IMAGES IN UROGYNECOLOGY Voiding dysfunction due to female urethral carcinoma Fernanda Monteiro Orellana 1 & Pablo Leonardo Traete 1 & Luís Gustavo Morato de Toledo 2 Received: 16 April 2020 /Accepted: 20 July 2020 # The International Urogynecological Association 2020 Keywords Urethral carcinoma . Voiding dysfunction . Periurethral masses . Female . Surgical resection . Urethrectomy . Urothelial carcinoma Introduction Urethral carcinomas account for 0.02% of female cancers. They are most prevalent between the 5th and 6th decade of life [1]. The most common subtypes are squamous cell carcinomas (60%), urothelial carcinoma (16–22%) and adenocarcinoma (10–16%) [1]. Risk factors are chronic inflammation, urethral stricture and urethral diverticula [ 1 ]. Common symptoms in women are hematuria, dyspareunia, chronic pain and dysuria [2]. Diagnostic tools include physical examination, cystourethroscopy, computed tomography (CT) or magnetic resonance imag- ing (MRI) and transurethral biopsy [1, 2]. Treatment of localized disease involves surgery (partial or total urethrectomy and radical cystectomy) [3]. Multimodal therapy is used for locally advanced disease. It con- sists of neoadjuvant chemotherapy followed by cystourethrectomy. Metastatic disease management in- cludes systemic therapy [1–3]. Case The authors present the case of a 61-year-old Caucasian woman who initially presented to the Emergency Department in August 2017 because of post-renal failure and urinary retention. Associated symptoms were hypogastric pain, 5 months of pollakiuria, urinary hesitan- cy and abdominal voiding. Physical examination demon- strated a painful suprapubic palpable mass and a hardened bulging anterior vaginal wall. Serum creatinine was 4.9 mg/dl. Cystography revealed signs of chronic bladder outlet obstruction such as thickened walls, multiple diver- ticula and shape deformity (Fig. 1b). During investigation after bladder catheterization, abdominal and pelvic MR demonstrated an urethral tumor with no signs of metasta- tic disease (Fig. 1). The patient underwent cystoscopy, hysteroscopy with endometrial biopsy and transvaginal incisional biopsy of the tumor. Histology demonstrated a high-grade invasive urothelial urethral carcinoma. Treatment proposal was radical cystectomy and lymphad- enectomy. Neoadjuvant chemotherapy was performed using four cycles of cisplatin and gemcitabine. Due to clinical regression of 90% of the tumor, the treatment proposal was changed to a less aggressive surgical ap- proach. The procedure was urethrectomy, bladder-neck excision, pelvic extended lymphadenectomy and cystostomy (Figs. 2, 3 and 4). So far, in 2020, 24 months after the surgery, the patient has shown no signs of recur- rence with routine surveillance. The future reconstructive resolution proposal is bladder augmentation with conti- nent diversion (Mitrofanoff), since her bladder capacity and complacence are compromised because of the chronic obstruction (Fig. 5). * Fernanda Monteiro Orellana orellanafm13@gmail.com 1 Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, Brazil 2 Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil International Urogynecology Journal https://doi.org/10.1007/s00192-020-04460-9