Transurethral resection and oral mucosal grafting for urethral-involved extramammary Paget disease: A function-preserving approach.

Extramammary Paget disease with urethral involvement presents considerable challenges, primarily because of the difficulty in achieving clear surgical margins while preserving urinary function. This report describes four women with urethral extramammary Paget disease who were treated using transurethral resection followed by oral mucosal grafting for urethral reconstruction. The primary objective was complete excision of the diseased area while minimizing postoperative complications, with a particular focus on preservation of urinary function. Transurethral resection enabled precise resection of the urethral mucosa without compromise of the urethral sphincter. Pathological analysis confirmed negative margins in three of the four patients; one patient had preoperative evidence of tumor cell invasion at the internal urethral orifice. Urinary function was preserved in all patients, and postoperative complications such as urethral stricture were successfully managed using dilation. No recurrences were observed during follow-up. This approach, which combines transurethral resection and oral mucosal grafting, offers a minimally invasive and function-preserving surgical option for urethral-involved extramammary Paget disease, demonstrating favorable oncological and functional outcomes.