Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer — practice in a single centre

Abstract

ObjectivesTo report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution.MethodsWe retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013.ResultsOf 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1–174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6–120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%).ConclusionsEn bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.

A Contemporary Analysis of Urethral Recurrence following Radical Cystectomy

“…For example, in an analysis of 8 patients with UR after RC, Zhou et al did separate UR from distant recurrences, but did not include survival outcomes for patients with no recurrence at all. 7 Comparing CSS and OS among patients with UR to patients without any recurrence as we have done may have allowed the impact of UR on survival to emerge.…”

“…1,2 Nevertheless, for patients undergoing radical cystectomy (RC), urothelial recurrences represent a relatively infrequent event, reported in 3%–6% of patients. 3,4 Moreover, as the prognostic significance of recurrence following RC has been demonstrated to vary by anatomical location of recurrence, 5–7 urethral recurrence (UR) in particular has been suggested to have limited impact on patients’ long-term survival. 8–11 Indeed, debate exists regarding the utility of routine surveillance for UR among otherwise asymptomatic patients following RC.…”

First Brazilian consensus on the management of localized and locally advanced urothelial bladder cancer: a SBU-SBOC-SBRT-LACOG-GU panel review

“…138 Patients undergoing orthotopic neobladder with urethral involvement have a 0.5 to 17% recurrence rate. [139][140][141][142] Therefore, after treatment with the curative intent for MIBC where the urethra has not been resected, we recommend regular follow-up of this region with examination defined on a per-case basis (recommendation, LE: 4 GR: C).…”