Management of urethral recurrence after orthotopic urinary diversion

Taylor, Jennifer; Spiess, Philippe E.; Kassouf, Wassim; Munsell, Mark F.; Kamat, Ashish M.; Dinney, Colin P.; Grossman, H. Barton; Pisters, Louis L.

doi:10.1111/j.1464-410x.2009.09095.x

Cited by 26 publications

(14 citation statements)

References 25 publications

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“…Remnant urethral recurrence was identified in only one patient (2.0%). These results are similar to the previous reports (Taylor et al 2010 ; Hautmann et al 2006 ). Our data indicate that anterior urethra sparing cystoprostatectomy for bladder cancer did not influence the incidence of remnant urethral recurrence and oncologic clinical outcome based upon different approaches to simultaneous urinary diversion.…”

Section: Resultssupporting

confidence: 94%

Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

et al. 2015

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PurposeDecision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome.Patients and methodsA total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion between 2000 and 2013, and underwent follow up for 4 months or more. We assessed differences in the perioperative outcomes, oncologic outcomes and recurrence rates according to the urinary diversion.ResultsThe median patient age and follow-up period were 66 years and 35 months, respectively. The 5- and 10-year recurrence free survival (RFS) rates in ileal conduit (IC) group vs. orthotopic neobladder reconstruction (NB) group were 45.0 and 20.3% vs. 39.3 and 19.6%, respectively. Likewise, the 5- and 10-year disease specific survival (DSS) were 52.7 and 32.1% vs. 39.3 and 29.5%, respectively. Multivariate analysis revealed two independent prognostic factors for RFS and DSS, including age at surgery and lymph node status. Local recurrence in the remnant anterior urethra occurred in only 1 patient (2.0%) at 57 months after surgery.ConclusionsOur long-term data show that anterior urethra sparing cystoprostatectomy is an oncologically-safe procedure regardless of the type of urinary diversion in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the urethra/bladder neck and urethral surgical margin.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1200-7) contains supplementary material, which is available to authorized users.

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Section: Resultssupporting

confidence: 94%

Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

et al. 2015

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“…Anderson Cancer Center, the urethral recurrence rate was 2.3% at a median of 2.4 years (range 0.7-3.6 years) after cystectomy and ONB. 8 In our cystectomy database, 58 (3%) urethral recurrences occurred with a median time to recurrence of 2.1 years (range 0.2-17.2 years), seven of which were in pT4aN0M0 patients, and just two in the orthotopic group. Soloway reported tumor in the prostate as a risk factor for urethral recurrence.…”

Section: Discussionmentioning

confidence: 90%

Radical cystectomy and orthotopic urinary diversion in male patients with pT4a urothelial bladder carcinoma: Oncological outcomes

et al. 2013

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Abbreviations & AcronymsAbstract: The aim of the present study was to evaluate the oncological outcomes of radical cystectomy followed by orthotopic urinary diversion in male patients with urothelial bladder carcinoma involving prostatic stroma (pT4a). A total of 1964 patients with urothelial bladder carcinoma who underwent cystectomy between 1971 and 2008 were retrospectively analyzed. Among them, male patients with pT4aN0M0 disease at cystectomy and orthotopic urinary diversion were identified and included in the analysis. Exclusion criteria were perioperative mortality and primary urethrectomy. The outcomes were urethral recurrence, local recurrence, recurrence-free survival and overall survival. Univariate and log-rank statistics were used to examine associations between variables and outcome. A total of 33 patients (1.7%) entered the study with a median age of 71 years. Median follow up was 4.8 years (range 0.1-21 years). A total of two urethral recurrences (6%) occurred at a median of 2.4 years after cystectomy. No patient had local recurrence. The 5-year recurrence-free survival and overall survival was 56% Ϯ 10% and 56% Ϯ 9%, respectively. The probability of urethral and local recurrence after orthotopic diversion in pT4a urothelial bladder carcinoma patients is low. Thus, orthotopic urinary diversion appears to be oncologically safe in this patient population.

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“…Urethral recurrences have also been reported with the negative urethral margin, the incidence of which has been described to range from 0.9% to 2.8%. [ 12 14 23 ] In one series, two of 13 patients with positive FSA had urethra recurrence as opposed to 13 recurrences in 222 patients who had negative FSA. [ 12 ] Therefore, the urethral margin status failed to accurately predict recurrence at the urethral stump.…”

Section: Discussionmentioning

confidence: 99%

Is frozen section analysis of the urethra at the time of radical cystectomy and orthotopic neobladder urinary diversion mandatory?

et al. 2015

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Introduction:This study was aimed at analyzing the need for routine use of frozen section analysis (FSA) before performing orthotopic neobladder (ONB) after radical cystectomy for carcinoma urinary bladder.Materials and Methods:A total of 233 patients underwent radical cystectomy from January 2000 to June 2013. Of these, 151 (65.6%) patients were planned for ONB. In the initial 109 (72%) patients, FSA of urethral margin was performed, but, in the subsequent 42 (28%) patients, frozen section of urethral margin was not sent. Impact of hydroureteronephrosis, tumor size and location of tumor in relation to the bladder neck on the status of the urethral margin was analyzed.Results:Only three of the 109 (2.7%) patients had a positive urethral margin. Two of them had ileal conduit and one, after negative re-resection, had ONB. Although none of the factors was found to be significant, all three patients with a positive urethral margin had growth at the bladder neck and died of cancer at a mean follow up of 29.33 ± 18.3 months, without urethral recurrence. Among the negative FSA (106), two patients had recurrence in the penile urethra. The mean follow-up was 46.3 ± 25.1 months. None of the patients without FSA (42) had urethral recurrence at the mean follow-up of 36 ± 9.3 months. Of the 28 patients who had their growth located at the bladder neck, three had positive FSA, while none with growth away from the bladder neck had positive FSA.Conclusion:Routine FSA of the urethra before performing ONB can be avoided in those patients where the tumor does not reach the bladder neck.

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Management of urethral recurrence after orthotopic urinary diversion

Cited by 26 publications

References 25 publications

Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

Radical cystectomy and orthotopic urinary diversion in male patients with pT4a urothelial bladder carcinoma: Oncological outcomes

Is frozen section analysis of the urethra at the time of radical cystectomy and orthotopic neobladder urinary diversion mandatory?

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