The fate of the urethra after definitive treatment of invasive transitional cell carcinoma of the urinary bladder

Bell,; Gujral,; Collins, '; Sibley,; Persad,

doi:10.1046/j.1464-410x.1999.00016.x

Cited by 24 publications

(9 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, despite early concerns of an increased risk of urethral recurrence with an intact female urethra, previous studies reported a urethral recurrence rate in women after RC of 1.4–12%[7–9], and in the present study, only one patient (2%) developed a urethral recurrence after ONR. These results are also comparable with the reported incidence of urethral recurrence in men after RC without urethrectomy in a long‐term follow‐up [16]. However, the most accurate means of predicting urethral recurrence, and thereby selecting appropriate patients for ONR, continues to be debated.…”

Section: Discussionsupporting

confidence: 81%

Functional and oncological outcomes after orthotopic neobladder reconstruction in women

et al. 2008

View full text Add to dashboard Cite

OBJECTIVE To review our experience with orthotopic neobladder reconstruction (ONR) in women, highlighting functional and oncological outcomes, as ONR has been used increasingly for urinary diversion in women after radical cystectomy (RC), largely due to a better understanding of the natural history of urothelial cell carcinoma (UCC) and of the anatomy underlying the female continence mechanism, but defining the safety and long‐term efficacy of ONR remain important to expanding its use. PATIENTS AND METHODS We identified 59 women who had RC with ONR between 1995 and 2006 at the Mayo Clinic. Their records were reviewed for clinicopathological demographics, and functional and oncological outcomes. RESULTS The median (range) age at surgery of the women was 62 (20–82) years, and the median follow‐up was 29.2 (1–141) months. Fifty‐three women had RC for malignant disease, including UCC in 47. Five women (8.5%) required resection of the anterior vaginal wall during surgery, while 39 (66%) had concurrent hysterectomy. One patient had a positive surgical margin, at the left distal ureter, on final pathology. Thirteen (22%) patients had perioperative complications, including two (3%) who required reoperation. In addition, three patients (5%) developed a neobladder‐vaginal fistula after RC with ONR, requiring surgical repair. At the last follow‐up, daytime urinary continence (defined as needing no pads) was reported by 44/49 (90%) patients, while 28/49 (57%) had achieved continence at night. Seventeen (31%) patients required intermittent self‐catheterization to facilitate emptying of the neobladder. Fifteen (28%) women had recurrence of disease, at a median of 8 (2–36) months after ONR, including seven (13%) who developed a pelvic recurrence. Twelve (20%) patients died during the follow‐up, with four (8%) dying from UCC at a median of 14 (11–65) months after surgery. CONCLUSION ONR provides a safe and effective option for urinary diversion in women, with oncological and functional outcomes similar to those for men. Thus, the technique remains a preferred option for urinary diversion in appropriately selected women treated with RC.

show abstract

Section: Discussionsupporting

confidence: 81%

Functional and oncological outcomes after orthotopic neobladder reconstruction in women

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Previous reports suggest 0.5-18% of patients with invasive bladder cancer will develop a urethral recurrence after RC [1,[5][6][7][8][9][10][11][12][13][14]. A meta-analysis including > 3100 patients described an overall risk of 8.1% for urethral recurrence after RC [15].…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis including > 3100 patients described an overall risk of 8.1% for urethral recurrence after RC [15]. Previously identified risk factors for urethral recurrence include tumour at the bladder neck, multifocal tumours, carcinoma in situ (CIS), a positive urethral margin, tumour in the prostatic urethra, and prostatic stromal invasion [6,15,16]. The reported rate of local recurrence in the urethra after RC and orthotopic diversion is 0.5-17.2% [1,[7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Orthotopic urinary reconstruction after radical cystectomy (RC) for bladder cancer has gained popularity for patients and provides cancer control rates similar to those of ileal conduits, with the potential of offering improved quality of life [1][2][3][4]. Previous reports suggest 0.5-18% of patients with invasive bladder cancer will develop a urethral recurrence after RC [1,[5][6][7][8][9][10][11][12][13][14]. A meta-analysis including > 3100 patients described an overall risk of 8.1% for urethral recurrence after RC [15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of urethral recurrence after orthotopic urinary diversion

