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Urethral tumor

  What is urethral tumor

  Urethral tumors are relatively common tumors in the urogenital system. More than 75% of patients present with hematuria as the first symptom. The degree of anemia caused by hematuria is generally proportional to the severity of the tumor. Frequent urination, dysuria, or nocturia may indicate necrosis or infiltration of the bladder, resembling symptoms of cystitis. Tumors located at the bladder neck or pedunculated tumors can cause urinary obstruction or urinary retention. Urinary tract obstruction caused by infection can lead to fever and pyuria.

  Urethral tumors include male urethral tumors and female urethral tumors. The primary sites of male urethral tumors vary, with the most common being transitional cell carcinoma and squamous cell carcinoma. The causes are related to urethritis, urethral stenosis, and repeated urethral dilation. However, when the tumor invades the penis and perineum, it can metastasize to the inguinal lymph nodes. Urethral tumors rarely occur blood metastasis. In the late stage, the most common distant metastasis is lung, followed by liver and stomach metastasis.

  Male urethral tumors are generally treated for urethral obstruction, mass, urethral perineal abscess, urine extrusion, urethral fistula, and urethral discharge of secretions. Some patients have pain, hematuria, or blood seminal. Female urethral tumors are more common in elderly women, and the usual symptoms are urethral bleeding and hematuria. Other symptoms include frequent urination, dysuria, burning sensation during urination, urinary obstruction or pain, and locally visible or palpable masses. The necrosis, ulceration, and infection of the tumor may result in yellow or bloody discharge with an odor from the urethra or vagina. Late symptoms include weight loss, pelvic pain, urethral perineal abscess, urinary incontinence, urethrovaginal fistula, or urinary retention.

Table of Contents

1. What are the causes of urethral tumors?
2. What complications can urethral tumors easily lead to
3. What are the typical symptoms of urethral tumors
4. How to prevent urethral tumors
5. What laboratory tests are needed for urethral tumors
6. Diet taboos for urethral tumor patients
7. Conventional methods of Western medicine for the treatment of urethral tumors

1. What are the causes of urethral tumors?

  What are the causes of urethral tumors?

  About 50% of urethral tumors are secondary to bladder, ureter, or renal pelvis transitional cell carcinoma. Primary urethral tumors are relatively rare and mainly occur in women.

  The following factors are likely to trigger urinary tract infections:

  ① Urinary tract obstruction: Urinary tract stones, tumors, and stenosis can all cause urinary tract obstruction. Benign prostatic hyperplasia and neurogenic bladder can lead to poor urine flow and increased residual urine in the bladder. About 60% of patients with urinary tract obstruction have concurrent pyelonephritis.

  ② Urinary tract malformation or functional abnormality: Polycystic kidney, malformation of the renal pelvis or ureter, and incomplete renal development can often cause urine vesicoureteral reflux, even intrarenal reflux, providing favorable conditions for ascending bacterial infection.

  ③ Local trauma or decreased defense function: Catheterization, cystoscopy, and urinary system surgery can all induce infection.

  ④ Low systemic resistance: The incidence of urinary tract infections in patients with diabetes, long-term use of adrenal cortical hormones, chronic consumptive diseases, chronic diarrhea, heart failure, renal congestion, and other conditions is increased.

  ⑤ Pregnancy and sexual life: Increased estrogen secretion in pregnant women leads to reduced smooth muscle tone in the ureters, weakened peristalsis, and during the later stages of pregnancy, the enlarged uterus compresses the ureters and bladder, causing poor urine flow and increased vesicoureteral reflux. During sexual activity, due to the pressure, indentation, and trauma of the female urethral orifice, bacteria in the anterior urethra can directly be squeezed into the bladder, causing infection.

  The following diseases can trigger urinary tract tumors:

  1. Secondary to systemic diseases (such as hypertension and arteriosclerosis, systemic lupus erythematosus, allergic purpura nephritis, diabetes, gout, and others).

  2. Type primary glomerulonephritis (membranous proliferative nephritis, rapid progressive nephritis, membranous nephritis, focal glomerulosclerosis, etc.)

