A 62-year-old woman presented with symptoms of decreased force of stream, and two times acute urinary retention about 580 ml, 620 ml. She was treated with a urethral catheterization to relieve an acute micturition pain and spontaneous urinary retention. She had no history of hematuria or urinary disturbance, but only hypertension. Pelvic examination revealed a stony hard mass around urethra with no other abnormalities at vagina. On blood chemistry, only serum creatinine was slightly increased (1.7 mg/dl). And urinalysis was normal finding. Urodynamic study confirmed bladder outlet obstruction with no detrusor instability. Evaluation revealed bladder neck mass with bilateral hydronephrosis on ultrasonography. Cystoscopy confirmed a midurethral stony hard mass at the 12-3 o'clock position and transurethral biopsy was done. The pathology report revealed a urethral adenocarcinoma. For more detail information, pelvic magnetic resonance imaging study (MRI) was done. MRI showed about 3.3×2.9 cm sized well enhancement urethral mass with surrounding cystic component such as urethral cancer from urethral diverticulum (Fig. 1). No demonstrable lymph nodes enlargement in pelvic cavity. Gastrointestinal and gynecologic evaluation revealed no other primary source for the malignancy. The patient underwent pelvic exenteration and ileal conduit. On gross histopathologic examination, the tumor was largely confined to the periurethral region (Fig. 2). On microscopic histopathologic examination, it infiltrated into the subepithelial stroma of the urethra and the bladder neck. It was a moderately differentiated mucinous adenocarcinoma (Fig. 3). There was no definite lymphovascular permeation. All the resection margins were clear. Lymph nodes were identified in the lymphadenectomy specimen and were free of metastatic disease. This patient still alive in good health for 17 months after operation.

A 64-year-old woman was referred for evaluation of newly onset urinary retention of unclear etiology. She had history of dysuria, voiding difficulty and urinary incontinence for 3 months and suffered from both flank pain. Serum creatinine was 2.1 mg/dl. Urethral catheterization was tried to relieve an acute urinary retention but not passed. And then, suprapubic cystostomy was done. Urodynamic study revealed a high pressure, low flow voiding pattern with a postvoid residual volume of 500 ml, consistent with bladder outlet obstruction. Ultrasonography showed both moderate hydronephrosis, severe trabeculation of bladder and pelvic mass lesion. Pelvic examination and palpation of the anterior vaginal wall confirmed a firm mass lateral to the left proximal urethra. On cystourethroscopy with a 19.5F cystoscopy, it was difficult to pass into the urethra, Irregular urethral mucosa on the left side of the proximal urethra was biopsied transurethrally with cold-cup biopsy forceps. Pathologic examination revealed poorly differentiated adenocarcinoma. After serum creatinine was normal level, for further evaluation of pelvic mass, computed tomography (CT) was done. CT showed ill-defined low attenuated mass at bladder neck with bilateral hydronephrosis. Gastrointestinal and gynecologic evaluation revealed no other primary source for the malignancy. Operation was recommended. But she refused and not followed up.