et al. 2010

View full text Add to dashboard Cite

RESULTSIn all, 260 patients underwent RC with a Studer or Hautmann orthotopic urinary diversion; the median (range) follow-up was 5.1 (0-15.6) years. Six patients (2.3%) developed local recurrence of urothelial cancer (UC) within the urethra after this treatment. The median (range) time to presentation with recurrence after RC was 2.4 (0.7-3.6) years for pT1-4 UC. Recurrences were treated with various methods, including transurethral resection, urethrectomy with conversion of neobladder to continent catheterizable diversion, and chemotherapy. At the last follow-up, four of these six patients were alive without disease, one was alive with disease, and one had died from disease. CONCLUSIONSIn our experience, local recurrences involving the urethra are infrequent. Complete surgical excision can provide a good outcome. Neoadjuvant chemotherapy should be considered for recurrences with adverse clinicopathological features. KEYWORDSurinary bladder neoplasms/ surgery, carcinoma, transitional cell, cystectomy, urinary reservoirs, continent, recurrence Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo evaluate our experience with urethral recurrences in patients treated by radical cystectomy(RC) and orthotopic neobladder urinary diversion for carcinoma of the bladder. PATIENTS AND METHODSWe retrospectively reviewed the records of patients treated with RC and orthotopic urinary diversion between

show abstract

“…[6][7][8][9][10] It is estimated that between 0.5% to 18% of patients with invasive TCC of the bladder will develop urethral recurrences following radical cystectomy. 7,[11][12][13] Risk factors that have been associated with increased urethral recurrence include multifocal disease, carcinoma in situ (CIS), tumor located at the bladder neck, a positive transurethral (TUR) prostatic urethral biopsies, prostatic stromal invasion, positive urethral margin on frozen section, and non-orthotopic urinary diversion. 14 Although it is generally accepted that patients with high risk for urethral recurrence should not be advised to undergo an ileal neobladder, some authors still advocate an ileal neobladder as long as negative margins of urethral frozen section are obtained.…”

Section: Introductionmentioning

confidence: 99%

Prostatic Urethral Biopsy Has Limited Usefulness in Counseling Patients Regarding Final Urethral Margin Status During Orthotopic Neobladder Reconstruction

et al. 2008

View full text Add to dashboard Cite

Purpose-To determine the value of preoperative transurethral (TUR) prostatic urethral biopsy in predicting final distal urethral margin status at radical cystectomy.Materials and Methods-Out of 1006 patients undergoing radical cystectomy at our institution between 1990 and 2004, 252 were male patients who underwent ileal neobladder and form the basis of this report. Variable collected include pathology of prostatic urethral biopsies, final pathology of the prostate, frozen section of the distal urethra, final urethral margins, and survival data.Results-Median age of patients was 61. Of 252 patients, 245 had data regarding pre-operative TUR prostatic urethral biopsy and/or frozen section of urethra at time of surgery: 127 patients had TUR of the prostatic urethra alone, 68 had urethral frozen section alone, 50 had both. The incidence of positive distal urethral margin (on final pathology) was 1.1% (3/252) and urethral recurrence was 0.7% (2/252). The correlation between TUR findings and frozen section margins was only 68%; 16 patients with positive TUR findings had negative frozen section margins. The negative predictive value of TUR biopsy with respect to final margins was 99.4% and that of frozen section was 100%.Conclusion-While patients with no tumor on TUR biopsy of the prostatic urethra have a high likelihood of negative urethral margins on final pathologic evaluation, optimal negative predictive value is obtained with frozen sections. Furthermore, a positive TUR prostatic urethral biopsy does not correlate with final margin and should not exclude patients from consideration for an orthotopic diversion.

show abstract

The fate of the urethra after definitive treatment of invasive transitional cell carcinoma of the urinary bladder

Cited by 24 publications

References 48 publications

Functional and oncological outcomes after orthotopic neobladder reconstruction in women

Functional and oncological outcomes after orthotopic neobladder reconstruction in women

Management of urethral recurrence after orthotopic urinary diversion

Prostatic Urethral Biopsy Has Limited Usefulness in Counseling Patients Regarding Final Urethral Margin Status During Orthotopic Neobladder Reconstruction

Contact Info

Product

Resources

About