Introduction: The objective of this study was to look at the usefulness and cost effectiveness of intraoperative frozen section analysis (FSA) of the ureters at the time of radical cystectomy. Methods: Pathology notes of patients undergoing radical cystectomy for primary bladder cancer between the years 2000-2015 at our institution were reviewed. Results: A total of 196 ureteric specimens from 98 patients were reviewed. Of the 98 patients, 9% (n = 9) had positive ureteric margins, of which all were ≥ T2, with 44% (4 of 9) being T = 4. In all cases of positive FSA, preoperative clinical staging was ≥ T2. In cases where cancer staging was upgraded post-cystectomy, there were no cases of positive FSA. After adjusting for tumor stage in ≥ T2a, using Cox regression analysis, positive frozen section was associated with a 4.2 fold increase in overall mortality (95%CI 1.3-13.8; p = 0.02). Cost associated with FSA was AU$1,351.90 to obtain 1 positive result. Conclusion: Patients with positive ureteric FSA are at higher risk of mortality post cystectomy, despite excision to negative tissue. However, FSA of the distal ureters at cystectomy were unlikely to be positive unless the bladder cancer stage was ≥ T2. Hence, routine ureteric FSA may not be necessary in patients undergoing cystectomy for non-muscle invasive bladder tumors.

These results provide information on the practice patterns of the increasing number of women urologists in Australia and New Zealand and have the potential to shape workforce and training planning in this region and worldwide.

In patients with spinal cord injury cystectomy is performed almost as often for nonmalignant as for malignant indications. Our data support a more aggressive presentation of cancer with a different pathological profile but not survival compared to normal populations. Centers treating patients with spinal cord injury should consider a lower threshold for the surgical management of bladder cancer where appropriate, especially considering that morbidity, satisfaction and outcome do not appear to be compromised in patients with spinal cord injury.

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