You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2018MP41-17 SHOULD ORTHOTOPIC BLADDER SUBSTITUTION BE OMITTED IF PRE-CYSTECTOMY BIOPSIES OF THE PROSTATIC URETHRA (MALE) OR BLADDER NECK (FEMALE) ARE POSITIVE? Bernhard Kiss, Ioannis Giannakis, Furrer Marc, Patrick Wuethrich, Fiona Burkhard, Gerorge Thalmann, and Beat Roth Bernhard KissBernhard Kiss More articles by this author , Ioannis GiannakisIoannis Giannakis More articles by this author , Furrer MarcFurrer Marc More articles by this author , Patrick WuethrichPatrick Wuethrich More articles by this author , Fiona BurkhardFiona Burkhard More articles by this author , Gerorge ThalmannGerorge Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1304AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When considering an orthotopic bladder substitution (OBS) preoperative biopsies of the prostatic urethra (in male) or bladder neck (in female) are usually performed to evaluate a potential involvement of the urethra. In case of positive preoperative biopsies, a non-orthotopic diversion is recommended in order to avoid positive urethral margin and to prevent local recurrence. Our aim was to investigate the influence of positive preoperative biopsies on local recurrence, cancer- specific (CSS) and overall survival (OS) after OBS. METHODS Retrospective analysis of 776 consecutive patients (77% [601/776] MIBC; 23% [175/776] recurrent NMIBC) who had undergone radical cystectomy with ileal OBS between 04/1985 and 01/2016 at our institution. RESULTS 94% (731/776) of patients had negative (Group A) and 6% (43/776) of patients (36 male, 7 female) had positive (Cis: 32/43 [74%]; pTa/pT1 G3: 11/43 [26%]; Group B) pre-cystectomy biopsies. Median follow-up was 71.5mts (range: 1-323). 32% (251/776) of patients experienced local and/or distant recurrences: 12% (31/251) urethral (23/31 CIS, 5/31 pTa, 3/31 ≥ pT1),14% (34/251) local recurrences other than urethral, and 74% (186/251) distant metastases. Urethral recurrence developed significantly more often (p<0.001) in Group B (13/43 [30%]) than in Group A (18/733 [2.5%]). Local recurrences other than urethral did not differ between the two groups (31/733 [4%] in Group A vs. 3/43 [7%] in Group B; p=0.4). Seventy-four percent (23/31) of patients with urethral recurrence could be managed successfully by local treatment whereas salvage urethrectomy and conversion of the urinary diversion was necessary in 26% (8/31). Despite the significantly higher urethral recurrence rates in Group B, CSS and OS were similar in both groups (70% and 61% in Group A vs 70% and 67 % in Group B, respectively; Figure 1). CONCLUSIONS Although positive biopsies of the prostatic urethra or the bladder neck prior to OBS increase the rate of urethral recurrences this does not translate into decreased CSS and OS. Most urethral recurrences could be managed successfully with local treatment; thus, OBS is an option in highly selected patients with positive, non-invasive preoperative biopsies provided that patients have regular follow-up including urethral washout cytology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e534 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bernhard Kiss More articles by this author Ioannis Giannakis More articles by this author Furrer Marc More articles by this author Patrick Wuethrich More articles by this author Fiona Burkhard More articles by this author Gerorge Thalmann More articles by this author Beat Roth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...