Surgical Science, 2010, 1, 46-48
doi:10.4236/ss.2010.12009 Published Online October 2010 (http://www.SciRP.org/journal/ss)
Condom-Assisted Transurethral Resection: A New Surgical
Technique for Urethral Tumor
Kazuhiro Sato, Motofumi Suzuki*, Masayoshi Nagata, Hiroaki Nishimatsu,
Akira Ishikawa, Yasuhiko Igawa, Haruki Kume, Yukio Homma
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Received August 9, 2010; revised August 9, 2010; accepted August 9, 2010
Abstract
Backgrounds: It is difficult to develop clear endoscopic field during transurethral resection (TUR) of urethral
tumors, because irrigation water easily spills out from the meatus. We have devised a surgical technique to
facilitate TUR of urothelial tumors. Methods: A 79-year old man developed urethral tumors in the anterior
urethra and fossa navicularis 6 months after TUR of bladder tumor. We covered his penis and the resecto-
scope with a tip-cut condom. The tip-end of condom and the resectoscope sheath was tightly sealed and irri-
gation water was filled inside the condom. Results: The urethral tumors were successfully resected under a
clear vision by filling irrigation water inside a tip-cut condom that covered over the resectoscope and the pe-
nis. Conclusion: This technique may be useful for TUR of anterior urethral tumors, especially tumors at
fossa navicularis, which is often associated with difficulty in obtaining clear surgical vision.
Keywords: Urethral Tumor, Fossa Navicularis, TUR, Condom
1. Introduction
Urethral cancer develops primarily or secondary to bla-
dder carcinoma. Overall risk of urethral recurrence of
urothelial carcinoma in men after radical cystectomy for
bladder cancer is approximately 4 to10% [1-3]. Urethral
recurrence is less frequent after transurethral resection of
bladder tumor (TUR-Bt); Saika et al. found a urethral
recurrence rate of 2.6% in 303 patients with superficial
bladder cancer undergoing TUR-Bt [4].
However, endoscopic surgery for urethral tumors, es-
pecially tumors at fossa navicularis may not be easy. We
experienced recurrent urethral tumors involving fossa
navicularis after TUR-Bt and managed them by a new
TUR procedure.
2. Methods
2.1. Case Report
A 79-year old man was admitted to our hospital for the
left acute pyelonephritis. During the check-up a single
papillary tumor was detected in the bladder, which was
subsequently treated by TUR-Bt on 25th September 2008.
Pathological finding was grade 1 urothelial carcinoma,
pTa. He was followed by cystoscopy every three months
and found for urethral tumors in the anterior urethra and
fossa navicularis on 27th April 2009 (Figure 1).
3. Findings
3.1. A New TUR Procedure - Condom - Assisted
TUR of Urethral Tumor
On 21st July 2009, endoscopic resection of the urethral
tumors was attempted. First we performed conventional
TUR by holding the resectoscope tip at the urethral
meatus. However it was almost impossible to endosco-
pically visualize the tumors, especially tumors at fossa
navicularis, because irrigation water easily spilled out
from the meatus. Then we covered his penis and the re-
sectoscope with a tip-cut condom.
The tip-end of condom and the resectoscope sheath
was tightly sealed and the proximal end was compressed
manually to prevent water leakage. Irrigation water was
filled inside the condom at 60 to 80 cmH2O (Figure 2).
By this procedure, we could perform TUR of urethral
tumors under a clear view of the urethral lumen. We re-
sected all the tumors to the depth of submucosa and co-
agulated their trace to stop bleeding. No recurrent tumors

K. SATO ET AL. 47
(a)
(b)
Figure 1. (a) Superficial tumors of fossa navicularis; (b)
Superficial tumors of anterior urethra.
were found in the bladder. Pathological finding of ure-
thral tumors was grade 2 urothelial carcinoma with squa-
mous differentiation, pTa. He was free of recurrence in
the urinary tract one year postoperatively.
4. Results and Discussion
Urethral cancer, primary or recurrent, is an uncommon
disease associated with poor outcomes. Steele, et al. re-
viewed 11 cases of primary urethral tumor of fossa na-
vicularis [5]. Four men with superficial urethral tumors
underwent TUR. A single case was free of disease one
Figure 2. Resectoscope is inserted through a tip-cut condom.
Proximal end of condom is manually fixed and the connec-
tion between condom and resectoscope was tightly sealed.
Irrigation water filled in the condom enables to visualize
tumors at fossa navicularis by urethroscopy.
year after TUR, while the remaining three were not re-
ported for the prognosis. Seven men with invasive ure-
thral tumor received total penectomy, partial penectomy
or radiation. Saika et al. reported that four of five men
with recurrent superficial urethral tumor treated by TUR
died of tumor progression [4]. Yoshida et al. performed
salvage urethrectomy in three of four men who devel-
oped recurrent urethral tumor after TUR of superficial
urethral tumors [6]. Poor prognosis of urethral tumors
may be related to the fact that the lamina propria is the
only barrier between the urethral mucosa and the vascu-
lar corpora [7]. Endoscopic surgery for urethral tumors is
a challenge, especially tumors at fossa navicularis due to
the poor surgical field. Excision and fulguration under
direct vision is commonly used for eradicating urethral
tumors at the fossa navicularis [8,9]. Our new TUR pro-
cedure using tip-cut condom may be useful to visualize
urethral tumors in the anterior urethra or fossa navicu-
laris and manage them properly.
5. Conclusions
We have devised a surgical technique to facilitate TUR
of urothelial tumors in fossa navicularis by using a tip-
cut condom that covers the resectoscope and the penis.
6. Acknowledgements
No conflict of interest.
7. References
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K. SATO ET AL. 48
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