Abstract
INTRODUCTION: Female urethral adenocarcinoma (FUA) is an exceptionally rare and aggressive malignancy, accounting for less than 0.02% of all cancers in women. Its nonspecific symptoms often lead to delayed diagnosis, with many cases detected at advanced stages. The rarity of FUA, particularly when presenting with a large mass, underscores the challenges in developing standardized treatment protocols. CASE PRESENTATION: A 65-year-old woman presented with urinary retention. Clinical examination revealed a large mass obstructing the urethral orifice. A computed tomography (CT) scan showed a malignant mass involving the entire length of urethra, with no signs of metastasis. Percutaneous cystostomy was performed, and cystoscopy through the cystostomy access revealed tumor infiltration into the anterior bladder wall, approximately 2 cm from the bladder neck. A radical urethrectomy with partial cystectomy and bladder outlet reconstruction was performed via a transurethral approach, with antegrade cystoscopy guidance. The bladder outlet was reconstructed using a segment of the anterior bladder wall to facilitate voiding through the orthotopic site with a Foley catheter. Pathology confirmed pT4 urethral adenocarcinoma with enteric subtype and clear surgical margins. Neither radiation nor chemotherapy was administered. At the 1-year follow-up, the patient was in continuous incontinence status. This condition is expected since the sphincter was also resected during the surgery as the tumor already infiltrated the anterior bladder. But with the use of silicone catheter, we can avoid any leak and patient still can void timely through regularly clamp catheter. At the 1-year follow-up, the patient reported satisfaction with her quality of life and showed no signs of recurrence or metastasis. CONCLUSION: This case highlights the feasibility of bladder-preserving surgical techniques in giant FUA with bladder infiltration. The approach achieved oncological control while maintaining the patient's quality of life. Bladder outlet reconstruction provided satisfactory functional outcomes and eliminated the need for suprapubic urinary diversion.