  3. Chronic urinary tract obstruction, such as kidney stones, bilateral ureteral stones, urinary tract stenosis, benign prostatic hyperplasia, tumors, etc.

  4. Chronic kidney infectious diseases, such as chronic pyelonephritis.

  5. Congenital kidney diseases, such as polycystic kidney disease, hereditary nephritis, and various congenital tubular dysfunction.

2. What complications are easy to cause by urethral tumors?

  What complications can urethral tumors easily cause?

  Tumors located at the bladder neck or pedunculated tumors can cause urinary obstruction or urinary retention. Urinary tract obstruction leads to pyuria and fever.

  Urethral tumors can cause the following complications: ① Obstruction of the urethra, causing difficult urination, but urinary retention occurs very rarely. ② Infection, which can penetrate the urethral corpus spongiosum, form perineal urethritis, or lead to perineal abscess; or spread to the scrotum, perineum, forming perineal urethral fistula.

  The metastatic pathways of urethral tumors include lymphatic, hematogenous, direct spread, and direct implantation of tumor cells. Lymphatic metastasis is the most common pathway, and urethral tumors can metastasize to the internal iliac, external iliac, obturator lymph node groups, or even to the common iliac lymph nodes. Some people point out that the internal iliac and obturator lymph nodes are the first lymph node stations for urethral tumor metastasis.

  Bloodborne metastasis of urethral tumors is common in advanced cases, most frequently in the liver, followed by the lungs and bones. The skin, adrenal glands, kidneys, pancreas, heart, testicles, salivary glands, ovaries, muscles, and gastrointestinal tract have all been reported, but they all account for a small number.

  Direct spread of urethral tumors often occurs in the prostate or posterior urethra. Urethral tumors can extend outside the bladder and adhere to the pelvic cavity to form fixed masses, or spread to the mucosa at the top of the bladder.

  Direct implantation of tumor cells in urethral tumors can occur during surgery, and masses may occur at the bladder incision site or under the skin incision after surgery. The recurrence of bladder tumors or the appearance of multiple tumors is partly due to tumor cell implantation. The appearance of tumors at the urethral stump after total bladder resection may also be the result of surgical implantation.

3. What are the typical symptoms of urethral tumors?

  What are the typical symptoms of urethral tumors?

  The incidence is mostly above 50 years old, with less in the young. Patients usually seek medical attention for symptoms such as urethral obstruction, mass, perineal abscess, extrinsic urine, urethral fistula, and urethral discharge. Some patients have symptoms such as pain, hematuria, or seminal blood. The tumor of the fossa navicularis manifests as ulcers or papillary lesions. Rectal bimanual examination should be performed on patients to determine whether the tumor has spread to the prostate, anus, and urogenital diaphragm.

  Urethral tumors that appear early are characterized by urethral irritation symptoms, such as frequent urination, dysuria, urethral orifice hardening or ulceration, accompanied by bloody discharge or post-urination bleeding. Larger tumors can cause obstruction, manifesting as difficult urination, urinary retention, and even urinary retention. The mass of distal urethral tumors protrudes from the urethral orifice, is hard to the touch and prone to bleeding, and some form cancerous ulcers or secondary infections with smelly discharge. The mass of proximal urethral tumors may not protrude outside the urethral orifice, but the hardened urethra or mass can be felt on the anterior vaginal wall. In the late stage of urethral tumors, the urethra is completely fixed with the vaginal wall, and enlarged metastatic lymph nodes can be palpated in both inguinal groins or urethra-vagina fistula may form.

  Specific symptoms:

  1. Urethral discharge [1], which is often an early symptom, can be serous, bloody, and may also present with urethral bleeding. When concurrent infection occurs, the discharge may become purulent.

  2. Urinary disorders, dysuria, difficulty in urination, thinning of the urine stream, bifurcation, or dripping, which can cause urinary retention.

  3. Urethral mass.

  4. Abnormal erection of the penis, which is ineffective for drug and decompression treatment.

  5. Complications, such as infection, can cause periurethral abscess, which can lead to fistula after rupture. The tumor can come out through the fistula, forming a cauliflower-like malignant ulcer.

