Urethral Recurrence of Bladder Tumor after Total Cystectomy / 대한비뇨기과학회지

PURPOSE: Multifocal development of transitional cell carcinoma in the urinary tract is well recognized. We reviewed the urethral recurrence following cystectomy for transitional cell carcinoma of the bladder and determined the factors influencing this recurrence. MATERIALS AND METHODS: From January 1984 to December 1996, 97 patients underwent total cystectomy in our hospital and 59 men were able to be followed up for transitional cell carcinoma of the bladder. The incidence of the urethral recurrence after cystectomy and its relationship to some factors including tumor stage, grade, number, shape, and location of the bladder cancer were evaluated. RESULTS: Of the 59 patients, nine(15.3%) had secondary urethral cancer which was more common in high stage & grade, multiple, sessile tumors and that involved the trigone, bladder neck or prostate. CONCLUSIONS: A proper evaluation of patients at high risk for subsequent development of cancer in the urethra after cystectomy appears to be important to determine whether or not preserve the urethra and to avoid unnecessary urethrectomy during the total cystectomy.

A clinical study on the urethral recurrence of transitional cell carcinoma of bladder following cystectomy / 대한비뇨기과학회지

Of 80 male patients who underwent cystectomy. 21 cases received concurrent urethrectomy and 59 cases without urethrectomy. In 59 cases without urethrectomy, urethral recurrence was observed in 6 cases (10.2%). The average period from cystectomy to urethral recurrence was 26.8 months (4-77 months). Early stage A urethral cancer was found in 2 cases and stage B in 4 cases. Histological grade 1 cancer was found in 1 case. grade 2 in 3 cases. and 3 in 2 cases. The proximal end or the urethra was found to be the most frequent site of recurrence with 5 cases exhibiting recurrence at this location and 1 case at distal urethra. Multiplicity of bladder tumor from the trigone to the bladder neck tended to cause recurrence in the urethra. We also assessed for prostatic involvement as well as tumor extent in the bladder. Of the 13 patients with tumor in the prostate, 4 (30.3%) surfered from urethral recurrences. Of the 38 patients with all other types of tumor involvement patterns exclusive of disease in the prostate, only 2(5.3%) had recurrence. We recommend rigorous screening for transitional cell carcinoma of the prostate before and during cystectomy. Prophylactic urethrectomy is indicated for patients with prostatic involvement or in the case of multiple bladder tumor involving trigone and bladder neck.