원발성 여성 요도 종양의 임상특성 및 추적관찰 = Clinical Charicteristics and Follow-up study in Primary Female Urethral Tumors

다국어 초록 (Multilingual Abstract)

Background : Female urethral lesions encompass a spectrum of entities that have significance in clinical urology. With that, female urethral lesions have rarely been reported and the differential diagnosis between benign and malignant lesions has not been established. I investigate retrospectively the incidence and the clinical presentations of female urethral lesions by my experience about 20 cases of the female primary urethral tumor. I also analyze the data to determine the optimum procedure for diagnosis and therapy. Method : The study included 20 patients with female urethral tumor treated by surgical procedure at Masan Samsung hospital of Sungkyunkwan University between Jan. 1994 to Apr. 2001. We investigated the clinical aspect of the female urethral tumor by symptom of each lesion, the spread of the patient's age, the method of the diagnosis and treatment. The preoperative evaluation included a thorough clinical history, physical examination, urinalysis, urine cytology, cystourethroscopy, and the radiologic studies, including voiding cystourethrography, retrograde urethrography, pelvic ultrasonography, pelvic CT or MRI. Results : The age range of the patients, who were surveyed for the 20 cases of the primary tumor, was between 25.2 and 74.6 (mean age 46.9 years), and 8 of them were in the period of menopause. We can inspect urethral diverticulum and we can treated it through diverticulectomy only. 4 cases were necessary to use Martius interposition graft when the path between urethra and the diverticulum was large. 2 cases had the stress incontinence postoperatively and there were necessary anterior vaginal wall sling procedure. The tumor was removed under transvaginal approach in urethral leiomyoma and leiomysarcoma and had not seen a significant morbidity. Urethral transitional cell carcinoma was found that it metastasized to the inguinal lymph nodes and distant metastasis to lung and bone after radical total cystourethrectomy. After the surgical excision of the benign urethral lesions, there would be no relapse or progression to malignancy. Conclusion : Urethral masses are essentially needed radiologic or endourologic procedure and pathologic examination due to possible development of a malignant tumor even though it is rare. A large scale of the urethral tumor like the leiomyoma of urethral diverticulum could be cured and safely managed by surgical excision, but the preventive procedure of the stress incontinence was needed. Finally it is important to perform auxiliary radiotherapy or chemotherapy with radical cystourethrectomy in female urethral malignant tumor to prevent the disease progression.