title: EAU guidelines on primary urethral carcinoma.
abstract: BACKGROUND
  The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC).
  
  
  OBJECTIVE
  To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence.
  
  
  METHODS
  A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol.
  
  
  RESULTS
  Primary UC is considered a rare cancer, accounting for <1% of all malignancies. Risk factors for survival include age, tumour stage and grade, nodal stage, presence of distant metastasis, histologic type, tumour size, tumour location, and modality of treatment. Pelvic magnetic resonance imaging is the preferred method to assess the local extent of urethral tumour; computed tomography of the thorax and abdomen should be used to assess distant metastasis. In localised anterior UC, urethra-sparing surgery is an alternative to primary urethrectomy in both sexes, provided negative surgical margins can be achieved. Patients with locally advanced UC should be discussed by a multidisciplinary team of urologists, radiation oncologists, and oncologists. Patients with noninvasive UC or carcinoma in situ of the prostatic urethra and prostatic ducts can be treated with a urethra-sparing approach with transurethral resection and bacillus Calmette-Guérin (BCG). Cystoprostatectomy with extended pelvic lymphadenectomy should be reserved for patients not responding to BCG or as a primary treatment option in patients with extensive ductal or stromal involvement.
  
  
  CONCLUSIONS
  The 2013 guidelines document on primary UC is the first publication on this topic by the EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy.
authors.affiliation: Department of Urology, Eberhard-Karls University, Tübingen, Germany. Electronic address: Georgios.gakis@googlemail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Cowan
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
authors.forename: Amir M
authors.initials: AM
authors.lastname: Sherif
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards / Q000627:therapeutic use; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000592:standards; D003952:Diagnostic Imaging / Q000592:standards; D003950:Diagnostic Techniques, Urological / Q000592:standards; D006801:Humans; D020360:Neoadjuvant Therapy / Q000592:standards; D011237:Predictive Value of Tests; D011379:Prognosis; D011878:Radiotherapy / Q000592:standards; D012307:Risk Factors; D014523:Urethral Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000592:standards; D014572:Urology / Q000592:standards*
keywords: Biopsy; Chemotherapy; Cystoscopy; Cytology; EAU; Guidelines; MRI; Penile-preserving surgery; Primary; Radiotherapy; Squamous cell carcinoma; Urethra-sparing surgery; Urethral carcinoma; Urethral neoplasms; Urethral stricture