Primary Urethral Carcinoma

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The literature for the complete document has been assessed and updated, where relevant.

A text section has been added:

  • Section 7.3.3 – Salvage treatment in recurrent primary urethral carcinoma after surgery for primary treatment.

New recommendations have been added to:

  • Section 7.1.1 – Summary of evidence and guidelines for the treatment of primary urethral carcinoma in males.


Recommendation LE Strength rating
Ensure complete circumferential assessment of the proximal urethral margin if penis-preserving surgery is intended. 3 Strong



  • Section 7.3.5 – Summary of evidence and guidelines for multimodal treatment in advanced urethral carcinoma in both genders.


Recommendations LE Strength rating
Systemic therapy in advanced disease should be selected based upon histology of the tumour. 3 Strong


Offer salvage surgery or radiotherapy to patients with urethral recurrence after primary treatment. 3 Strong




New relevant references have been identified through a structured assessment of the literature and incorporated in the various chapters of the 2017 Primary Urethral Carcinoma Guidelines.


No significant new information has been included for the 2016 print. This is the current version of the EAU Primary Urethral Carcinoma Guidelines.


The literature for the complete document has been assessed and updated, whenever relevant.

Key changes for the 2015 publication:

  • Evaluation of recent data on prognostic factors on oncologic outcomes in primary UC.
  • Evaluation of recent data on the degree of concordance between clinical and pathologic staging.
  • Evaluation of recent data on distal urethrectomy in men.
  • Evaluation of recent data on the prognostic effect of multimodal treatment in advanced primary UC.

Conclusions and recommendations have been rephrased and added to throughout the document, not resulting in a change in the level of evidence (LE) and grade of recommendation (GR). The sections where changes were made can be found below:


6.2          Predictors of survival in primary urethral carcinoma 

Conclusion LE
Risk factors for survival in primary UC are: age, race, tumour stage and grade, nodal stage, presence of distant metastasis, histological type, tumour size, tumour location, concomitant bladder cancer and type and modality of treatment. 3

UC = urethral carcinoma.


7.1          Treatment of localised primary urethral carcinoma in males

Recommendation LE GR
In localised anterior urethral tumours, distal urethrectomy presents an alternative to achieve negative surgical margins and should be offered as an alternative to penile amputation. 3 B


7.2.2       Radiotherapy

Recommendations LE GR
In women, local radiotherapy is an alternative to urethral surgery for localised urethral tumours but local toxicity needs to be considered. 3 C


7.3.2       Preoperative chemoradiotherapy in locally advanced squamous cell carcinoma of the urethra

Conclusions LE
In locally advanced UC, cisplatin-based chemotherapy with curative intent prior to surgery improves survival compared to chemotherapy alone or surgery followed by chemotherapy. 4
In locally advanced squamous cell carcinoma (SCC) of the urethra, the prognostic role and timing of surgery after completion of chemoradiotherapy is unclear. 4

UC = urethral carcinoma.


Recommendations LE GR
Chemotherapeutic regimens with curative intent prior to surgery should be cisplatinum-based. 4 C
In locally advanced SCC of the urethra, combination of curative radiotherapy with radiosensitising chemotherapy is an option for genital preservation. 4  C

 SCC = squamous cell carcinoma.


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