urethral resection for female urethral cancer

Primary female urethral cancer is rare. According to Zeigerman and Gordon (1970), squamous cell carcinoma accounts for 68%, adenocarcinoma 18%, transitional cell carcinoma accounts for 8%, and melanoma accounts for 4%. Female urethral cancer can occur anywhere in the urethra, but half of it is located in the lower urethra (distal) and outside the urethra. Urethral cancer is mostly infiltrated from the shallow to deep urethra. Clinically, according to the degree of infiltration and the presence or absence of metastasis, female urethral cancer is divided into five stages. The lower urethral cancer is mostly squamous cell carcinoma, and early metastasis and multi-directional inguinal lymph node metastasis have a good prognosis. The upper urethral cancer is mostly transitional cell carcinoma, which is late, multi-directional pelvic metastasis, poor prognosis; adenocarcinoma has poor prognosis. . The treatment of female urinary tract cancer is mainly based on its location and stage. Treatment consists of transurethral resection, cancer resection, partial or total urethrotomy, radiotherapy, simple urethral resection and anterior pelvic organ removal, and lymph node dissection is performed as appropriate. The lower urethral cancer is limited to stage 0 or stage A, can be resected by the urethra, and the lesions of stage B are smaller. If the urethra can be retained for a sufficient length, partial urethroplasty is feasible, and the prognosis is good. The 5-year survival rate can reach 90%. the above. In the upper urethral cancer, multiple urethral and total urethral resection and urinary diversion surgery, even so, the prognosis is not optimistic, according to Johnson (1982), these patients have been found to be more advanced in the tumor, more than 50% have lymphatic metastasis. The 5-year survival rate is only 10% to 17%. If the tumor has entered the C stage, the pelvic organ removal should be performed, that is, the bladder, urethra, vaginal anterior wall and side wall, clitoris, uterus and its attachments should be removed in one piece, and bilateral pelvic lymphadenectomy should be performed routinely. Treatment of diseases: female urethral cancer Indication 1. Early urethral cancer, no invasion of the surrounding tissues of the urethra, partial urethral resection. 2. The upper urethral cancer, limited without metastasis, or the lower urethral cancer has invaded to the middle urethra, a total urethral resection is feasible. Surgical procedure 1. The incision is 0.5cm away from the outer edge of the urethra to make an annular incision around the external urethra. At the 6 o'clock incision, the medial longitudinal incision of the anterior vaginal wall is performed. The length of the longitudinal incision depends on the length of the urethra resection, generally 3 to 4 cm. Just fine. 2. Free urethral vaginal anterior wall longitudinal incision, the vaginal wall wound edge is clamped with tissue clamp, and the urethra is separated from the plane between the vaginal wall and the urethral wall. This plane is loose, easy to separate, and has less bleeding. 3. Excision of the urethra After the urethra is completely freed, the urethra is cut 2 cm above the tumor or the bladder neck is cut off, and the urethra and the tumor are removed. 4. Close the urethral stump or the bladder neck and urethral stump or the bladder neck end with 3-0 absorbable line discontinuity or continuous full-layer suture closure, and the outer layer is then reinforced with thin wire suture. 5. After suturing the vaginal incision and urethral resection, the wound should be completely stopped, and then the vaginal incision is sutured in two layers with a thin wire and a 2-0 absorbable line, and the incision is closed. A piece of gauze is placed in the vagina to cover the incision. 6. A permanent suprapubic bladder stoma.