Diagnosis, risk factors, and outcome of urethral recurrences following radical cystectomy for bladder cancer in 729 male patients.

OBJECTIVES: We evaluated incidence, diagnosis, risk factors, and outcome of urethral recurrences (URs) following radical cystectomy in men with bladder urothelial carcinoma (UC).

METHODS: Between 1978 and 2003, a total of 729 male patients underwent radical cystectomy for UC. We determined UR presentation mode and diagnosis. UR was analysed by multivariate analyses according to clinical and pathological risk factors. We evaluated the relative influence of bladder versus urethral pathology on overall survival.

RESULTS: A total of 34 URs (4.6%) were identified. Previous history of non-muscle-invasive bladder cancer (NMIBC) (p=0.005), NMIBC pathological subgroup (pTis, pTa, pT1) (p=0.038) and prostate tumor involvement (p=0.0001) in cystectomy specimens were independent predictors of UR. URs developed in 5 (2.2%) of 219 cases with orthotopic diversion and in 29 (5.6%) of 510 with cutaneous diversion (p=0.073). The difference could be explained by patient selection. Cutaneous diversion group had more patients at risk of UR: more cases with prostate tumor involvement (p=0.026) and with a history of NMIBC (p=0.009). Neither bladder nor urethral pathology showed any superiority as a predictor of overall survival.

CONCLUSIONS: Previous history of NMIBC, and also NMIBC and prostate tumor involvement in cystectomy specimen were predictors of UR. The lower incidence of UR in patients with orthotopic diversion could be a result of patient selection. Bladder tumor, UR, and even an upper urinary tract tumor could have been the cause of death in these patients.