case_images: PMC11821390_01
case_images: Erythematous plaque over the urethral meatus.
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case_images: There was a 1 * 2 cm erythematous plaque over the urethral meatus (Fig. 1), but no palpable lesion was observed in the penis or inguinal area on physical examination.
case_images: Axial pelvic MRI arrow head showing T1 intermediate intense round lesion at distal penile invading corpus spongiosum.
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case_images: Pelvic MRI shows 1.7 cm * 1.7 cm T1intermidete (Fig. 2) and T2 hyperintense round lesion at distal penile invading corpus spongiosum but not corpus cavernous (Fig. 3).
case_images: Intraoperative images showing partial glansectomy with 5 mm margin.
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case_images: Since the biopsy showed squamous carcinoma in situ penile preservation was considered the patient subsequently underwent partial glansectomy and partial anterior urethrectomy with proximal penile meatoplasty (Fig. 4, Fig. 5).
case_images: Histopathological sections show penile urethra predominantly lined by stratified columnar epithelium with areas of squamous metaplasia, full-thickness dysplasia.
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case_images: Intraoperative images total anterior urethrectomy with buccal mucosa graft augmented perineal urethrostomy.
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case_images: Fig. 7), but not cavernous, and the urethral margin was positive for the high-grade squamous intraepithelial lesion, frozen section was not taken due to service lack at time. Finally, a multi-disciplinary discussion was held, and due to limited radiotherapy sitting, on the 6th post-operative week surgical margin was managed by completion of anterior total urethrectomy with buccal mucosa graft-augmented perineal urethrostomy (Fig. 8, Fig. 9), after an intraoperative frozen section showed a negative margin.
case_images: 12-month postoperative image arrow head showing Functional perineal urethrostomy.
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case_images: Currently, the patient is at 12 months post-operative follow-up (Fig. 10) with 6 monthly pelvic MRI and flexible cystoscopy and has a satisfactory quality of life (no urinary complaints and maintaining an erection).