  6. In the late stage, symptoms such as urinary fistula, weight loss, anemia, and cachexia may appear.

  Skin metastases from renal cell tumors and overcellular tumors, or local metastasis (often on surgical scars), or distant metastasis, from adrenal tumors, are common in the head and neck, while transitional cell carcinoma is common in the trunk and limbs.

  Renal cell metastatic carcinoma is a solitary or extensive dermal nodule, with a color of flesh, especially purple, with obvious vascular distribution, as seen in kaposi sarcoma or suppurative granuloma. Metastatic skin cancer from transitional cell carcinoma, usually a single or multiple flesh-colored dermal nodules, warty papules, and inflammatory plaques are less common skin metastases.

4. How to prevent urethral tumors

  What measures can prevent urethral tumors

  Middle-aged men are a high-risk group for urethral tumors. If the urethral tumor of the patient increases, it can also cause difficulty in urination. If urethral tumors are not treated for a long time, they can develop into malignancy. Malignant urethral tumors include carcinoma, sarcoma, melanoma, and so on. Urethral tumors can cause symptoms such as blood in the urine, frequent urination, urgency, and dysuria in the early stage. As the tumor grows, it can also cause difficulty in urination. Therefore, the emphasis is on the prevention of urethral tumors. The methods of preventing urethral tumors in daily life are:

  1. Drink more water, which will lead to more urination of concentrated urine. Drinking more water can not only dilute the blood but also effectively dilute the concentration of urine.

  2. Moderation in sexual life, to prevent prostate enlargement, it is necessary to start from young adulthood. The key is to have moderate sexual life, avoid overindulgence, and do not abstain from sex. Frequent sexual activity can cause the prostate to remain in a state of congestion for a long time, leading to its enlargement. Therefore, especially in the period of strong sexual desire in youth, it is necessary to moderate sexual life, avoid repeated congestion of the prostate, and give the prostate sufficient time for recovery and repair. Of course, excessive abstinence can also cause a feeling of fullness and discomfort, which is also harmful to the prostate.

  3. Do not hold urine. Once the bladder is full and you feel the urge to urinate, you should urinate. Holding urine is harmful to the bladder and prostate. Before taking a long-distance bus, you should empty your bladder first and then get on the bus. If you feel an urgent need to urinate during the journey, you should greet the driver and get off the bus to urinate. Do not hold it in at all costs.

  4. Relax more, as life pressure may increase the chance of prostate enlargement. Clinical studies have shown that when life pressure is reduced, the symptoms of urethral tumors will be alleviated. Therefore, it is best to maintain a relaxed state in daily life.

  5. Taking a warm water bath can relieve the tension of muscles and the prostate, and alleviate discomfort symptoms. It is undoubtedly beneficial for patients with urethral tumors to take a warm water bath regularly. If you take a warm water bath for the perineum once a day, it can also achieve a good effect.

  In addition, men should pay attention to regular lifestyle, ensure adequate sleep, and engage in cultural and sports activities. Try to avoid excessive sexual activity during periods of overwork, stress, or when relationships with colleagues are not harmonious. This can help prevent and avoid the occurrence of urethra tumors.

5. What laboratory tests are needed for urethra tumors

  What laboratory tests are needed for urethra tumors

  Imaging examination

  1. X-ray urethrogram can show the location and extent of the filling defect in the urethra; IVU shows the condition of the kidney, ureter, and bladder; when there is bone metastasis, the pelvic flat film can show bone destruction.

  2. Ultrasound, CT, MRI are helpful in understanding whether the pelvic lymph nodes are enlarged, and whether the bladder and prostate are accompanied by tumors.

  Laboratory examination

  Cytological examination or FCM analysis of urethral secretions, urine sediment, urethral lavage or brushing materials can detect urethra tumor cells.

  Urethral cystoscopy

  The examination can directly observe the lesion and take a biopsy of the lesion tissue; however, sometimes due to the tumor, the lumen is too narrow to insert. The location, size, and number of the urethral tumor can be observed directly, and a biopsy can be taken to confirm the diagnosis. The examination should start from the urethral orifice, observing while inserting the urethroscope to avoid missing any areas; at the same time, it can also avoid the trauma caused by the insertion of the cystoscope, which may affect the examination results. It is also important to note the presence of tumors within the bladder.

