Treatment and Outcomes of Urethral Recurrence of Urinary Bladder Cancer in Women after Radical Cystectomy and Orthotopic Neobladder: A Series of 12 Cases

Abstract

Introduction: The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature. Patients and Methods: A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed. Results: The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months. Conclusions: UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis.

Oncological Outcomes of Patients with Concomitant Bladder and Urethral Carcinoma

“…Nonetheless, it has to be acknowledged that urethral cancer is a rare disease for which therapeutic strategies still need to be better defined [12] . Though secondary urethral cancer after RC for BC is more frequent than concomitant urethral and BC it is difficult to draw meaningful conclusions for clinical practice owing to distinct differences in tumor biologic characteristics [13] . Given this, to our opinion, our study gives important insights into the clinical course of patients with urethral carcinoma which may be further used for prognostication and clinical decision-making in daily practice.…”

Successful Pregnancy and Neobladder Subsequent to Muscle Invasive Bladder Cancer and Fertility Preserving Surgery: Case Report and Review of the Literature

“…In addition to the internal genitalia, the preserved urethra for urethroileal anastomosis also inherits a risk for tumor recurrence with a median survival of only 6 months in women if detected [12]. …”

The Role of Surgery in Local Recurrences after Radical Cystectomy for Bladder Cancer

“…LR is defined as tumor in the surgical bed and/or pelvic lymph nodes dissection (PLND) site below the bifurcation of the common iliac vessels [3]. LR does not include urethral or uretheral recurrences, mostly considered metachronous tumors with favorable prognosis if not associated with local or distant relapse [4]. …”