Diagnosis and treatment of urethral recurrence after radical cystectomy in the male

Abstract

ContextFrom 4 to 6% of males subjected to radical cystectomy due to urothelial carcinoma will have urethral recurrence (UR) during the follow-up. ObjectiveTo analyze the diagnosis, treatment and course of the patients with UR following a cystectomy. Acquiring of evidenceAnalysis of original articles and reviews related with the diagnosis, treatment, and course of patients subjected to radical cystectomy and who develop UR. The articles were obtained from a search in PubMed. Synthesis of evidenceMost of the UR appear during the first 3 years of the cystectomy. Approximately 50% of the URs of contemporary series were diagnosed through urethral cytology, the patient being asymptomatic. The urethrectomy is the treatment of choice in patients with UR and cutaneous diversion. In patients with orthotopic bladder replacement (OBR): (1) the treatment of the intraurethral BCG can be useful in patients with carcinoma in situ (CIS), (2) papillary type conservative treatment in UR has contradictory results, and (3) when the uretrectomy is necessary, the ileal duct or conversion of the OBR in a continent urinary derivation can be used. ConclusionsUrethral cytology is a test having high sensitivity and can contribute to the diagnosis of UR in the earliest stages. In patients with OBR, the diagnosis of a UR is a therapeutic challenge. The bladder tumor, urethral recurrence, and presence of an upper urinary tract tumor in 25% of the cases may be a cause of death in these patients.