6. Dietary recommendations for urethra tumor patients

  Dietary recommendations for urethra tumor patients

  Treating urethra tumors is an important aspect, but prevention is also crucial. Therefore, when preventing urethra tumors, attention should be paid to the following points in diet:

  It is recommended to eat...

  (1) It is recommended to eat foods that have an anti-bladder and urethra tumor effect, such as toads, frogs, snails, seaweed, wakame, tortoise shell, turtle, sea cucumber, water snake, Job's tears, water chestnuts, walnuts, goat kidney, pork kidney, broad bean, sand worm, perch, and mackerel. It is advisable to avoid foods that can exacerbate inflammation and fever, such as pork head meat, chicken, mushrooms, flatfish, crabs, bamboo shoots, peaches, and others.

  (2) Daily consumption should include seaweed, wakame, seaweed, and green crab, and avoid spicy and刺激性 substances such as tobacco, alcohol, coffee, and cocoa. Spicy foods can exacerbate urinary tract irritation symptoms, make urination difficult, and in some cases, can cause redness and swelling of the urethral opening, and can also cause congestion and pain in the inflamed area.

  (3) For infections, it is recommended to eat anti-infection foods such as yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus root starch, buckwheat, malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed, loach, and others. It is advisable to avoid gas-forming foods such as milk, soy milk, and sugar. Urinary tract infections often cause a sense of distension and pain in the lower abdomen, and abdominal distension can make urination more difficult.

  (4) Patients should consume blood-boosting foods such as celery, chrysanthemum, leek, winter melon, black plum, dried persimmon, sesame seeds, lotus seeds, sea cucumber, and mouse meat, and avoid acidic foods such as pork, beef, oysters, and shrimp. The pH of urine is closely related to the growth of bacteria and the antibacterial activity of drugs. The purpose of avoiding acidic foods is to create an alkaline urine environment, enhancing the efficacy of antibiotics; as carbohydrates can also increase acidity in the body, foods with high sugar content should also be limited.

7. The conventional method of Western medicine for treating urethral tumors

  The conventional method of Western medicine for treating urethral tumors

  1. Local tumor resection

  ① Single, superficial, well-differentiated, low-stage urethral tumors; patients who cannot tolerate or refuse surgery; palliative treatment for metastatic urethral tumors can be adopted by TUR, transurethral electrocoagulation, laser, and local resection of the urethral orifice can be performed as thoroughly as possible to remove the tumor.

  ② Partial urethrectomy

  For low-stage anterior urethral tumors, the urethral margin should be 2 cm away from the tumor edge, and the length of the proximal urethra should be preserved at least 2 cm to maintain a standing posture for urination. There are few complications, and the treatment effect of distal urethral tumors is generally satisfactory.

  ③ Radical urethrectomy

  Suitable for O, A, or B stage urethral tumors, and the tumor proximal to the midline of the bulb. In cases where the penile length cannot be maintained in a normal voiding posture after the resection of the urethral part of the anterior urethral tumor, it is more reasonable to perform cystoprostatectomy and total urethrectomy. And pelvic lymph node dissection should be performed simultaneously. Those with confirmed inguinal lymph node metastasis should also be cleared.

  ④ Radical extensive organ resection

  C-stage posterior urethral tumors (bulbous, membranous) are often widely spread at the time of diagnosis, and most cases cannot be resected, with poor prognosis. Radical extensive organ resection has a wide surgical range, many complications, and a high recurrence rate.

  2. For advanced urethral tumors, perform cystostomy, radiotherapy, and chemotherapy.

  Generally, the urethral bulb membrane tumors are often widely spread at the time of diagnosis, and even if radical surgery is performed, it cannot be cured. The high recurrence rate after surgery is due to the obstruction of the pubic rami, pubic symphysis, and pelvic floor muscles near the tumor, which hinders the local extensive resection of the urethral bulb tumor. If the tumor, lower urinary tract, reproductive system, and the above structures are extensively resected as a whole, the cure rate can be improved. Preoperative radiotherapy may be valuable, but experience is limited. Simple radiotherapy is not effective in controlling the tumor.

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