Distal Urethrectomy with Neourethra Reconstruction for Localized Disease: A Step-by-Step Surgical Technique

L. G. Medina, S. M. Saleh, F. Hatoum, G. Yankelevich, S. B. Jazayeri, P. E. Spiess

Urethral Cancer, Urethrectomy, Urethral reconstruction, organ-sparing, rare genitourinary malignancy

Primary urethral carcinoma (PUC) is a rare genitourinary malignancy, accounting for approximately 1% of genitourinary cancers, with limited high-level evidence available to guide management (1,2).

Tumor location is an important determinant of treatment and prognosis, with distal urethral tumors generally demonstrating more favorable outcomes than proximal disease (3,4). In patients with localized distal urethral carcinoma, there has been a paradigm shift toward organ-preserving approaches, provided that complete resection with negative margins can be achieved. EAU guidelines note that positive proximal margins have been associated with higher progression risk, particularly in tumors with lymphovascular or perineural invasion, reinforcing the importance of complete circumferential proximal margin assessment before surgery (1,3,5). Within this context, distal urethrectomy represents an important organ-preserving surgical option, particularly when urethral involvement precludes a more limited excision yet does not necessitate penectomy.

Beyond oncologic safety, organ preservation is critically important from both functional and psychosocial perspective. Radical procedures such as partial or total penectomy can significantly affect urinary function, sexual health, body image, and overall quality of life. Recognition of the psychosexual and urinary morbidity associated with radical local treatments has contributed to the increased interest for penile-preserving approaches for carefully selected patients (5).

Despite growing interest in organ-preserving strategies, there is a notable lack of detailed, reproducible technical descriptions in the literature outlining how to safely perform distal urethrectomy with neourethral reconstruction while optimizing functional and oncologic outcomes. This gap may limit broader adoption, particularly among surgeons who encounter this rare disease infrequently. In this video, we present a step-by-step distal urethrectomy technique for localized distal urethral carcinoma, with emphasis on margin control, preservation of penile anatomy, and a reproducible reconstruction technique, with the goal of facilitating a broader implementation of organ-preserving approaches.

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