980 URETHRAL RECURRENCE AFTER RADICAL CYSTECTOMY AND ILEAL ORTHOTOPIC BLADDER SUBSTITUTION: CAN THE URETHRA BE SPARED?

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011980 URETHRAL RECURRENCE AFTER RADICAL CYSTECTOMY AND ILEAL ORTHOTOPIC BLADDER SUBSTITUTION: CAN THE URETHRA BE SPARED? Gianluca Giannarini, Thomas M. Kessler, Bernhard Kiss, Urs E. Studer, and George N. Thalmann Gianluca GiannariniGianluca Giannarini Bern, Switzerland More articles by this author , Thomas M. KesslerThomas M. Kessler Bern, Switzerland More articles by this author , Bernhard KissBernhard Kiss Bern, Switzerland More articles by this author , Urs E. StuderUrs E. Studer Bern, Switzerland More articles by this author , and George N. ThalmannGeorge N. Thalmann Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.991AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal management of urethral recurrence after radical cystectomy and orthotopic bladder substitution is still a matter of debate. We assessed the long-term outcome of patients with urethral recurrence after radical cystectomy and ileal orthotopic bladder substitution. METHODS We retrospectively analyzed 495 consecutive patients with bladder carcinoma and no neoadjuvant therapy who underwent extended pelvic lymph node dissection and radical cystectomy with ileal orthotopic bladder substitution. Preoperative paracollicular (men) or bladder neck (women) biopsies were negative for carcinoma. All patients were prospectively followed with a standardized protocol, including urethral cytology 6-monthly for 2 years, then annually for 3 years. In case of positive cytology, urethroscopy with biopsy and staging for metastases were performed. Based on recurrence stage, patients were treated with endourethral bacillus Calmette-Guérin (BCG) (6 weekly instillations with 81 mg in 150 ml saline), transurethral resection plus endourethral BCG, urethrectomy or systemic chemotherapy. Urethral recurrence rate, detection rate by cytology, urethra-preservation rate after endourethral BCG and overall survival with preserved urethra were the study outcome measures. RESULTS After a median follow-up of 45 months (range 3–250) urethral recurrence was diagnosed in 24/495 (4.8%) patients, in 21 (88%) by cytology and in 3 (12%) by hematuria. Carcinoma in situ (Tis), Ta/T1 and T2 recurrences were detected in 13, 7 and 4 patients, respectively. All patients with Tis were treated with endourethral BCG, and 6 of 7 with Ta/T1 recurrence with transurethral resection plus endourethral BCG. Urethrectomy was performed in 1 patient with T2 recurrence, while systemic chemotherapy was given to 4 patients (1 with Ta and 3 with T2 recurrence) due to concomitant metastases. The urethra could be preserved in 11/13 patients with Tis and 3/6 with Ta/T1 recurrence treated with endourethral BCG. Six of 13 patients with Tis, 1/7 with Ta/T1 recurrence and 0/4 with T2 recurrence are still alive with preserved urethra and no evidence of disease. CONCLUSIONS With routine cytology approximately 90% of urethral recurrences can be detected. In patients with Tis recurrence, the urethra should be primarily spared, since endourethral BCG is successful in most cases. On the contrary, in patients with Ta/T1 recurrence urethrectomy is usually required. Patients with T2 recurrence have a poor prognosis due to frequent concomitant metastases. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e395 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gianluca Giannarini Bern, Switzerland More articles by this author Thomas M. Kessler Bern, Switzerland More articles by this author Bernhard Kiss Bern, Switzerland More articles by this author Urs E. Studer Bern, Switzerland More articles by this author George N. Thalmann Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...