Abstract:

This article reports a case of a woman who was diagnosed with primary urethral cancer after the discovery of a bladder mass. The patient went to the Department of Urology， Sun Yat-sen Memorial Hospital， Sun Yat-sen University， for treatment due to"dysuria， frequent urination， and urgency for more than 10 days". CT examination showed bladder mass. Then cystourethroscopy combined with diagnostic transurethral resection was performed， and a broad-based tumor was found at the bladder neck and internal urethral orifice，which partially protruded into the bladder （urethral tumor）， pathology showed high-grade urothelial carcinoma， infiltrating the muscle layer.Subsequently， whole-body PET/CT showed residual lesions around the urethral orifice， and flurodeoxyglacose metabolism was active，considering the possibility of malignant tumors. After discussion of the case within the department and communication with the patient， it was decided to perform neoadjuvant therapy： GC （Gemcitabine and Cisplatin） combined with PD1 （Tislelizumab）. Before the fourth cycle of neoadjuvant therapy， fever and grade 4 bone marrow suppression occurred. After a multidisciplinary consultation on difficult cases in the Guangdong Urological Association， experts recommended communicating with the patient to perform radical cystectomy and total urethrectomy， and immunotherapy was an optional option. After communicating with the patient and obtaining his consent， our department performed "bilateral pelvic lymph node dissection and complete bladder-urethra resection and uterine adnexectomy and partial vaginal anterior wall resection and ileal conduit". Postoperative pathology showed no cancer residue. For patients with localized urethral cancer，preoperative "GC combined with PD1" neoadjuvant therapy has significant efficacy and is worth promoting.

Key words: Primary urethral cancer, Female, Radical cystectomy, Ileal conduit, Myelosuppression, Targeted therapy, Immunotherapy, PD-1, HER2