# Case Report: Radical urethrectomy with partial cystectomy and bladder outlet reconstruction in giant female urethral adenocarcinoma infiltrating the bladder: A rare case report

## TL;DR

A rare case of large female urethral cancer invading the bladder was successfully treated with a bladder-preserving surgery, avoiding the need for urinary diversion and maintaining quality of life.

## Contribution

Demonstrates a novel bladder-preserving surgical approach for giant female urethral adenocarcinoma with bladder infiltration.

## Key findings

- Radical urethrectomy with partial cystectomy and bladder outlet reconstruction achieved clear surgical margins.
- The patient had no recurrence or metastasis at 1-year follow-up with good quality of life.
- Bladder-preserving surgery eliminated the need for suprapubic urinary diversion.

## Abstract

Female urethral adenocarcinoma (FUA) is an exceptionally rare and aggressive malignancy, accounting for less than 0.02% of all cancers in women. Its nonspecific symptoms often lead to delayed diagnosis, with many cases detected at advanced stages. The rarity of FUA, particularly when presenting with a large mass, underscores the challenges in developing standardized treatment protocols.

A 65-year-old woman presented with urinary retention. Clinical examination revealed a large mass obstructing the urethral orifice. A computed tomography (CT) scan showed a malignant mass involving the entire length of urethra, with no signs of metastasis. Percutaneous cystostomy was performed, and cystoscopy through the cystostomy access revealed tumor infiltration into the anterior bladder wall, approximately 2 cm from the bladder neck. A radical urethrectomy with partial cystectomy and bladder outlet reconstruction was performed via a transurethral approach, with antegrade cystoscopy guidance. The bladder outlet was reconstructed using a segment of the anterior bladder wall to facilitate voiding through the orthotopic site with a Foley catheter. Pathology confirmed urethral adenocarcinoma with clear surgical margins. Neither radiation nor chemotherapy was administered. At the 1-year follow-up, the patient reported satisfaction with her quality of life and showed no signs of recurrence or metastasis.

This case highlights the feasibility of bladder-preserving surgical techniques in giant FUA with bladder infiltration. The approach achieved oncological control while maintaining the patient’s quality of life. Bladder outlet reconstruction provided satisfactory functional outcomes and eliminated the need for suprapubic urinary diversion.