Guidelines

Primary Urethral Carcinoma

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1. INTRODUCTION

1.1. Aims and scope

This overview represents the updated European Association of Urology (EAU) Guidelines for Primary Urethral Carcinoma (PUC). The aim is to provide practical recommendations on the clinical management of PUC, with a focus on clinical presentation. When the first carcinoma in the urinary tract is detected in the urethra, this is defined as PUC, in contrast to secondary urethral carcinoma, which presents as recurrent carcinoma in the urethra after prior diagnosis and treatment of carcinoma elsewhere in the urinary tract. Most often, secondary urethral carcinoma is reported after radical cystectomy for bladder cancer [1,2] (see Sections 6.7.1 and 6.7.5 of the EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer [MIBC]) [2].

It must be emphasised that clinical guidelines present the best evidence available to the experts, but following Guidelines recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2. Panel composition

The EAU Guidelines Panel on MIBC is responsible for this publication. This Panel is an international multidisciplinary group of clinicians, including urologists, oncologists, a pathologist, a radiotherapist, a radiologist and two patient representatives. Members of this Panel have been selected based on their expertise to represent the professionals that treat patients suspected of suffering from urethral carcinoma. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU Website: https://uroweb.org/guidelines/primary-urethral-carcinoma.

1.3. Available publications

A quick reference document (Pocket Guidelines) is available in print, presenting the main findings of the PUC Guidelines. This reference document is an abridged version that may require consultation together with the full text version. All documents are accessible on the EAU Website Uroweb: https://uroweb.org/guidelines/primary-urethral-carcinoma. The most recent scientific summary paper was published in 2020 [3]. An EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, Guidelines cheat sheets and links to the extended Guidelines.

1.4. Publication history and summary of changes

The PUC Guidelines were first published in 2013. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. These 2026 PUC Guidelines present a limited update of the 2025 publication.

1.4.1. Summary of changes

For the 2026 PUC Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include:

  • In Chapter 4, the 9th edition (2025) of the Tumour, Node, Metastasis (UICC/TNM) classification is incorporated.
  • In Chapter 6, updates regarding prognostic factors.
  • In Section 7.3.6, updated recommendations for multimodal treatment of advanced urethral carcinoma.