Abstract
RATIONALE: Urethral metastasis recurrence after surgery for urothelial carcinoma (UC) is a common clinical challenge, yet there is no established optimal treatment strategy to effectively control postoperative metastasis and recurrence. This case report evaluates the efficacy of total urethrectomy combined with adjuvant chemotherapy and PD-1 + antibody-drug conjugate (ADC) immunotherapy in managing UC urethral metastasis. PATIENT CONCERNS: Three patients with a history of UC surgery presented with urethral metastasis recurrence, raising concerns about disease progression, treatment options, and long-term survival. DIAGNOSES: All 3 patients were definitively diagnosed with UC urethral metastasis recurrence based on clinical, imaging, and histopathological examinations. INTERVENTIONS: Each patient underwent total urethrectomy followed by adjuvant chemotherapy and PD-1 inhibitor + ADC combination immunotherapy. OUTCOMES: Post-treatment follow-up, including serum tumor marker assessments and imaging studies, showed no significant recurrence. The patients exhibited prolonged overall survival and maintained a satisfactory postoperative quality of life. LESSONS: Total urethrectomy combined with chemotherapy and PD-1+ADC immunotherapy may significantly improve outcomes in UC patients with postoperative urethral metastasis recurrence. This multimodal approach warrants further investigation in larger clinical studies.