with right seminal vesicle invasion and a suggestion of posterior bladder wall adherence. No evidence of visceral or nodal metastases at this point. Considering the tumor being locally advanced, a concurrent chemoradiotherapy with intensity modulated technique was indicated after a multidisciplinary meeting with a 70 Gy total target dose delivered in 35 fractions and weekly Cisplatin. A year and a half after, he developed a cerebellous metastases revealed by intracranial hypertension with no other visceral lesion and complete local remission with the disappearance of the lower urinary tract symptoms and the pain and the appearance of a prostatic atrophy. The PSA level was still on the upper limit of normal. He underwent metastasectomy, and the anatomopathological study was in favor of a cerebellous metastasis of the known BCC. The patient presented postoperatively paraparesis of lower limbs with balance problems for which he was placed in palliative care with indication of postoperative radiation therapy in case of improvement of his general condition. He did not recover and deceased three months later.ConclusionsThe prostatic basal cell carcinoma is a rare aggressive entity often non-evoked at the clinical or radiological stages because of its unspecific appearance. The diagnostic of these tumors is based on histological examination and a large immunohistochemistry panel. Given its scarity, very few data is available for locally advanced non-metastatic stages treated by radiation therapy. We assess here a good local response with concurrent chemoradiation therapy.

An unusual case of LUTS in an adolescent man: a case report and literature review

Congenital prostatic cysts are rare and it is unusual for these patients to present with symptoms. We report the case of a 17-year-old man who presented with obstructive lower urinary tract symptoms and was found to have a prostatic cyst and other abnormalities of the genitourinary system. The patient subsequently underwent transurethral aspiration of the cyst with good effect. A brief review of the embryology behind these lesions along with a review of the literature is provided. Level of evidence: Not applicable for this multicentre audit.

AN UNUSUAL CASE OF LARGE PENILE URETHRAL CALCULUS WITH URETHROCUTANEOUS FISTULA IN AN ELDERLY MAN.

Impacted penile urethral calculus complicated with urethrocutaneous stula is a rare condition. Such calculi can form as a result of urethral strictures, meatal stenosis, urethral diverticulum, and migration of stones from the proximal urinary tract. A 65 year old male presented to our emergency department with complaints of fever and urinary dribbling since 2-3 weeks and obstructive lower urinary tract symptoms since 6 months. He showed features of sepsis and a palpable bladder on examination. Xray KUB and penile USG was suggestive of a 2x1.5cm distal penile urethral calculus. In this paper we present our approach to such case.

Vesicourachal diverticulum with calculus in a recurrent stone former: A rare entity

The urachus is a tubular embryonic structure connecting the allantois at the umbilicus to the bladder. It gets obliterated and remains as median umbilical ligament. Partial or complete failure of this process results in urachal anomalies. We are reporting a rare case of 54 year male patient presenting with obstructive lower urinary tract symptoms and history of spontaneous passage of stones in urine and on evaluation found to have vesicourachal diverticulum with calculus in it.

An Unusual Presentation of Prostatic Tuberculous Abscess - Obstructive Lower Urinary Tract Symptoms (LUTS) with Renal Compromise in an Immunocompetent Patient

An Unusual Presentation of Prostatic Tuberculous Abscess - Obstructive Lower Urinary Tract Symptoms (LUTS) with Renal Compromise in an Immunocompetent Patient

Mesonephric (Wolffian-derived) Adenocarcinoma of the Female Urethra

The current World Health Organization (WHO) classification of adenocarcinoma of the urinary tract including the urethra includes uncommon Müllerian-derived carcinomas such as clear cell and endometrioid adenocarcinomas. The concept of primary mesonephric (Wolffian-derived) adenocarcinoma (MA) in the urethra (and urinary tract in general) is currently regarded as controversial as the term "mesonephric" had been also inaccurately applied in the past to label Müllerian-derived carcinomas, particularly clear cell adenocarcinoma. Further, pathologically well-documented or bona fide urethral MAs have not yet to be reported. Herein, we describe 2 examples of MA in elderly females that primarily presented in the urethra and manifested clinically with obstructive lower urinary tract symptoms. Both tumors exhibited histology similar to those in MAs of the female genital tract including the distinctive tubular proliferations with luminal eosinophilic materials. The first case, in addition, showed a variety of patterns including ductal (glandular), solid, fused/sieve-like tubules, dilated tubules, and spindled cells. The second case also showed a transition to the more irregular and poorly formed tubular proliferation of cells with greater nuclear atypia and with a desmoplastic response. Both tumors showed positivity for PAX8, GATA3, and luminal CD10, and 1 tumor analyzed harbored KRAS and ARID1A mutations. One patient received neoadjuvant chemotherapy and underwent resection but had local tumor recurrence and metastasis to the lungs and lumbar spine 12 months after presentation. In conclusion, MA, similar to those occurring in the female genital tract and distinct from the recognized Müllerian-derived carcinomas, may present primarily as urethral tumors. MA in the urethra probably shares a common pathogenesis with vaginal MA as both may originate from the same caudal loci of mesonephric remnants along the closely apposed anterior vaginal and posterior urethral walls. MA should be considered in future classifications for urethral tumors and we recommend that the confusing term "mesonephroid adenocarcinoma" should no longer be used.